Where we’ve been, where we are, and where we’re going: Heart Disease and Stroke Statistics-2013 Update
Disclosure: Dr. Arnett has nothing to disclose.
Pub Date: Wednesday, Dec. 12, 2012
Author: Donna Arnett, PhD, MSPH
Affiliation: University of Alabama at Birmingham, School of Public Health, Department of Epidemiology
Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Magid D, Marcus GM, Marelli A, Matchar DB, McGuire D, Mohler E, Moy CS, Mussolino ME, Nichol G, Paynter NP, Schreiner PJ, Sorlie PD, Stein J, Turan TN, Virani SS, Wong ND, Woo D, Turner MB; on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation.2013: published online before print December 12, 2012, 10.1161/CIR.0b013e31828124ad
Today marks the publication of the 2013 update of Heart Disease and Stroke Statistics, published annually by the American Heart Association (AHA) and produced in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other agencies.1 The release of the annual Update is something of an event in the cardiovascular (CV) disease treatment and prevention community: it presents, as its authors note, “the best national data available on heart disease, stroke, and other cardiovascular disease-related morbidity and mortality and the risks, quality of care, medical procedures and operations, and costs associated with the management of these diseases.” The Update is freely available on the AHA website.
This year the Update contains an expanded chapter on cardiovascular health in addition to the usual outstanding statistical assessments of CV diseases and their attendant risk factors. These data are presented in support of the AHA’s 2020 Impact Goals. After largely exceeding its 2010 impact goal of reducing mortality rates of coronary heart disease and stroke risk by 25%, the AHA set a bold new goal to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%.2 This new goal necessitated the development of a new definition of “cardiovascular health.” As constituent parts of this definition, the AHA identified seven health behaviors and factors (smoking, diet, physical activity, body weight, blood pressure, cholesterol, and glucose) and established criteria to classify individuals and populations as achieving poor, intermediate, or ideal levels of health for each behavior and factor. The rationale behind the new goal was to expand our disciplinary gaze beyond simple mortality to more fully embrace a lifecourse approach to CV disease risk development, that is, to make primordial prevention a central element of cardiovascular public health.
The authors of the Update do an excellent job presenting and reviewing current cardiovascular health prevalences in the United States; a few of their observations deserve special emphasis:1
This selection of statistics related to CV health in young people is not meant to imply poor CV health is more of a concern for our youth than adults. For the majority of the health factors and behaviors, the prevalence of ideal health is, in fact, higher in children than in adults. Given what is known about the natural history of CV diseases (and importance of increased age with respect to some the health factors such as blood pressure and cholesterol), this is not surprising. What is alarming, however, is that the (low) prevalence of ideal physical activity in children is roughly equivalent to adults, and the prevalence of an ideal healthy diet is lower in children than adults. It is worth noting that virtually all efforts to improve both physical activity and diet fall soundly into the realm of behavioral and environmental modification. It’s also worth noting (as the Update authors do), evidence from the Young Finns Study suggest that, when assessed in youth, the AHA CV health factors and behaviors predict future CV risk.3
Although policies, practices, and programs must work to prevent disease and improve health in all age strata, giving special emphasis to the health of young people is crucial. This is not simply because children represent a vulnerable population whose ultimate care lies in the hands of responsible adults. The behaviors we instill in and the environments we bequeath to our young people will serve not only their generation, but are likely to be handed down to their children as well. It is reasonable that any efforts to improve CV health in young people will be especially effective at reaching long-term public health goals.
The authors of this year’s Update have given unprecedented attention to the behavioral, environmental, and other systemic elements that will prove pivotal in all future gains in cardiovascular health for all age strata. Although the Update is recognized primarily as a source for quantitative measures of prevalence estimates, temporal trends, and summary and comparative statistics, this year the chapter on the AHA 2020 Impact Goals also contains tables (2-4, 2-5, 2-6) that aggregate important and useful information regarding evidence-based strategies for individual, health care system, and population approaches to improve health behaviors and factors. Another table (2-8) outlines advocacy and policy strategies germane to the impact goals. I’ve written elsewhere4 that those of us involved in fostering CV health and preventing disease are faced with “wicked problems”—problems nested in a context of complex interdependencies whose solution reveals or creates other problems. The tables noted above—which hit upon everything from increasing patient motivation to electronic toolkits for assessing health behaviors to nutrition legislation to improving sidewalk and street design—make manifest the wickedness of the problems we face. But these tables, conveniently aggregated in the Update, also represent a powerful heuristic and useful roadmap as we push forward to meet our 2020 goals.
The Heart Disease and Stroke Statistics-2013 Update will certainly prove to be, once again, the “go to” resource for the most current and best data on the status and trends of CV health and disease in the United States. Clinicians, public health professionals, health educators, and policy makers who may have used the Update in previous years merely to reinforce rationales for their efforts should take a closer look this year: they will find the enhancements related to CV health and the catalog of evidence-based strategies and policies especially useful.
- Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Magid D, Marcus GM, Marelli A, Matchar DB, McGuire D, Mohler E, Moy CS, Mussolino ME, Nichol G, Paynter NP, Schreiner PJ, Sorlie PD, Stein J, Turan TN, Virani SS, Wong ND, Woo D, Turner MB; on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation.2013: published online before print December 12, 2012, 10.1161/CIR.0b013e31828124ad.
- Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, Greenlund K, Daniels S, Nichol G, Tomaselli GF, Arnett DK, Fonarow GC, Ho PM, Lauer MS, Masoudi FA, Robertson RM, Roger V, Schwamm LH, Sorlie P, Yancy CW, Rosamond WD, American Heart Association Strategic Planning Task F, Statistics C. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond. Circulation. 2010;121:586-613.
- Laitinen TT, Pahkala K, Magnussen CG, Viikari J S, Oikonen M, Taittonen L, Mikkila V, Jokinen E, Hutri-Kahonen N, Laitinen T, Kahonen M, Lehtimaki T, Raitakari OT, Juonala M. Ideal cardiovascular health in childhood and cardiometabolic outcomes in adulthood: the Cardiovascular Risk in Young Finns Study. Circulation. 2012;125:1971-1978.
- Arnett DK. Wicked problems and worthy pursuits: resolving to meet American Heart Association 2020 Impact Goals. Circulation. 2012;125:2554-6.
-- The opinions expressed in this commentary are not necessarily those of the editors or of the American Heart Association --