CHD and Stroke Death Rates Declining, but Will They Continue to?

January 23, 2008

January 23, 2008 (Atlanta, GA and Dallas, TX) - New mortality data from the US Centers for Disease Control and Prevention (CDC) show that, since 1999, death rates from coronary heart disease and stroke have fallen by about 25%.

The latest figures, based on 2005 data, mean that the American Heart Association's (AHA's) 2010 strategic goal for reducing deaths from CHD has already been achieved, and the goal for reducing stroke deaths has almost already been achieved, AHA president Dr Dan Jones told heartwire . But he cautioned that the news was not all good. "That's the 'cup-half-full' part of the story. But the 'cup-half-empty' part is that we are not meeting goals for risk factors. While cholesterol levels have shown a big improvement, the statistics for hypertension, smoking, and physical activity are not so good--they are going in the right direction but not fast enough. And rates of obesity and diabetes are increasing," he noted.

"The mortality targets have been met by mainly by improved treatment strategies--particularly of acute events, such as improved reperfusion therapies for MI and more rapid and improved treatment of acute stroke. We must keep this up but at the same time focus efforts on prevention in years to come. We need to replicate the success with statins on cholesterol in other areas of drug treatment, but we also need to focus on changing lifestyles. That is very difficult. There have been dramatic changes in lifestyles in the US and Europe during the past few decades, but unfortunately these have been in a negative direction," Jones added. "If this trend continues, death rates could begin to rise again in years ahead."

In 1999, the AHA set a goal of reducing the death rates from CHD and stroke and reducing the risk factors for these diseases by 25% by 2010. The new CDC data show that the mortality figures are being achieved but the goals for the risk factors are not, which means that the victory could be short-lived.

Age-adjusted death rate (per 100 000 population) for CHD and stroke

  1999 2000 2001 2002 2003 2004 2005
CHD 194.6 186.8 177.8 170.8 162.9 150.2 144.4
Stroke 61.6 60.9 57.9 56.2 53.5 50.0 46.6

Gender/ethnic differences

While CHD death rates for women are falling at a slightly greater pace than for men, stroke death rates are showing the opposite trend--down by 23.7% for women vs 25.8% for men since 1999. Both CHD and stroke death are falling more slowly in blacks than in whites. The CHD death rate is down 23.8% in blacks vs 25.6% in whites, and stroke deaths are down by 20.3% in blacks vs 25% in whites. "These disparities are unacceptable," Jones said. "We are actively seeking ways to better address these issues, so that we can ensure that every person has the appropriate care they need to live a healthier, longer life."

240 000 lives saved in 2008?

The reduction in the CHD and stroke death rates equates to approximately 160 000 lives saved in 2005 (the most recent year for which data are available) compared with the 1999 baseline data. If the current mortality trends hold, the AHA projects that there may be a 34% decline in CHD death rates and a 34% reduction in stroke death rates in the 2008 data (in comparison with the 1999 data). The population size in 2008 will also be larger, so it is projected that the estimated lives saved in 2008 will be approximately 240 000.

But no room for complacency

But the AHA warns that further reductions in mortality will not be seen if risk factors are not improved more than is being done currently. The data show some progress on the number of people with uncontrolled hypertension (down 16%), the number of people with raised cholesterol (down 19.2%), and in those who smoke (down 15.4%), but the rate of physical inactivity has declined only by 2.5%, and the prevalence rates for obesity and type 2 diabetes are actually increasing and are appearing at earlier ages than ever before, the organization points out.

Strategic goals for risk factors

  Uncontrolled hypertension (%) Raised cholesterol (%) Smokers (%) Physical inactivity (%)
Baseline (1999) 77.3 20.8 24.7 40
Current status (2004–2006) 64.9 16.8 20.9 39

2010 goal 58 15.6 18.5 30
Data sources NHANES (2004 data) NHANES (2004 data) NHIS (2005 data) NHIS (2006 data)

NHANES=National Health and Nutrition Examination Survey; NHIS=National Health Interview Survey

"If we don't make a concerted effort to reduce these risks, we will lose the momentum we celebrate today. We will see our children developing heart disease earlier, experiencing early deaths, or needing major medical care sooner," Jones stresses.

The complete contents of Heartwire , a professional news service of WebMD, can be found at www.theheart.org, a Web site for cardiovascular healthcare professionals.

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