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Cardiovascular Disease and Related Risk Factors in Virginia

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Title: Cardiovascular Disease and Related Risk Factors in Virginia


1
Cardiovascular Disease and Related Risk Factors
in Virginia
  • Stephanie M. Gruss, PhD, MSW
  • Epidemiologist
  • Virginia Department of Health (VDH)
  • Division of Chronic Disease Prevention Control

2
Overall Impact of Chronic Disease in the U.S.
  • By 2030, there will be about 71 million adult
    baby boomers who will have reached their 65th
    birthday.
  • At least 80 of older adults (age 65) have at
    least one chronic disease 50 have two.
  • Chronic diseases claim the lives of 1.7 million
    Americans each year70 of all deaths. Heart
    disease, stroke, cancer, COPD, and diabetes
    account for two-thirds of all deaths.

Sources The State of Aging and Health in
American, CDC and Merck Institute on Aging and
Health, 2004, 2007 The Burden of Chronic
Diseases and Their Risk Factors, CDC, 2004
Boult et al. American Journal of Public Health
1996 86(10), 1388-1393.
3
Cardiovascular Disease (CVD) Mortality
4
Impact of CVD in the U.S.
  • Cardiovascular disease (CVD), including heart
    disease and stroke, is the 1 killer of
    Americans, accounting for more deaths in the U.S.
    than all cancer, accidents, and other chronic
    disease deaths combined.
  • Almost 700,000 people die of heart disease in the
    U.S. each year, accounting for about 29 of all
    U.S. deaths.
  • Blacks had the highest heart disease mortality
    rate at 300/100,000, followed by whites at 228
    51 of heart disease deaths were to women.
  • In 2006, heart disease is projected to cost more
    than 258 billion, including health care
    services, medications, and lost productivity.

Source CDC, Heart Disease Fact
Sheet-http//www.cdc.gov/dhdsp/library/fs_heart_di
sease.htm http//www.cdc.gov/heartdisease/.
5
CVD Deaths in VA, 2005
  • A total of 19,081 Virginians died from major CVD
    in 2005.
  • CVD accounts for 33 of all deaths.
  • Of those deaths, 14,132 people died from heart
    disease and 3,666 died from stroke.
  • Total CVD mortality rate was 267.2/100,000
    population 197.2 for heart disease and 52.0 for
    stroke.

Source VDH, Division of Health Statistics, 2005
rates are age-adjusted per 100,000 population.
6
Leading Causes of Death in VA, 2005
Source VDH, Division of Health Statistics, 2005
Unintentional Injury.
7
CVD Deaths in VA, 2005
  • Total CVD mortality rates, including heart
    disease and stroke, have significantly declined
    in Virginia since 1995 primarily for whites and
    Blacks.
  • Other races and Hispanics have shown little to
    no decline since 1995. In fact, Hispanic stroke
    rates have increased.
  • Despite the declining rates, Blacks (particularly
    males) continue to have the highest mortality
    rates for CVD, including heart disease and
    stroke, than any other race/ethnicity in
    Virginia.

8
CVD Death Rates by Race/Ethnicity in VA, 1995-2005
Source VDH Division of Health Statistics,
1995-2005 age-adjusted.
9
Heart Disease Mortality in VA, 2005
  • Heart disease, specifically, was the leading
    cause of death in Virginia in 2005, as it was in
    the U.S.
  • In Virginia, heart disease accounts for 25 of
    total deaths and 74 of CVD deaths.
  • Black males have the highest rates of heart
    disease mortality in Virginia, followed by white
    males, then Black females.
  • Other females and Hispanic females tend to have
    the lowest heart disease mortality rates in
    Virginia.

10
Heart Disease Death Rates by Race/Ethnicity in
VA, 1995-2005
Source VDH Division of Health Statistics,
2002-2005 age-adjusted Hispanic data
unavailable for 2005.
11
Heart Disease Death Rates by Gender and Race in
VA, 1995-2005
Source VDH Division of Health Statistics,
2002-2005 age-adjusted Hispanic data
unavailable for 2005.
12
Heart Disease Death Rates by VA Health District,
2005
  • The top three health districts with the highest
    age-adjusted rates of heart disease deaths were
  • 1. Lenowisco (284.5/100,000)
  • 2. Pittsylvania-Danville (284.2/100,000)
  • 3.Cumberland Plateau (277.9/100,000)

Source VDH Division of Health Statistics,
2002-2005 age-adjusted.
13
Data note State rates listed here are based on
calculations ran by health district, if a data
point does not have a corresponding health
district location reported, the data point is not
included thus, these rates can vary slightly
from overall, state rates.
14
Stroke Mortality in VA, 2005
  • Stroke, or cerebrovascular disease, was the third
    leading cause of death in Virginia in 2005.
  • In the U.S., stroke was the second leading cause
    of death for women and the third leading cause of
    death for men, behind cancer.
  • All blacks (male and female) have significantly
    higher stroke rates than any other race or
    ethnicity.
  • The total Hispanic rate for stroke deaths has
    doubled from 1995-2005 the Hispanic stroke
    mortality rate exceeded that for whites for the
    first time in Virginia history in 2005.

15
Stroke Death Rates by Race/Ethnicity in VA,
1995-2005
Source VDH Division of Health Statistics,
1995-2005 age-adjusted.
16
Stroke Death Rates by VA Health District, 2005
  • The top three health districts with the highest
    age-adjusted rates of stroke deaths were
  • 1. Southside (76.5/100,000)
  • 2. Chickahominy (71.6/100,000)
  • 3. Norfolk (71.0/100,000)

Source VDH Division of Health Statistics,
2002-2005 age-adjusted.
17
Data note State rates listed here are based on
calculations ran by health district, if a data
point does not have a corresponding health
district location reported, the data point is not
included thus, these rates can vary slightly
from overall, state rates.
18
CVD Deaths and Women
  • Mortality rates for CVD are slowly declining, but
    at a slower rate for women than men.
  • Although stroke mortality rates are similar for
    men and women, women are more likely to have a
    stroke at a younger age (40s or 50s) and are more
    likely to die from stroke.
  • Nationally, women account for more than 60 of
    the annual deaths due to stroke, making it the
    second leading cause of death among American
    women, preceded by heart disease.

Sources VDH Division of Health Statistics, 2004
http//www.cdc.gov/mmwr/.
19
Hospitalizations Due to CVD
20
Hospitalization Cost of CVD in VA, 2005
  • The total cost of hospitalizations due to a
    primary diagnosis of CVD was 3.6 billion.
  • There were 115,988 hospital discharges due to
    CVD, averaging about 31,038 per admission, up
    from 22,663 in 2004.
  • Average length of stay was 5.1 days.
  • If hospitalizations for CVD in VA were reduced by
    just 5 per year, the savings by 2010 would be
    approximately 900 million.

Source VHI Dataset, 2005 primary diagnoses of
all CVD codes.
21
Heart Disease Hospital Discharge Rates by VA
Health District, 2005
  • There were 65,544 discharges due to a primary
    diagnosis of heart disease state rate of
    88.2/10,000.
  • The top three health districts with the highest
    age-adjusted rates of heart disease discharges
    were
  • 1. Crater (152.2/10,000)
  • 2. Southside (135.6/10,000)
  • 3. Norfolk (132.5/10,000)

Source VHI Health Information, Inc. rates are
age-adjusted.
22
Data note State rates listed here are based on
calculations ran by health district, if a data
point does not have a corresponding health
district location reported, the data point is not
included thus, these rates can vary slightly
from overall, state rates.
23
Stroke Hospital Discharge Rates by VA Health
District, 2005
  • There were 20,181 discharges due to a primary
    diagnosis of stroke state rate of 27.6/10,000.
  • The top three health districts with the highest
    age-adjusted rates of stroke discharges were
  • 1. Crater (46.5/10,000)
  • 2. Portsmouth (42.7/10,000)
  • 3. Roanoke City (41.4/10,000)

Source VHI Health Information, Inc. rates are
age-adjusted.
24
Data note State rates listed here are based on
calculations ran by health district, if a data
point does not have a corresponding health
district location reported, the data point is not
included thus, these rates can vary slightly
from overall, state rates.
25
CVD and Related Risk Factors
26
CVD and Non-preventable Risk Factors
  • Age- 65 and older
  • Minorities- Blacks, Native Americans
  • Gender- Men in terms of most risk factors women
    in terms of stroke and arthritis
  • Persons with a family history of chronic disease
    (genetics)
  • Young children/adolescents- less physically
    active today and have higher rates of poor
    dietary intake non-preventable because children
    do not often have control over their own physical
    activity or dietary intake- parents/other adults
    do!

27
CVD and Preventable Risk Factors
  • Smoking/tobacco use
  • Obesity- Body Mass Index (BMI) of 30 or greater
  • Overweight- BMI of 25 29.9
  • Poor diet- eating less than five fruits for
    vegetables per day
  • Sedentary lifestyle- no leisure time physical
    activity within 30 days
  • High blood pressure and high cholesterol-
    independent risk factors/conditions associated
    with type-2 diabetes and heart disease
  • Andlack of education on signs and symptoms of
    heart attack and stroke!!

28
Recognition of Heart Attack Signs Symptoms
Source BRFSS, 2001-2005 adults 18 weighted
percents Trick question- not meant for
respondents to say yes to not a sign or
symptom of a heart attack.
29
Recognition of Stroke Signs Symptoms
Source BRFSS, 2001-2005 adults 18 weighted
percents Trick question- not meant for
respondents to say yes to not a sign or
symptom of a stroke.
30
Previous Heart Attack Stroke as Risk Factors
for Cardiovascular Disease
  • 2 to 4 Times the Risk of Early Mortality- Prior
    to Average Life Expectancy (77.8 yrs. in VA in
    2004)

Source VDH, Division of Health Statistics most
recent year available.
31
Previous Heart Attack, VA
  • Heart attack prevalence in 2001-2004 timeframe
    was 3.6.
  • American Indian/Alaskan Natives (AI/AN) were 1.5
    times more likely to have a heart attack than any
    other race and ethnicity.
  • Whites had the second highest heart attack rates.

Source BRFSS, 2001-2004 adults 18 weighted
percents based on aggregated rates due to low
sample size.
32
Previous Heart Attack, VA, 2001-2004
Source BRFSS, 2001-2004 adults 18 weighted
percents data are aggregated due to small
sample size.
33
Previous Stroke, VA
  • Stroke prevalence in 2001-2004 timeframe in
    Virginia was 2.10.
  • American Indian/Alaskan Natives (AI/AN) were 2.2
    times more likely to have a stroke than any other
    race and ethnicity.
  • Blacks had the second highest stroke rates.

Source BRFSS, 2001-2005 adults 18 weighted
percents based on aggregated rates due to low
sample size.
34
Previous Stroke, VA, 2001-2004
Source BRFSS, 2001-2004 data are aggregated
due to small sample size adults 18 weighted
percents.
35
Tobacco Use
36
Impact of Smoking in U.S. VA, 2005
  • Smoking causes coronary heart disease cigarette
    smokers are 24 times more likely to develop
    coronary heart disease than nonsmokers.
  • 8.6 million people in the U.S. have a disease
    caused by smoking they will likely die from CVD,
    cancer, or a respiratory syndrome, as a result.
  • Smoking is the leading cause of preventable
    death.
  • 400,000 deaths annually from smoking, plus 38,000
    deaths from Second Hand Smoke (SHS) and 1,000
    from prenatal exposure.
  • 9,300 deaths from smoking, plus 950 to 1,690
    deaths from SHS and prenatal smoking, in Virginia

Source CDC- http//www.cdc.gov/tobacco/health_eff
ects/heart.htm.
37
Adult Tobacco Use in VA, 2005
  • 20.6 of adults currently smoke cigarettes in
    Virginia.
  • Over half (53) of adults who smoked said that
    they started smoking regularly between the ages
    of 13 and 17.
  • Smoking rates begin to decline starting at age
    50 40-49 year-olds have the highest rates.

Source BRFSS, 2005 adults 18 weighted
percents.
38
Obesity Overweight
39
Obesity Overweight in U.S., 2005
  • Associated with increased risk for hypertension,
    dyslipidemia, type 2 diabetes, coronary heart
    disease, stroke, osteoarthritis, and certain
    cancers
  • The second leading cause of preventable death
  • A combined 61 of U.S. adults were either
    overweight, obese, or extremely obese (3.0 with
    a BMI of gt 40!)
  • U.S. obesity and overweight rates were highest
    for men, Blacks, 50-59 year-olds
  • Source MMWR, State-specific prevalence of
    obesity among adults, September 15, 2006 /
    55(36)985-988.

40
Obesity Overweight in VA, 2005
  • A combined 60.6 of adults were either obese
    (25.1) or overweight (35.5).
  • Prevalence rates tend to be higher in males,
    Blacks, and 55-64 year olds.

Source MMWR website, CDC, http//www.cdc.gov/mmwr
/ VA BRFSS, 2005 adults 18 weighted
percents.
41
Diet
42
Proper Nutrition
  • Diets rich in foods containing fiber (fruits,
    vegetables, whole grains) may reduce the risk of
    coronary heart disease, stroke, type 2 diabetes,
    and certain cancers (oral cavity and pharynx,
    larynx, lung, esophagus, stomach, and
    colorectal).
  • Diets rich in milk and milk products can reduce
    the risk of low bone mass throughout the life
    cycle.
  • Source USDA Dietary Guidelines Fact Sheet,
    2005.

43
Eating Fruits Vegetables, U.S. VA, 2005
  • In the U.S., the prevalence of eating fruits or
    vegetables 3-5 times per day was 27.2.
  • Rates were higher among women, whites, and
    increased with increasing age. Hispanics had the
    lowest prevalence rate among any other race or
    ethnicity.
  • In Virginia, the prevalence of eating fruits or
    vegetables 3-5 times per day was 37.5. Rates
    were higher among women and whites. Rates were
    lowest for 25-34 year-olds and Hispanics.

Source MMWR, Fruit and Vegetable Consumption
Among Adults- U.S., March 16, 2007/
56(10)213-217 VA BRFSS, 2005 adults 18
weighted percents.
44
Physical Activity (or, Not!)
45
Sedentary Lifestyle in U.S. VA, Adults, 2005
  • Sedentary lifestyle is defined by the CDC as,
    not participating in any leisure time activity
    in 30 days.
  • About 24 of U.S. adults reported being
    sedentary!
  • 22.6 of adults in Virginia reported being
    sedentary. Black females and other non-Hispanic
    males had the highest rates of sedentary
    lifestyle.
  • Sedentary lifestyle is associated with
    hyperlipidemia, hypertension, and obesity.

Source MMWR website, CDC, http//www.cdc.gov/mmwr
/ VA BRFSS, 2005 adults 18 weighted percents.
46
Physical Activity in Children Adolescents, VA,
2003
  • 64 of high school students participated in
    vigorous physical activity most week days (at
    least 5)
  • 27 of high school students participated in
    moderate physical activity most week days
  • High school students attending physical education
    classes daily decreased from 42 in 1991, to 25
    in 1995, and to 33 in 2005.

Source VDH, WIC Program, An Examination of
Healthy Behaviors in Virginias Children, 2003.

47
Hypertension (High Blood Pressure)
48
High Blood Pressure in the U.S. VA, 2005
  • Pre-hypertension defined as blood pressure gt
    120-139 (systolic) or gt 80-89 (diastolic)
    hypertension defined as anything higher than 140
    90 and probably requires medication
  • In the U.S., about 1/3 of all adults has high
    blood pressure- 65 million! Highest prevalence in
    Blacks.
  • Costly- cause of more doctors visits than any
    other condition 64 billion/yr. in medical costs
  • 26.7 of all Virginia adults has high blood
    pressure and rates are similar to U.S.- highest
    prevalence in Blacks, no significant gender
    differences, and rates increase with increasing
    age.

Sources U.S. Department of Health and Human
Services, Controlling High Blood Pressure,
Legislator Policy Brief, 2007 BRFSS, 2005.
49
Hypertension-Related Deaths in VA, 2005
  • Hypertension is considered both a risk factor and
    a form of heart disease.
  • Also an underlying cause of death- the silent
    killer
  • In 2005, hypertensive heart, hypertensive renal
    disease, and essential hypertension killed 1,050
    Virginians.

Source VDH Division of Health Statistics, 2005.
50
High Blood Pressure Trends in VA by
Race/Ethnicity, 2001-2004

Source American Indian/Alaskan Native BRFSS,
2001-2004 data aggregated due to small sample
size.
51
High Blood Pressure Prevalence Rates by VA Health
District, 2005
  • The top three health districts with the highest
    prevalence rates of high blood pressure were
  • 1. Pittsylvania-Danville (42.0)
  • 2. Lenowisco (39.6)
  • 3. Eastern Shore (38.5)

Source BRFSS, 2005 adults 18 weighted
percents.
52
Data note State rates listed here are based on
calculations ran by health district, if a data
point does not have a corresponding health
district location reported, the data point is not
included thus, these rates can vary slightly
from overall, state rates.
53
High Cholesterol
54
High Cholesterol in the U.S. VA, 2005
  • Optimal cholesterol levels are
  • LDL (Bad) lt100, HDL (Good) gt60, Total lt200,
  • Triglycerides lt150
  • In the U.S., 35.6 of all adults has high
    cholesterol.
  • In the U.S., males have slightly higher rates
    than females, whites have the highest rates
    across race/ethnicity, and high blood pressure
    increases with increasing age.
  • 36.2 of all Virginia adults had high cholesterol
    and rates were similar to U.S. rates across
    gender, race/ ethnicity, and age.

Sources U.S. Department of Health and Human
Services, National Institutes of Health- National
Heart, Lung, and Blood Institute, High Blood
Cholesterol- What You Need to Know, 2002 BRFSS,
2005.
55
High Cholesterol Trends in VA by Race/Ethnicity,
2001-2004
Source BRFSS, 2001-2004 adults 18 weighted
percents data aggregated due to small sample
size.
56
High Cholesterol Prevalence Rates by VA Health
District, 2005
  • The top three health districts with the highest
    prevalence rates of high cholesterol were
  • 1. Alleghany (45.1)
  • 2. Lord Fairfax (43.4)
  • 3. Chesterfield (43.2) Pittsylvania- Danville
    (43.1)

Source BRFSS, 2005 adults 18 weighted
percents.
57
Data note State rates listed here are based on
calculations ran by health district, if a data
point does not have a corresponding health
district location reported, the data point is not
included thus, these rates can vary slightly
from overall, state rates.
58
Diabetes Mellitus (DM)
Image retrieved from- http//www.fotosearch.com/ph
otos-images/diabetes.html.
59
Diabetes as an Independent Risk Factor for CVD
  • Diabetes can lead to coronary heart disease,
    stroke, peripheral artery disease,
    cardiomyopathy, and congestive heart failure.
  • People with diabetes are two to four times more
    likely to have a heart attack or stroke than
    people without diabetes.
  • People with diabetes are more likely to die from
    a second heart attack than people with CVD who do
    not suffer from diabetes.
  • A secondary diagnosis of CVD is found in about
    75 of all diabetes-coded deaths.

Source http//www.ndep.nih.gov/control/CVD.htm.
60
Diabetes as an Independent Risk Factor for
CVD,VA, 2005
  • Persons with diabetes were 2.4 times more likely
    to be obese than persons without diabetes
  • Persons with diabetes were 2.9 times more likely
    to have high blood pressure than persons without
    diabetes
  • Persons with diabetes were 2.0 times more likely
    to have high cholesterol than persons without
    diabetes
  • When looking at the above risk factors in
    combination with one another, obesity has the
    highest contribution to a diagnosis diabetes.

Source Gruss, S.M. Jennings, G.C., BRFSS data
analysis of risk factors for having diabetes,
2005.
61
Diabetes Prevalence Rates by VA Health District,
2005
  • The top three health districts with the highest
    prevalence rates of diabetes were
  • 1. Eastern Shore (15.4)
  • 2. Lenowisco (14.2)
  • 3. Crater (12.6)

Source BRFSS, 2005 adults 18 weighted
percents.
62
Data note State rates listed here are based on
calculations ran by health district, if a data
point does not have a corresponding health
district location reported, the data point is not
included thus, these rates can vary slightly
from overall, state rates.
63
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