The Prevention Of Cardiovascular Disease: Have We Really Made Progress?

Thomas A. Pearson

Disclosures

Health Affairs. 2007;26(1):49-60. 

In This Article

Are We Really Preventing CVD?

The reductions in mortality from CVD have been appropriately lauded as one of the major health accomplishments of the twentieth century. However, these promising results have been tempered by the large annual reductions in age adjusted CVD mortality rates slowing to 1.5 percent per year and stroke mortality not declining altogether.[4] To understand mortality rates, one must know two parameters: the incidence (rate of new cases) and their case-fatality rates (percentage of cases dying of the disease). Dramatic declines in case-fatality rates have been documented over the past thirty-five years. However, at least two well-designed, population-based studies found no change in the incidence of acute myocardial infarction (AMI)-in Worchester, Massachusetts, and in Olmstead County, Minnesota-from 1990 onward.[5] The recent decline in mortality has been mostly attributed to improvements in acute cardiac care and secondary prevention after CVD onset.[6] In this case, policy development has been impaired by limited surveillance data, which highlights the need for improved systems of surveillance for incidence and prevalence of CVD.

A stable incidence in the setting of an improving case-fatality rate can translate into only one thing: an increasing prevalence, as people previously succumbing to CVD now survive the acute presentation of the disease. These people then return to their communities as CVD cases. In 2000 the American College of Cardiology (ACC) estimated that the population of 12.5 million Americans with the diagnosis of heart disease in that year would double in size by 2050, on the basis of the aging of the population.[7] Continued case-fatality reductions would further accelerate this rise in prevalence. The implications for health care costs and for public health are enormous. Some of these survivors will have sequelae of their disease namely, disability and reduced quality of life. Almost all will require numerous medications, increased care by medical specialists, recurrent testing, and, for some, recurrent hospitalizations and invasive procedures.

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