Reducing Risk of Heart Disease
& Stroke - A Life Long Quest
Jeffrey P. Gold, M.D.
University of Toledo Medical Center
Reducing Risk of Heart Disease
& Stroke - A Life Long Quest
Coronary Artery Disease
Coronary Artery Disease
Where will you be in 33
seconds?
Heart Disease &
Stroke in 2007
A Few Facts &
Figures
Heart Disease in 2007
15.8 Million Americans have CAD
0.45 Million Americans die of CAD
1234 Americans die of CAD every day
Lifetime Risk for American Male @ 40 - 40%
Lifetime Risk for American Female @ 40 - 25%
52%
13%
.4%
.5%
4%
6%
Coronary Heart Disease
Heart Failure
Diseases of the Arteries
Defects
Rheumatic Fever/
Rheumatic Heart Disease
7%
17%
Stroke
High Blood Pressure
Congenital Cardiovascular
Other
Percentage breakdown of deaths from cardiovascular diseases
(United States:2004)
Source: NCHS and NHLBI.
Deaths in Thousands
520
500
480
460
440
420
400
380
0
79 80
85
90
95
Years
Males
Females
00
04
900
Deaths in Thousands
800
700
600
500
400
300
200
100
04
00
90
80
70
60
50
40
30
20
10
1900
0
Years
Deaths from diseases of the heart (United States: 1900–
2004.) Note: See Glossary for an explanation of
“Diseases of the Heart. Total CVD data are not
available for much of the period covered by this chart.
Source: NCHS and NHLBI.
7
Discharges in Millions
6
5
4
3
2
1
0
70
90
80
00
04
Years
Hospital discharges for cardiovascular diseases.
(United States: 1970-2004). Note: Hospital discharges
include people discharged alive, dead and status unknown.
Source: NCHS and NHLBI.
Percent of Population
70
60
50
40
48
47
40
40
30
20
65
56
29
24
29
28
18
20
10
0
1971-74
1976-80
Overweight/Obesity
1988-94
Hypertension
1999-00
High Blood Cholesterol
Trends in the age-adjusted prevalence of health conditions,
U.S. adults ages 20-74 (NHANES: 1971-74 to 1999-2000).
Source: Briefel and Johnson. Annu Rev Nutr. 2004;24:401-431.
Printed with permission from the Annual Review of Nutrition.
Per 100,000 Population
200
148.6
150
115.4
100
64.9
47.4
50
41.6 39.0
23.7
31.9
0
Coronary Heart
Disease
Stroke
White Females
Lung Cancer
Breast Cancer
Black Females
Age-adjusted death rates for coronary heart disease, stroke,
and lung and breast cancer for white and black females
(United States: 2004).
Source: NCHS and NHLBI.
92.0
Percent of Population
100.0
71.3 75.1
80.0
83.0
60.0
39.1 39.5
40.0
20.0
14.8
9.4
0.0
20-39
40-59
Males
60-79
80+
Females
Prevalence of cardiovascular diseases in adults age 20 and older
by age and sex (NHANES: 1999-2004). Source: NCHS and NHLBI.
These data include coronary heart disease, heart failure, stroke and hypertension.
Estimated 10-Year Rate (%)
40
37
35
Men
Women
30
27
25
25
20
20
13
15
10
8
5
5
5
0
A
B
A
B
C
C
D D
Blood Pressure (mm Hg)
120/80
140/90
140/90
140/90
Total Cholesterol (mg/dL)
200
240
240
240
HDL Cholesterol (mg/dL)
50
50
40
40
Diabetes
No
No
Yes
Yes
Cigarettes
No
No
No
Yes
mm Hg = millimeters of mercury. mg/dL = milligrams per deciliter of blood
Estimated 10-Year CHD risk in 55-year-old adults according to levels of
various risk factors (Framingham Heart Study).
Source: Wilson et al., Circulation. 1998;97:1837-47.
New and Recurrent Attacks
500,000
410,000
372,000
400,000
300,000
250,000
Men
Women
200,000
100,000
88,000
34,000
10,000
0
29-44
45-64
65+
Ages
Annual number of Adults having diagnosed heart attack by age
and sex (ARIC: 1987-2000). Source: Extrapolated from rates in the NHLBI’s
ARIC surveillance study, 1987-2000. These data don’t include silent MIs.
Percent of Population
35.0
32.7
30.0
22.8
25.0
20.0
21.6
15.4
15.0
7.8
10.0
5.0
5.5
0.6 0.6
0.0
20-39
40-59
Men
60-79
Women
Prevalence of coronary heart disease by age and sex
(NHANES :1999-2004). Source: NCHS and NHLBI.
80+
Discharges in Thousands
1400
1200
1000
800
600
Males
400
Females
200
0
70
80
90
00
Years
Hospital discharges for coronary heart disease by sex
(United States: 1970-2004). Source: NHDS, /NCHS and NHLBI.
04
Percent of Population
83.8
90.0
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
73.9
69.5
63.6
55.4
49.1
37.5 37.4
23.2
11.2
18.3
6.4
20-34
35-44
45-54
Men
55-64
65-74
75+
Women
Prevalence of high blood pressure in Adults by age and sex
(NHANES: 1999-2004). Source: NCHS and NHLBI.
Percent of Population
80
70
60
50
40
30
20
10
0
74.6
75.3
62.5
68.4
52.3
39.8
35.8
34.3
24.6
Awareness
Treatment
20-39
40-59
Controlled
60+
Extent of awareness, treatment and control of high blood
pressure by age (NHANES : 1999-2004.) Source: NCHS and NHLBI.
Percent of Population
14
11.6
12
12.4
10
7.2
8
5.2
6
4
2
2
0.3
1.5
0.2
0
20-39
40-59
Men
60-79
Women
Prevalence of heart failure by age and sex
(NHANES: 1999-2004). Source: NCHS and NHLBI.
80+
Discharges in Thousands
700
600
Male
500
Female
400
300
200
100
0
79 80
85
90
95
00
Years
Hospital discharges for heart failure by sex
(United States: 1979-2004). Source: NHDS, NCHS and NHLBI.
Note: Hospital discharges include people discharged alive, dead and
status unknown..
04
Per 1,000 Person Years
50
43.0
40
Men
30
30.7
22.3
20
10
Women
14.8
9.2
4.7
0
65-74
75-84
85-94
Age
Incidence of Heart Failure* by age and sex. (FHS: 1980-2003).
Source: NHLBI.
* HF based on physicians review of medical records and strict
diagnostic criteria.
Percent of Population
45
40
35
30
25
20
15
10
5
0
24.9
27
24.8
19.2
14
NH Whites
11.9
NH Blacks
Males
Hispanics
Females
Prevalence of high school students in grades 9-12 reporting
current cigarette smoking by race/ethnicity and sex.
(YRBS:2005).Source: MMWR. 2006;55:SS-5. June 9, 2006. . NH – non-Hispanic.
Percent of Population
40
35
30
25
20
15
10
5
0
37.3
33.4
24.1 23.9
20.4 20.2
18.9 17.8
15
11.3
Men
NH White
NH Black
Hispanic
Women
Asian
American Indian or Alaska Native
Prevalence of current smoking for Adults age 18 and older
by race/ethnicity and sex (NHIS:2004).
Source: MMWR. 2004;54:1121-24. NH – non-Hispanic.
Mean Total Blood Cholesterol
180
175
171
170
165
160
155
170
165 166
161
163 163
172
166
163 164
174
168
161
156
155
150
145
White Males
Black Males
1976-80
1988-94
White Females
1999-02
Black Females
2003-04
Trends in mean total blood cholesterol among adolescents
ages 12-17 by race, sex, and survey (NHES: 1966-70;
NHANES: 1971-74 and 1988-94). Source: NCHS and NHLBI.
Percent of Population
45
40
35
30
25
20
15
10
5
0
39.0
32.0 32.0
Total Population
32.0
34.0
NH Whites
Men
32.0 30.0
31.0
NH Blacks
Mexican
Americans
Women
Age-adjusted prevalence of Adults age 20 and older with LDL
cholesterol of 130 mg/dL or higher, by race/ethnicity and sex
(NHANES: 2003-2004). Source: NCHS and NHLBI. NH – non-Hispanic.
Percent of Population
30
25
28
26
25
20
16
13
15
10
9
9
7
5
0
Total
NH Whites
Men
NH Blacks
Mexican
Americans
Women
Age-adjusted prevalence of Adults age 20 and older with HDL
cholesterol <40 mg/dL, by race/ethnicity and sex
(NHANES: 2003-2004). Source: NCHS and NHLBI. NH – non-Hispanic.
Percent of Population
45
40
35
30
25
20
15
10
5
0
39.2
36.0
33.6
33.1
30.8
28.2
27.2
29.3
26.3
26.4
19.0
17.0
14.8 14.9
1.8
High Total
Cholesterol
1960-62
High Blood
Pressure
1971-75
1976-80
Smoking
1988-94
4.6 5.0
3.4 3.5
Diagnosed
Diabetes
1999-2000
Trends in cardiovascular risk factors in the U.S. population ages 20-74
(NHES: 1960-62, NHANES:1971-75 to 1999-2000).
Source: Gregg et al., JAMA 2005;293:1868-74.
In this study, high total cholesterol was defined as greater than or equal to 240 mg/dL;
high blood pressure was defined as greater than or equal to 140/90 mm Hg.
Percent of Population
50
45
40
35
30
25
20
15
10
5
0
46.9
NH White
38.2
NH Black
Hispanic
39
30.2
26.5
21.3
Male
Female
Sex and Race/Ethnicity
Prevalence of students in grades 9-12 who met currently recommended
levels of physical activity during the past 7 days by race/ethnicity and
sex (YRBS: 2005).
Source: MMWR. 2006;55:No. SS-5. NH – non-Hispanic.
Percent of Population
45.7
50
40
30
37.5
34.2
26.4
27.0
32.5
25.0
39.6
33.9
31.5
24.0
28.3
23.8
21.6
20.4
18.4
20
34.4
44.8
36.3
31.8
10
0
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2004
Prevalence of leisure-time physical inactivity among adults age
18 and older by race/ethnicity, and sex. (BRFSS: 1994 and 2004).
Source: MMWR, 2005;54:No. 39. NH – non-Hispanic.
Percent of Population
24
21.3
20
16
15.2
16.1
15.9
12.1
12
8.2
8
4
0
Males
NH Whites
Females
NH Blacks
Hispanics
Prevalence of overweight among students in grades 9-12
by race/ethnicity and sex (YRBS: 2005). Source: BMI 95th
percentile or higher. MMWR. 2006 55: No. SS-5. NH – non-Hispanic.
Percent of Population
40
34
30.2
30
26
20.6
20
10.7
12.2
15.7
12.8
16.8
17.1
10
0
Men
1960-62
Women
1971-74
1976-80
1988-94
2001-2004
Age-adjusted prevalence of obesity in Adults ages 20-74 by
sex and survey
(NHES, 1960-62; NHANES, 1971-74, 1976-80, 1988-94 and
2001-2004). Source: Health, United States, 2006, unpublished data. NCHS.
Note: Obesity is defined as a BMI of 30.0 or higher.
Percent of Population
20
18
16
14
12
10
8
6
4
2
0
18.7
16.3
11.6
11
6.6
6.4
4.3
3.6
6-11
1971-74
12-19
1976-80
1988-94
2001-2004
Trends in prevalence of overweight among U.S. children and
adolescents by age and survey
(NHANES, 1971-74, 1976-80, 1988-94 and 2001-2004).
Source: Health, United States, 2006, unpublished data. NCHS.
2,363
Number of Transplants
2,500
2,107
2,199
2,125
00
05
2,000
1,500
1,000
719
500
10
22
57
70
75
80
0
85
90
95
Years
Trends in Heart Transplants (UNOS: 1970-2005).
Source: United Network for OrganSharing (UNOS), scientific registry data.
Procedures in Thousands
1400
1200
1000
800
600
400
200
0
79
80
85
90
95
00
Years
Catheterizations
PCI
Open-Heart
Carotid Endarterectomy
Bypass
Pacemakers
Trends in Cardiovascular Operations and Procedures
(United States: 1979-2004). Source: NCHS and NHLBI.
Note: Inpatient procedures only.
04
160
151.6
Billions of Dollars
140
120
100
80
66.4
62.7
60
33.2
40
20
ea
rt
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is
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ro
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or
on
ar
y
H
ea
rt
D
is
ea
se
0
Estimated direct and indirect costs of major cardiovascular
diseases and stroke (United States: 2007).
Source: NHLBI.
Reducing Risk of Heart Disease & Stroke
- A Life Long Quest
• Recognize: Heart Attack & Stroke
– Number 1 Killer in Western World
– Prevention is more effective than
treatment
– Progression of Atherosclerosis
– Age & Gender Related Issues
– Concept of Risk Factors
– Prevention = Risk Factor Control
Reducing Risk of Heart Disease & Stroke
- A Life Long Quest
• Understand: Risk Factors for Heart
Disease & Stroke
– Genetics & Related Issues
 Gender, Ethnicity
– Diet & Related Issues
– Lipids, Calories, Body Weight
– Exercise & Related Issues
– Types, Duration, Frequency
– Blood Pressure Control
 Normal, Diet, Medications
– Tobacco & Drugs
– Metabolic Conditions
 Diabetes, SLE, etc.
Reducing Risk of Heart Disease & Stroke
- A Life Long Quest
• Medical Care: Detect &
Prevent Heart Disease &
Stroke
– History of Patient & Family
– Physical Examination


Blood Pressure & Cardiac Exam
Blood Lipid Measurements
– Exercise Stress Tests



Radionucleide Scans
Echocardiography
MRI & PET Scans
– CTT, Cath & Angiography
– Education
Reducing Risk of Heart Disease & Stroke
- A Life Long Quest
• Five Steps to Prevention
–
–
–
–
–
Diet- Lipids
Exercise - Weight
Hypertension - Diabetes
Tobacco - Drugs
Medical Screening
Reducing Risk of Heart Disease & Stroke
- A Life Long Quest
• Four Steps of Therapy
– Risk Factor Control
– Education
– Medical Care




Pharmaceuticals
Angioplasty
Surgery
Gene Therapy, etc.
Reducing Risk of Heart Disease & Stroke
- A Life Long Quest
• More Information?
– Ask Your Physician, Nurse, Parent
– The American Heart Association


1-800-AHA-USA1
http://www.amhrt.org
– Ask University of Toledo Medical Center


1-800-383-5454
http://www.utoledo.edu
Reducing Risk of Heart Disease & Stroke
- A Life Long Quest
Where will you be in 33
seconds?