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Heart Disease

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Despite intensified efforts to prevent cardiovascular disease, disparities continue for some groups and regions

Cardiovascular disease (CVD) has been the dominant cause of death in the United States for at least 50 years, with heart disease ranking first and stroke ranking third as specific causes of death. A National Conference on Cardiovascular Disease Prevention was convened in September 1999 to assess the magnitude and causes of trends in coronary heart disease (CHD), stroke, and other CVD; examine disparities in levels and trends of CVD rates by race/ethnicity, socioeconomic status, and geography; and explore strategies for CVD prevention.

Findings from the conference indicate that CHD mortality rates are especially high in middle-aged black men, and stroke mortality rates are strikingly higher in blacks in general. CVD mortality rates also vary markedly by U.S. region, with age-adjusted CHD rates varying more than two-fold among certain States. Rural and poor areas have particularly high CHD mortality rates.

Since 1990, there has been little or no progress in reducing risk factors for CVD, such as smoking (currently at 25 percent of the population), physical inactivity (29 percent report no regular physical activity outside of work), and hypertension (only 11 of 43 million U.S. residents with hypertension are treated and controlled). Moreover, there is a trend suggesting greater dietary intake of calories (50 to 60 percent of adults are overweight), a rapid rise in obesity prevalence (20 to 25 percent of adults), and a striking increase of type-2 diabetes to 7 percent of adults.

More can and should be done for population-based primary prevention, notes Daniel Stryer, M.D., of the Agency for Healthcare Research and Quality. Dr. Stryer and his coauthors note that within the health care sector, fewer than 50 percent of patients will reliably have their risk factors assessed, treated, or controlled. Similar disparities are observed in secondary prevention, despite widely accepted guidelines. To restore and even accelerate the decline in CVD mortality, conference participants recommended a strategy that emphasizes primary risk factor prevention, detection, and management; attention to all population subgroups, especially those at high risk; and mobilization of multifaceted resources needed to effectively implement this strategy.

See "Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States: Findings of the National Conference on Cardiovascular Disease Prevention," by Richard Cooper, M.D., Jeffrey Cutler, M.D., Patrice Desvigne-Nickens, M.D., and others, in the December 19, 2000, Circulation 102, pp. 3137-3147.

Reprints (AHRQ Publication No. 01-R021) are available from the AHRQ Publications Clearinghouse.

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