potential for reducing coronary heart disease mortality in the USA

Cardiovascular risk factor trends and potential for reducing coronary heart disease mortality in the United States of America

Simon Capewell ^a, Earl S Ford ^b, Janet B Croft ^c, Julia A Critchley ^d, Kurt J Greenlund ^c & Darwin R Labarthe ^c

a. Division of Public Health, University of Liverpool, Liverpool, L69 3GB, England.
b. Division of Adult and Community Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America (USA).
c. Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
d. Institute of Health and Society, Newcastle University, Newcastle, England.

Correspondence to Simon Capewell (e-mail: capewell@liverpool.ac.uk).

(Submitted: 18 August 2008 – Revised version received: 30 December 2008 – Accepted: 07 June 2009 – Published online: 08 December 2009.)

Bulletin of the World Health Organization 2010;88:120-130. doi: 10.2471/BLT.08.057885

INTRODUCTION

Coronary heart disease (CHD) accounted for over 450 000 deaths in the United States of America in 2004.^1,2 The burden of CHD in the United States is enormous; more than 13 million people are affected, and the costs of direct health care exceed US$ 150 billion annually.^1,2

Since the late 1970s, age-adjusted CHD mortality rates have been halved in most industrialized countries, including the United States. However, between 1990 and 2000 this decrease diminished, and in younger age groups it nearly ceased.^1,2 Many adults in the United States are still at high risk for cardiovascular disease. Total blood cholesterol levels exceed 200 mg/dl among more than 100 million adults; approximately 70 million have or are being treated for high blood pressure (systolic blood pressure 140 mmHg or diastolic blood pressure 90 mmHg), and over 50 million people still smoke.^2–4

The Healthy People 2010 (HP2010) initiative promoted by the government of the United States contains targets for heart disease and stroke that explicitly address risk factor prevention, detection and management, along with prevention of recurrent events. HP2010 objectives include a 20% reduction in age-adjusted CHD mortality rates (from an overall rate of 203 per 100 000 population in 1998 to 162 per 100 000 in 2010).³ They also include specific targets for reducing mean total blood cholesterol (to 199 mg/dl), smoking (to 12% of the population), hypertension (to 16%), diabetes (to 6%), obesity (to 15%) and inactivity (to 20%).³ Inactivity was measured in the Behavioral Risk Factor Surveillance System of the United States Centers for Disease Control and Prevention as the proportion of adults engaging in no physical activity.⁵ If those targets are achieved, what reduction in CHD mortality might actually result by 2010?/.../