Circulation. 2009;119:e21-e181
Published online before print December 15, 2008,
doi: 10.1161/CIRCULATIONAHA.108.191261
(Circulation. 2009;119:e21-e181.)
© 2009 American Heart Association, Inc.
Heart Disease and Stroke Statistics—2009 Update
A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
WRITING GROUP MEMBERS;
Donald Lloyd-Jones, MD, ScM, FAHA;
Robert Adams, MD, FAHA;
Mercedes Carnethon, PhD, FAHA;
Giovanni De Simone, MD;
T. Bruce Ferguson, MD;
Katherine Flegal, PhD*;
Earl Ford, MD, MPH*;
Karen Furie, MD;
Alan Go, MD;
Kurt Greenlund, PhD*;
Nancy Haase;
Susan Hailpern, DPH;
Michael Ho, MD, PhD;
Virginia Howard, PhD, FAHA;
Brett Kissela, MD;
Steven Kittner, MD;
Daniel Lackland, PhD, FAHA;
Lynda Lisabeth, PhD;
Ariane Marelli, MD;
Mary McDermott, MD;
James Meigs, MD;
Dariush Mozaffarian, MD, PhD, FAHA;
Graham Nichol, MD, FAHA;
Christopher O'Donnell, MD, MPH, FAHA;
Veronique Roger, MD, FAHA;
Wayne Rosamond, PhD, FAHA;
Ralph Sacco, MD, FAHA;
Paul Sorlie, PhD;
Randall Stafford, MD, PhD, FAHA;
Julia Steinberger, MD, MSC, FAHA;
Thomas Thom;
Sylvia Wasserthiel-Smoller, PhD;
Nathan Wong, PhD;
Judith Wylie-Rosett, EdD;
Yuling Hong, MD, PhD, FAHA, for the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
 |
Table of Contents
|
|---|
- Summary...480/e21
- 1. About These Statistics...e28
- 2. Cardiovascular Diseases...e31
- 3. Subclinical Atherosclerosis...e53
- 4. Coronary Heart Disease, Acute Coronary Syndrome, and Angina Pectoris...e59
- 5. Stroke (Cerebrovascular Disease)...e71
- 6. High Blood Pressure...e87
- 7. Congenital Cardiovascular Defects...e96
- 8. Heart Failure...e101
- 9. Other Cardiovascular Diseases...e105
- — Arrhythmias (Disorders of Heart Rhythm)...e107
- — Arteries, Diseases of (Including Peripheral Arterial Disease)...e108
- — Bacterial Endocarditis...e106
- — Cardiomyopathy...e107
- — Rheumatic Fever/Rheumatic Heart Disease...e105
- — Valvular Heart Disease...e106
- — Venous Thromboembolism...e109
- 10. Risk Factor: Smoking/Tobacco Use...e113
- 11. Risk Factor: High Blood Cholesterol and Other Lipids...e118
- 12. Risk Factor: Physical Inactivity...e123
- 13. Risk Factor: Overweight and Obesity...e127
- 14. Risk Factor: Diabetes Mellitus...e132
- 15. End-Stage Renal Disease and Chronic Kidney Disease...e140
- 16. Metabolic Syndrome...e144
- 17. Nutrition...e148
- 18. Quality of Care...e160
- 19. Medical Procedures...e168
- 20. Economic Cost of Cardiovascular Diseases...e172
- 21. At-a-Glance Summary Tables...e174
- — Men and Cardiovascular Diseases...e175
- — Women and Cardiovascular Diseases...e176
- — Ethnic Groups and Cardiovascular Diseases...e177
- — Children, Youth, and Cardiovascular Diseases...e178
- 22. Glossary...e179
- Appendix I: List of Statistical Fact Sheets. URL: http://www.americanheart.org/presenter.jhtml?identifier=2007
|
Acknowledgments
|
|---|
We thank Drs Sean Coady, Eric L. Ding, Brian Eigel, Gregg C.
Fonarow, Linda Geiss, Cherie James, Michael Mussolino, and Michael
Wolz for their valuable comments and contributions. We acknowledge
Tim Anderson and Tom Schneider for their editorial contributions,
and Karen Modesitt for her administrative assistance.
Disclosures
Summary
Each year, the American Heart Association, in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update. The Statistical Update is a valuable resource for researchers, clinicians, healthcare policy makers, media professionals, the lay public, and many others who seek the best national data available on disease morbidity and mortality and the risks, quality of care, medical procedures and operations, and costs associated with the management of these diseases in a single document. This year’s edition includes several areas not covered in previous editions. Below are a few highlights from this year’s Update.
|
Death Rates From Cardiovascular Disease Have Declined, Yet the Burden of Disease Remains High
|
|---|
- The 2005 overall death rate from cardiovascular disease (CVD) (International Classification of Diseases 10, I00–I99) was 278.9 per 100 000. The rates were 324.7 per 100 000 for white males, 438.4 per 100 000 for black males, 230.4 per 100 000 for white females, and 319.7 per 100 000 for black females. From 1995 to 2005, death rates from CVD declined 26.4%. Preliminary mortality data for 2006 show that CVD (I00–I99; Q20–Q28) accounted for 34.2% (829 072) of all 2 425 900 deaths in 2006, or 1 of every 2.9 deaths in the United States.
- On the basis of 2005 mortality rate data, nearly 2400 Americans die of CVD each day—an average of 1 death every 37 seconds. The 2006 overall preliminary death rate from CVD was 262.9. More than 150 000 Americans killed by CVD (I00–I99) in 2005 were <65 years of age. In 2005, 32% of deaths from CVD occurred before the age of 75 years, which is well before the average life expectancy of 77.9 years.
- Coronary heart disease (CHD) caused about 1 of every 5 deaths in the United States in 2005. CHD mortality in 2005 was 445 687. In 2009, an estimated 785 000 Americans will have a new coronary attack, and about 470 000 will have a recurrent attack. It is estimated that an additional 195 000 silent first myocardial infarctions occur each year. About every 25 seconds, an American will have a coronary event, and about every minute someone will die from one.
- Each year, about 795 000 people experience a new or recurrent stroke. About 610 000 of these are first attacks, and 185 000 are recurrent attacks. Preliminary data from 2006 indicate that stroke accounted for about 1 of every 18 deaths in the United States. On average, every 40 seconds someone in the United States has a stroke. From 1995 to 2005, the stroke death rate fell 29.7%, and the actual number of stroke deaths declined 13.5%.
- In 2005, 1 in 8 death certificates (292 214 deaths) in the United States mentioned heart failure.
|
Control of Risk Factors Remains an Issue for Many Americans
|
|---|
- Data from the National Health and Nutrition Examination Survey 2005–2006 found that between 1999–2000 and 2005–2006, mean serum total cholesterol levels in adults
20 years of age declined from 204 mg/dL to 199 mg/dL. This decline was observed for men 40 years of age and for women 60 years of age. There was little change over this time period for other sex/age groups. In 2005–2006, approximately 65% of men and 70% of women had been screened for high cholesterol in the previous 5 years. In 2005–2006, 16% of adults had serum total cholesterol levels of 240 mg/dL.
- Despite recommendations that some proportion of activity be vigorous (activity that causes heavy sweating and a large increase in breathing and/or heart rate), 62% of adults >18 years of age who responded to the 2006 National Health Interview Survey reported no vigorous activity lasting >10 minutes per session.
- On the basis of data from the National Health and Nutrition Examination Survey (National Center for Health Statistics), the prevalence of overweight (body mass index–for–age values at or above the 95th percentile) in children 6 to 11 years of age increased from 4.0% in 1971–1974 to 17.0% in 2003–2006. The prevalence of body mass index–for–age values at or above the 95th percentile in adolescents 12 to 19 years of age increased from 6.1% to 17.6% in that same time frame. Among infants and children between the ages of 6 and 23 months, the prevalence of high weight-for-age was 7.2% in 1976–1980 and 11.5% in 2003–2006 (National Health and Nutrition Examination Survey, National Center for Health Statistics).
- Just over 12% of preschool children 2 to 5 years of age were overweight in 2003–2006.
|
The 2009 Update Expands Data Coverage of Congenital Cardiovascular Defects and Nutritional/Dietary Intake and Adds a New Chapter on Epidemiology and Statistics of Subclinical Atherosclerosis and a Subsection on Family History of CVD
|
|---|
Several chapters and sections that have been added or revised
for this year’s Update merit specific mention. First,
we have added a new chapter (Chapter 3) that describes the epidemiology
of subclinical atherosclerosis. It has been known for decades
that atherosclerosis, the underlying cause of the majority of
clinical CVD events, is typically present for decades before
the onset of a clinical CVD event or symptoms. As discussed
in Chapters 2 and 4, the initial manifestation of clinical atherosclerotic
CVD too often is a fatal event, such as sudden cardiac death,
or a devastating nonfatal event, such as a large nonfatal myocardial
infarction or a disabling stroke. Advances in imaging technology
over the past several decades have made it possible to detect
and evaluate the burden of subclinical atherosclerosis in a
variety of different vascular beds. Two modalities, ultrafast
computed tomography for imaging of coronary artery calcification
(CAC) and B-mode ultrasound for measurement of carotid intima-media
thickness (IMT), have been studied widely in diverse population
samples and have greatly enhanced our understanding of the development
and progression of subclinical atherosclerosis, as well as its
relationship to subsequent clinical events. The American Heart
Association Statistics Committee felt that, given the extensive
literature in this area and the increasing consideration of
use of these modalities in clinical practice, it was time to
provide a review of the epidemiological data from representative,
nonreferral population samples to provide a measure of context
for the data on subclinical atherosclerosis in the scientific
and lay media.
For example, the National Heart, Lung, and Blood Institute’s Coronary Artery Risk Development in Young Adults (CARDIA) study and Multi-Ethnic Study of Atherosclerosis (MESA) have helped to define age-, sex-, and race-specific levels of CAC in a diverse population. In younger adults in CARDIA, 33 to 45 years of age, 15.0% of men and 5.1% of women already had CAC, and 1.6% had a CAC score >100. Among older adults in MESA, the prevalence and 75th percentile levels of CAC were highest in white men and lowest in black and Hispanic women, as shown in Table 3-1 in Chapter 3. Significant ethnic differences persisted after adjustment for risk factors, with the relative risk of having CAC being 22% lower in blacks, 15% lower in Hispanics, and 8% lower in Chinese, as compared with whites. Longitudinal data from MESA also highlight the risks associated with the presence and extent of CAC. Chart 3-3 in Chapter 3 shows the relative risks or hazard ratios associated with CAC scores of 1 to 100, 101 to 300, and >300 compared with those without CAC (score=0), after adjustment for standard risk factors. Persons with CAC scores of 1 to 100 were approximately 4 times more likely and those with CAC scores >100 were 7 to 10 times more likely to suffer a coronary event than those without CAC.
Carotid IMT, in the absence of frank atherosclerotic plaque, is thought to represent an earlier and more continuous manifestation of atherosclerosis than CAC. Analyses from the Bogalusa Heart Study, CARDIA, MESA, and the Cardiovascular Health Study have helped to describe the epidemiology of carotid IMT across the spectra of age, sex, and race. Concurrent levels of risk factors in young adulthood and early levels of risk factors, even those measured in people 4 to 17 years of age, were significantly associated with carotid IMT at a mean age of 32 years. Higher body mass index and low-density lipoprotein cholesterol levels measured at 4 to 17 years of age were associated with increased risk for being above the 75th percentile for carotid IMT later on in young adulthood. Higher systolic blood pressure and low-density lipoprotein cholesterol and lower high-density lipoprotein cholesterol in young adulthood were also associated with having high carotid IMT. These data highlight the importance of adverse risk factor levels and obesity in early childhood and young adulthood in the early development of atherosclerosis. In the Cardiovascular Health Study, among older Americans, after a mean follow-up of 6.2 years, those with maximal carotid IMT in the highest quintile had a 4- to 5-fold greater risk for incident heart attack or stroke than that of those in the bottom quintile. After adjustment for other risk factors, there was still a 2- to 3-fold greater risk for the top versus the bottom quintile. These data should help to provide some context for physicians and patients to help understand the evolving roles of subclinical atherosclerosis imaging in research and clinical practice.
As in prior years, we continue to highlight (in Chapter 2) the importance of maintaining low risk factor burden through young adulthood to middle and older ages. An extensive body of literature has demonstrated that individuals who survive to middle age (eg, age 50) without developing traditional CVD risk factors, such as hypercholesterolemia, hypertension, diabetes, or smoking, enjoy a broad array of health benefits, including substantially greater longevity, substantially reduced short- and long-term and remaining lifetime risks for CVD events even in the face of greater longevity, lower risks for both CVD death and non-CVD death, better health-related quality of life in older age, and substantially reduced total and annual Medicare expenditures.
A new section in Chapter 2 also highlights some of the increasing knowledge available about the complex association between family history of CVD and future risk for CVD among offspring and siblings. In future updates, we anticipate including greatly expanded information and discussion of results from genetic studies that may help elucidate novel underlying mechanisms and pathways of atherosclerosis and CVD development.
The chapter on congenital cardiovascular disease (Chapter 7) has been completely revised to provide updated and more useful information. Whereas surveillance for congenital heart defects is incomplete, these data reflect more contemporary estimates and represent the best available data. For example, on the basis of present estimates, 9 congenital heart defects per 1000 live births, or 36 000 infants born with congenital heart defects, are expected in the United States per year. Of these, several studies suggest that 9200, or 2.3 per 1000 live births, require invasive treatment or result in death in the first year of life.
We have substantially revised and updated the chapter (Chapter 17) describing current nutritional intake data, trends and changes in intakes, estimated effects on cardiovascular risk factors and cardiovascular outcomes, and current costs and trends for all foods. New tables and charts added to the chapter this year include: Table 17-1, on dietary consumption by US adults (>20 years of age) of selected foods and nutrients related to cardiometabolic health; Table 17-2, on dietary consumption by US children and teenagers of selected foods and nutrients related to cardiometabolic health; Chart 17-1, on age-adjusted trends in macronutrients and total calories consumed by US adults (20 to 74 years of age); Chart 17-2, on per capita calories consumed from different beverages by US adults (19 years of age); and Chart 17-3, on total US food expenditures away from home and at home.
Reporting and monitoring quality-of-care measures stratified by patient’s race/ethnicity and sex are important steps toward addressing disparities in health care through organizational quality improvement. In Chapter 18, new data on quality of care and quality-of-care measures stratified by race/ethnicity and sex, are reported for hospitals participating in Get With The Guidelines from January 1, 2007, through December 31, 2007 (Tables 18-3, 18-9, and 18-10) for the first time in our annual Statistics Update.
Other new data that are of note in this year’s Update include:
- The 10 leading diagnoses from the National Hospital Discharge Survey (Chapter 2).
- Extent of awareness, treatment, and control of high blood pressure, by race/ethnicity and sex (Chapter 6).
- Trends in the prevalence of total serum cholesterol in adults 20 years of age, by sex and race/ethnicity (Chapter 11).
- Prevalence of students in grades 9 through 12 who did not meet currently recommended levels of moderate-to-vigorous physical activity during the past 7 days, by race/ethnicity and sex (Chapter 12).
- Prevalence of children 6 to 19 years of age who attained sufficient moderate-to-vigorous physical activity to meet public health recommendations of 60 minutes per day on 5 of 7 days, by sex and age (Chapter 12).
- Trends in diabetes prevalence in adults 20 years of age, by sex (Chapter 14).
- Number of surgical procedures in the 10 leading diagnostic groups (Chapter 19).
- Direct costs of the 10 leading diagnostic groups (Chapter 20).
The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current data available in the Statistics Update. The 2006 preliminary mortality data have been released. More information can be found at the National Center for Health Statistics Web site, http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_16.pdf.
Finally, it must be noted that this annual Update is the product of an entire year’s worth of effort by dedicated professionals, volunteer physicians and scientists, and outstanding American Heart Association staff members, without whom publication of this valuable resource would be impossible. Their contributions are gratefully acknowledged.
Donald Lloyd-Jones, MD, ScM, FAHA
Nancy Haase
Yuling Hong, MD, PhD, FAHA
On behalf of the American Heart Association Heart Disease and Stroke Statistics Writing Group
1. About These Statistics
The American Heart Association (AHA) works with the Centers
for Disease Control and Prevention’s (CDC’s) National
Center for Health Statistics (NCHS); the National Heart, Lung,
and Blood Institute (NHLBI); the National Institute of Neurological
Disorders and Stroke (NINDS); and other government agencies
to derive the annual statistics in this Update. This chapter
describes the most important sources and the types of data we
use from them. For more details, see Chapter 22 of this document,
the Glossary.
The surveys used are:
- Behavioral Risk Factor Surveillance Survey (BRFSS)—ongoing telephone health survey system
- Greater Cincinnati/Northern Manhattan Stroke Study (GCNKSS)—stroke incidence rates and outcomes within a biracial population
- Medical Expenditure Panel Survey (MEPS)—data on specific health services that Americans use, how frequently they use them, the cost of these services, and how the costs are paid
- National Health and Nutrition Examination Survey (NHANES)—disease and risk factor prevalence and nutrition statistics
- National Health Interview Survey (NHIS)—disease and risk factor prevalence
- National Hospital Discharge Survey (NHDS)—hospital inpatient discharges and procedures (discharged alive, dead, or status unknown)
- National Ambulatory Medical Care Survey (NAMCS)—physician office visits
- National Hospital Ambulatory Medical Care Survey (NHAMCS)—hospital outpatient and emergency department visits
- National Inpatient Sample (NIS) of the Agency for Health Research and Quality (AHRQ)—hospital inpatient discharges, procedures, and charges
- National Nursing Home Survey (NNHS)—nursing home visits
- National Vital Statistics—national and state mortality data
- Youth Risk Behavior Surveillance (YRBS) (CDC)—trends for 6 categories of priority health-risk behaviors in youth and young adults
- World Health Organization (WHO)—mortality rates by country
|
Disease Prevalence
|
|---|
Prevalence is an estimate of how many people have a disease
at a given point or period in time. The NCHS conducts health
examination and health interview surveys that provide estimates
of the prevalence of diseases and risk factors. In this Update,
the health interview part of the NHANES is used for the prevalence
of cardiovascular diseases (CVD). NHANES is used more than the
NHIS because in NHANES, angina pectoris (AP) is based on the
Rose Questionnaire; estimates are made regularly for heart failure
(HF); hypertension is based on blood pressure (BP) measurements
and interviews; and an estimate can be made of total CVD to
include myocardial infarction (MI), AP, HF, stroke, and hypertension.
A major emphasis of this Update is to present the latest estimates of the number of persons in the United States who have specific conditions to provide a more realistic estimate of burden. Most estimates based on NHANES prevalence rates are based on data collected from 2005 to 2006 (in most cases, these are the latest published figures). These are applied to census population estimates for 2006. Differences in population estimates based on extrapolations of rates beyond the data collection period by using more recent census population estimates cannot be used to evaluate possible trends in prevalence. Trends can only be evaluated by comparing prevalence rates estimated from surveys conducted in different years.
|
Risk Factor Prevalence
|
|---|
The NHANES 2005–2006 data are used in this Update to present
estimates of the percentage of persons with high lipid values,
diabetes, overweight, and obesity. The NHIS is used for the
prevalence of cigarette smoking and physical inactivity. Data
for students in grades 9 through 12 are obtained from the Youth
Risk Factor Surveillance System.
|
Incidence and Recurrent Attacks
|
|---|
An incidence rate refers to the number of new cases of a disease
that develop in a population per unit of time. The unit of time
for incidence is not necessarily 1 year, although we often discuss
incidence in terms of 1 year. For some statistics, new and recurrent
attacks or cases are combined. Our national incidence estimates
for the various types of CVD are extrapolations to the US population
from the Framingham Heart Study (FHS), the Atherosclerosis Risk
in Communities (ARIC) study, the Cardiovascular Health Study
(CHS), all conducted by the NHLBI, and the Greater Cincinnati/Northern
Kentucky Stroke Study (GCNKSS), which is funded by the NINDS.
The rates change only when new data are available; they are
not computed annually. Do not compare the incidence or the rates
with those in past editions of the Heart Disease and Stroke
Statistics Update (also known as the Heart and Stroke "Statistical"
Update for editions before 2005). Doing so can lead to serious
misinterpretation of time trends.
|
Mortality
|
|---|
Mortality data are presented according to the underlying cause
of death. "Total-mention" mortality is the number of death certificates
in a year that mention the given disease classification either
as the underlying cause or as a contributing cause. For many
deaths classified as attributable to CVD, selection of the most
likely single underlying cause can be difficult when several
major comorbidities are present, as is often the case in the
elderly population. It is, therefore, useful to know the extent
of mortality from a given cause, regardless of whether it is
the underlying cause or a contributing cause—ie, its "total
mentions." The number of total-mention deaths in 2005 was tabulated
by the NHLBI from the NCHS public-use electronic files on mortality.
The first set of statistics for each disease in this Update includes the number of deaths for which the disease is the underlying cause. That number is referred to as "mortality." Mortality is followed by the number for "total-mention mortality." All other numbers or rates of deaths in the Update refer to the given disease as the underlying cause. One exception is Chapter 9, where total-mention HF mortality statistics are presented.
National and state mortality data presented by the underlying cause of death were computed from the Data Warehouse mortality tables of the NCHS Web site or the CDC compressed file. Total-mention numbers of deaths were tabulated from the electronic mortality files of the NCHS Web site. Note that any mortality data for 2006 are preliminary.
|
Population Estimates
|
|---|
In this publication, we have used national population estimates
from the US Census Bureau for 2006 in the computation of morbidity
data. NCHS population estimates for 2005 were used in the computation
of death rate data. The Census Bureau Web site
1 contains these
data as well as information on the file layout.
|
Hospital Discharges and Ambulatory Care Visits
|
|---|
Estimates of the numbers of hospital discharges and numbers
of procedures performed are for inpatients discharged from short-stay
hospitals. Discharges include those discharged alive, dead,
or with unknown status. Unless otherwise specified, discharges
are listed according to the first-listed (primary) diagnosis,
and procedures are listed according to the all-listed procedures
(primary plus secondary). These estimates are from the NHDS
of the NCHS unless otherwise noted. Ambulatory care visit data
from NHAMCS include patient visits to physicians’ offices
and hospital emergency and outpatient departments. Ambulatory
care visit data reflect the first-listed (primary) diagnosis.
These estimates are from the NAMCS and NHAMCS of the NCHS.
|
International Classification of Diseases
|
|---|
Morbidity (illness) and mortality (death) data in the United
States have a standard classification system: the
International Classification of Diseases (ICD). Approximately every 10 to
20 years, the ICD codes are revised to reflect changes over
time in medical technology, diagnosis, or terminology. Where
necessary for comparability of mortality trends across the 9th
and 10th ICD revisions, comparability ratios computed by NCHS
are applied as noted.
2 Effective with mortality data for 1999,
we are using the 10th revision (ICD-10). It will be a few more
years before the 10th revision is used for hospital discharge
data and ambulatory care visit data, which are based on the
International Classification of Diseases, Clinical Modification,
9th Revision (ICD-9-CM).
3
|
Age Adjustment
|
|---|
Prevalence and mortality estimates for the United States or
individual states comparing demographic groups or estimates
over time either are age specific or are age adjusted to the
2000 standard population by the direct method.
4 International
mortality data are age adjusted to the European standard.
5 Unless
otherwise stated, all death rates in this publication are age
adjusted and are per 100 000 population.
|
Data Years for National Estimates
|
|---|
In this Update, we estimate the annual number of new (incidence)
and recurrent cases of a disease in the United States by extrapolating
to the US population in 2006 from rates reported in a community-
or hospital-based study or multiple studies. Age-adjusted
incidence rates by sex and race are also given in this report as observed
in the study or studies. For US
mortality, most numbers and
rates are for 2005. For disease and risk factor
prevalence,
most rates in this report are calculated from the 2005–2006
NHANES. Rates by age and sex are also applied to the US population
in 2006 to estimate the numbers of persons with the disease
or risk factor in that year. Because NHANES is conducted only
in the noninstitutionalized population, we extrapolated the
rates to the total US population in 2006, recognizing that this
probably underestimates the total prevalence, given the relatively
high prevalence in the institutionalized population. The numbers
and rates of
hospital inpatient discharges for the United States
are for 2005 and 2006. Numbers of visits to
physician offices,
hospital emergency departments, and
outpatient departments are
for 2006. Except as noted,
economic cost estimates are projected
to 2009.
|
Cardiovascular Disease
|
|---|
For data on hospitalizations, physician office visits, and mortality,
CVD is defined according to ICD codes given in Chapter 22 of
the present document. This definition includes all diseases
of the circulatory system and congenital CVD. Unless so specified,
an estimate for total CVD does not include congenital CVD.
|
Race
|
|---|
Data published by governmental agencies for some racial groups
are considered unreliable because of the small sample size in
the studies. Because we try to provide data for as many racial
groups as possible, we show these data for informational and
comparative purposes.
|
Contacts
|
|---|
If you have questions about statistics or any points made in
this Update, please contact the Biostatistics Program Coordinator
at the American Heart Association National Center (e-mail nancy.haase@heart.org,
phone 214-706-1423). Direct all media inquiries to News Media
Relations at inquiries@heart.org or 214-706-1173.
We do our utmost to ensure that this Update is error free. If we discover errors after publication, we will provide corrections at our Web site, http://www.americanheart.org/statistics, and in the journal Circulation.
|
References
|
|---|
1. US Census Bureau population estimates. Available at: http://www.census.gov/popest/national/asrh/2006_nat_res.html. Accessed April 16, 2008.
2. National Center for Health Statistics. Health, United States, 2007, With Chartbook on Trends in the Health of Americans. Hyattsville, Md: National Center for Health Statistics; 2007. Available at: http://www.cdc.gov/nchs/hus.htm. Accessed May 5, 2008.
3. National Center for Health Statistics, Centers for Medicare and Medicaid Services. International Classification of Diseases, Ninth Revision. Clinical Modification (ICD 9 CM). Hyattsville, Md: National Center for Health Statistics; 1978.
4. Anderson RN, Rosenberg HM. Age standardization of death rates: implementation of the year 2000 standard. Natl Vital Stat Rep. 1998; 47: 1–16, 20.[Medline]
[Order article via Infotrieve]
5. World Health Organization. World Health Statistics Annual. Geneva, Switzerland: World Health Organization; 1998.
2. Cardiovascular Diseases
ICD-9 390–459, 745–747, ICD-10 I00–I99, Q20–Q28; see Glossary (Chapter 21) for details and definitions. See Tables 2-1 through 2-4 and Charts 2-1 through 2-21.
View this table:
[in this window]
[in a new window]
|
Table 2-2. 2005 Age-Adjusted Death Rates for CVD, CHD, and Stroke by State (Includes District of Columbia and Puerto Rico)
|
|
View this table:
[in this window]
[in a new window]
|
Table 2-3. International Death Rates (Revised 2008): Death Rates (Per 100 000 Population) for Total Cardiovascular Disease, Coronary Heart Disease, Stroke, and Total Deaths in Selected Countries (Most Recent Year Available)
|
|
View this table:
[in this window]
[in a new window]
|
Table 2-4. Remaining Risks for CVD and Other Diseases Among Men and Women Free of Disease at 40 and 70 Years of Age
|
|
View larger version (11K):
[in this window]
[in a new window]
|
Chart 2-1. Prevalence of CVD in adults 20 years of age by age and sex (NHANES: 2005–2006). Source: NCHS and NHLBI. These data include CHD, HF, stroke, and hypertension.
|
|
View larger version (11K):
[in this window]
[in a new window]
|
Chart 2-2. Incidence of CVD by age and sex (FHS, 1980–2003).CVD includes CHD, HF, stroke, or intermittent claudication but does not include hypertension alone. Source: NHLBI.3
|
|
View larger version (6K):
[in this window]
[in a new window]
|
Chart 2-3. Deaths due to diseases of the heart (United States: 1900–2006). See Glossary for an explanation of "diseases of the heart." Source: NCHS.
|
|
View larger version (8K):
[in this window]
[in a new window]
|
Chart 2-4. Deaths due to CVD (United States: 1900–2006). CVD does not include congenital CVD. Source: NCHS. *Preliminary.
|
|
View larger version (17K):
[in this window]
[in a new window]
|
Chart 2-5. Percentage breakdown of deaths due to CVD (United States: 2006, preliminary). Source: NCHS. May not add to 100 owing to rounding. *Not a true underlying cause.
|
|
View larger version (13K):
[in this window]
[in a new window]
|
Chart 2-7. CVD and other major causes of death: total, <85 years of age, and 85 years of age. Deaths among both sexes, United States, 2005. Source: NCHS and NHLBI.
|
|
View larger version (16K):
[in this window]
[in a new window]
|
Chart 2-8. CVD and other major causes of death: total, <85 years of age, and 85 years of age. Deaths among males, United States, 2005. Source: NCHS and NHLBI.
|
|
View larger version (16K):
[in this window]
[in a new window]
|
Chart 2-9. CVD and other major causes of death: total, <85 years of age, and 85 years of age. Deaths among females, United States, 2005. Source: NCHS and NHLBI.
|
|
View larger version (14K):
[in this window]
[in a new window]
|
Chart 2-10. CVD and other major causes of death for all males and females (United States: 2005). Source: NCHS and NHLBI. A indicates CVD plus congenital CVD; B, cancer; C, accidents; D, CLRD; E, diabetes; and F, Alzheimer’s disease.
|
|
View larger version (11K):
[in this window]
[in a new window]
|
Chart 2-11. CVD and other major causes of death for white males and females (United States: 2005). Source: NCHS. Abbreviations as in Chart 2-10. Note: Using the combined category of "diseases of the heart and stroke," which do not constitute total CVD, the percentages were 31.8 for males and 33.7 for females.
|
|
View larger version (11K):
[in this window]
[in a new window]
|
Chart 2-12. CVD and other major causes of death for black males and females (United States: 2005). Source: NCHS. A indicates CVD plus congenital CVD; B, cancer; C, accidents; D, diabetes; E, assault (homicide); and F, nephritis. Note: Using the combined category of "diseases of the heart and stroke," which do not constitute total CVD, the percentages were 29.4 for males and 33.3 for females.
|
|
View larger version (11K):
[in this window]
[in a new window]
|
Chart 2-13. Diseases of the heart and stroke and other major causes of death for Hispanic or Latino males and females (United States: 2005). Data for total CVD are not readily available. Source: NCHS. A indicates diseases of the heart and stroke; B, cancer; C, accidents; D, DM; E, assault (homicide); and F, CLRD.
|
|
View larger version (11K):
[in this window]
[in a new window]
|
Chart 2-14. Diseases of the heart and stroke and other major causes of death for Asian or Pacific Islander males and females (United States: 2005). "Asian or Pacific Islander" is a heterogeneous category that includes people at high CVD risk (eg, South Asian) and people at low CVD risk (eg, Japanese). More specific data on the groups are not available. Mortality data for total CVD are not readily available. Source: NCHS. A indicates diseases of the heart/stroke; B, cancer; C, accidents; D, CLRD; E, diabetes; and F, influenza and pneumonia.
|
|
View larger version (16K):
[in this window]
[in a new window]
|
Chart 2-15. Diseases of the heart and stroke and other major causes of death for American Indian or Alaska Native males and females (United States: 2005). Data for total CVD are not readily available. Source: NCHS. A indicates diseases of the heart/stroke; B, cancer; C, accidents; D, diabetes; E, chronic liver disease and cirrhosis; and F, CLRD.
|
|
View larger version (11K):
[in this window]
[in a new window]
|
Chart 2-16. Age-adjusted death rates for CHD, stroke, and lung and breast cancer for white and black females (United States: 2005). Source: NCHS.
|
|
View larger version (7K):
[in this window]
[in a new window]
|
Chart 2-17. CVD mortality trends for males and females (United States: 1979–2005). Source: NCHS. The overall comparability for CVD between the ICD-9 (1979–1998) and ICD-10 (1999–2005) is 0.9962. No comparability ratios were applied.
|
|
View larger version (5K):
[in this window]
[in a new window]
|
Chart 2-18. Hospital discharges for CVD (United States: 1970–2006). Hospital discharges include people discharged alive, dead, and "status unknown." Source: NCHS and NHLBI.
|
|
View larger version (22K):
[in this window]
[in a new window]
|
Chart 2-19. Hospital discharges for the 10 leading diagnostic groups (United States: 2006). Source: NHDS/NCHS and NHLBI.
|
|
View larger version (24K):
[in this window]
[in a new window]
|
Chart 2-20. Estimated average 10-year CVD risk in adults 50 to 54 years of age according to levels of various risk factors (Framingham Heart Study). Source: D'Agostino et al.75
|
|
|
Prevalence
|
|---|
An estimated 80 000 000 American adults (approximately 1 in
3) have 1 or more types of CVD. Of these, 38 100 000 are estimated
to be
60 years of age (extrapolated to 2006 from NCHS/NHANES
2005–2006 data). Total CVD includes diseases listed in
the bullet points below except for congenital CVD. Because of
overlap, it is not possible to add these conditions to arrive
at a total.
- High blood pressure (HBP)—73 600 000. (Defined as systolic pressure 140 mm Hg or diastolic pressure 90 mm Hg, use of antihypertensive medication, or being told at least twice by a physician or other health professional that one has HBP.)
- Coronary heart disease (CHD)—16 800 000.
- — Myocardial infarction (MI; heart attack)—7 900 000.
- — Angina pectoris (AP; chest pain)—9 800 000.
- Heart failure (HF)—5 700 000.
- Stroke—6 500 000.
- Congenital cardiovascular defects—650 000 to 1 300 000 (see Chapter 7).
The following prevalence estimates are for 2007 from NHIS, NCHS for people 18 years of age1:
- Among whites only, 11.4% have heart disease (HD), 6.1% have CHD, 22.2% have hypertension, and 2.2% have had a stroke.
- Among blacks or African Americans, 10.2% have HD, 6.0% have CHD, 31.7% have hypertension, and 3.7% have had a stroke.
- Among Hispanics or Latinos, 8.8% have HD, 5.7% have CHD, 20.6% have hypertension, and 2.5% have had a stroke.
- Among Asians, 6.9% have HD, 4.3% have CHD, 19.5% have hypertension, and 2.6% have had a stroke.
- Among Native Hawaiians or other Pacific Islanders, HD, CHD, and stroke numbers are suppressed owing to large relative standard error, and 28.5%* have hypertension. Among American Indians or Alaska Natives, 10.5% have HD, 5.6%* have CHD, and 25.5% have hypertension, and stroke numbers are suppressed owing to large relative standard error.
- Asian Indian adults (9%) are approximately 2 times as likely as Korean adults (4%) to have ever been told they have HD.2
|
Incidence
|
|---|
- On the basis of the NHLBI’s Framingham Heart Study (FHS) original and offspring cohort data from 1980 to 20033:
- — The average annual rates of first cardiovascular events rise from 3 per 1000 men at 35 to 44 years of age to 74 per 1000 men at 85 to 94 years of age. For women, comparable rates occur 10 years later in life. The gap narrows with advancing age.
- — Before 75 years of age, a higher proportion of CVD events due to CHD occur in men than in women, and a higher proportion of events due to stroke occur in women than in men.
- Among American Indian men 45 to 74 years of age, the incidence of CVD ranges from 15 to 28 per 1000 population. Among women, it ranges from 9 to 15 per 1000.4
- Data from the FHS indicate that the lifetime risk for CVD is 2 in 3 for men and more than 1 in 2 for women at 40 years of age (personal communication, Donald Lloyd-Jones, MD, Northwestern University, Chicago, Ill).
|
Mortality
|
|---|
Top
Table of Contents
Death Rates From Cardiovascular...
