Cardiovascular Disease and Related Risk Factors in Virginia

1
Cardiovascular Disease and Related Risk Factors
in Virginia

• Stephanie M. Gruss, PhD, MSW
• Epidemiologist
• Virginia Department of Health (VDH)
• Division of Chronic Disease Prevention Control

2
Overall Impact of Chronic Disease in the U.S.

• By 2030, there will be about 71 million adult
  baby boomers who will have reached their 65th
  birthday.
• At least 80 of older adults (age 65) have at
  least one chronic disease 50 have two.
• Chronic diseases claim the lives of 1.7 million
  Americans each year70 of all deaths. Heart
  disease, stroke, cancer, COPD, and diabetes
  account for two-thirds of all deaths.

Sources The State of Aging and Health in
American, CDC and Merck Institute on Aging and
Health, 2004, 2007 The Burden of Chronic
Diseases and Their Risk Factors, CDC, 2004
Boult et al. American Journal of Public Health
1996 86(10), 1388-1393.
3
Cardiovascular Disease (CVD) Mortality
4
Impact of CVD in the U.S.

• Cardiovascular disease (CVD), including heart
  disease and stroke, is the 1 killer of
  Americans, accounting for more deaths in the U.S.
  than all cancer, accidents, and other chronic
  disease deaths combined.
• Almost 700,000 people die of heart disease in the
  U.S. each year, accounting for about 29 of all
  U.S. deaths.
• Blacks had the highest heart disease mortality
  rate at 300/100,000, followed by whites at 228
  51 of heart disease deaths were to women.
• In 2006, heart disease is projected to cost more
  than 258 billion, including health care
  services, medications, and lost productivity.

Source CDC, Heart Disease Fact
Sheet-http//www.cdc.gov/dhdsp/library/fs_heart_di
sease.htm http//www.cdc.gov/heartdisease/.
5
CVD Deaths in VA, 2005

• A total of 19,081 Virginians died from major CVD
  in 2005.
• CVD accounts for 33 of all deaths.
• Of those deaths, 14,132 people died from heart
  disease and 3,666 died from stroke.
• Total CVD mortality rate was 267.2/100,000
  population 197.2 for heart disease and 52.0 for
  stroke.

Source VDH, Division of Health Statistics, 2005
rates are age-adjusted per 100,000 population.
6
Leading Causes of Death in VA, 2005
Source VDH, Division of Health Statistics, 2005
Unintentional Injury.
7
CVD Deaths in VA, 2005

• Total CVD mortality rates, including heart
  disease and stroke, have significantly declined
  in Virginia since 1995 primarily for whites and
  Blacks.
• Other races and Hispanics have shown little to
  no decline since 1995. In fact, Hispanic stroke
  rates have increased.
• Despite the declining rates, Blacks (particularly
  males) continue to have the highest mortality
  rates for CVD, including heart disease and
  stroke, than any other race/ethnicity in
  Virginia.

8
CVD Death Rates by Race/Ethnicity in VA, 1995-2005
Source VDH Division of Health Statistics,
1995-2005 age-adjusted.
9
Heart Disease Mortality in VA, 2005

• Heart disease, specifically, was the leading
  cause of death in Virginia in 2005, as it was in
  the U.S.
• In Virginia, heart disease accounts for 25 of
  total deaths and 74 of CVD deaths.
• Black males have the highest rates of heart
  disease mortality in Virginia, followed by white
  males, then Black females.
• Other females and Hispanic females tend to have
  the lowest heart disease mortality rates in
  Virginia.

10
Heart Disease Death Rates by Race/Ethnicity in
VA, 1995-2005
Source VDH Division of Health Statistics,
2002-2005 age-adjusted Hispanic data
unavailable for 2005.
11
Heart Disease Death Rates by Gender and Race in
VA, 1995-2005
Source VDH Division of Health Statistics,
2002-2005 age-adjusted Hispanic data
unavailable for 2005.
12
Heart Disease Death Rates by VA Health District,
2005

• The top three health districts with the highest
  age-adjusted rates of heart disease deaths were
• 1. Lenowisco (284.5/100,000)
• 2. Pittsylvania-Danville (284.2/100,000)
• 3.Cumberland Plateau (277.9/100,000)

Source VDH Division of Health Statistics,
2002-2005 age-adjusted.
13
Data note State rates listed here are based on
calculations ran by health district, if a data
point does not have a corresponding health
district location reported, the data point is not
included thus, these rates can vary slightly
from overall, state rates.
14
Stroke Mortality in VA, 2005

• Stroke, or cerebrovascular disease, was the third
  leading cause of death in Virginia in 2005.
• In the U.S., stroke was the second leading cause
  of death for women and the third leading cause of
  death for men, behind cancer.
• All blacks (male and female) have significantly
  higher stroke rates than any other race or
  ethnicity.
• The total Hispanic rate for stroke deaths has
  doubled from 1995-2005 the Hispanic stroke
  mortality rate exceeded that for whites for the
  first time in Virginia history in 2005.

15
Stroke Death Rates by Race/Ethnicity in VA,
1995-2005
Source VDH Division of Health Statistics,
1995-2005 age-adjusted.
16
Stroke Death Rates by VA Health District, 2005

• The top three health districts with the highest
  age-adjusted rates of stroke deaths were
• 1. Southside (76.5/100,000)
• 2. Chickahominy (71.6/100,000)
• 3. Norfolk (71.0/100,000)

Source VDH Division of Health Statistics,
2002-2005 age-adjusted.
17
Data note State rates listed here are based on
calculations ran by health district, if a data
point does not have a corresponding health
district location reported, the data point is not
included thus, these rates can vary slightly
from overall, state rates.
18
CVD Deaths and Women

• Mortality rates for CVD are slowly declining, but
  at a slower rate for women than men.
• Although stroke mortality rates are similar for
  men and women, women are more likely to have a
  stroke at a younger age (40s or 50s) and are more
  likely to die from stroke.
• Nationally, women account for more than 60 of
  the annual deaths due to stroke, making it the
  second leading cause of death among American
  women, preceded by heart disease.

Sources VDH Division of Health Statistics, 2004
http//www.cdc.gov/mmwr/.
19
Hospitalizations Due to CVD
20
Hospitalization Cost of CVD in VA, 2005

• The total cost of hospitalizations due to a
  primary diagnosis of CVD was 3.6 billion.
• There were 115,988 hospital discharges due to
  CVD, averaging about 31,038 per admission, up
  from 22,663 in 2004.
• Average length of stay was 5.1 days.
• If hospitalizations for CVD in VA were reduced by
  just 5 per year, the savings by 2010 would be
  approximately 900 million.

Source VHI Dataset, 2005 primary diagnoses of
all CVD codes.
21
Heart Disease Hospital Discharge Rates by VA
Health District, 2005

• There were 65,544 discharges due to a primary
  diagnosis of heart disease state rate of
  88.2/10,000.
• The top three health districts with the highest
  age-adjusted rates of heart disease discharges
  were
• 1. Crater (152.2/10,000)
• 2. Southside (135.6/10,000)
• 3. Norfolk (132.5/10,000)

Source VHI Health Information, Inc. rates are
age-adjusted.
22
Data note State rates listed here are based on
calculations ran by health district, if a data
point does not have a corresponding health
district location reported, the data point is not
included thus, these rates can vary slightly
from overall, state rates.
23
Stroke Hospital Discharge Rates by VA Health
District, 2005

• There were 20,181 discharges due to a primary
  diagnosis of stroke state rate of 27.6/10,000.
• The top three health districts with the highest
  age-adjusted rates of stroke discharges were
• 1. Crater (46.5/10,000)
• 2. Portsmouth (42.7/10,000)
• 3. Roanoke City (41.4/10,000)

Source VHI Health Information, Inc. rates are
age-adjusted.
24
Data note State rates listed here are based on
calculations ran by health district, if a data
point does not have a corresponding health
district location reported, the data point is not
included thus, these rates can vary slightly
from overall, state rates.
25
CVD and Related Risk Factors
26
CVD and Non-preventable Risk Factors

• Age- 65 and older
• Minorities- Blacks, Native Americans
• Gender- Men in terms of most risk factors women
  in terms of stroke and arthritis
• Persons with a family history of chronic disease
  (genetics)
• Young children/adolescents- less physically
  active today and have higher rates of poor
  dietary intake non-preventable because children
  do not often have control over their own physical
  activity or dietary intake- parents/other adults
  do!

27
CVD and Preventable Risk Factors

• Smoking/tobacco use
• Obesity- Body Mass Index (BMI) of 30 or greater
• Overweight- BMI of 25 29.9
• Poor diet- eating less than five fruits for
  vegetables per day
• Sedentary lifestyle- no leisure time physical
  activity within 30 days
• High blood pressure and high cholesterol-
  independent risk factors/conditions associated
  with type-2 diabetes and heart disease
• Andlack of education on signs and symptoms of
  heart attack and stroke!!

28
Recognition of Heart Attack Signs Symptoms
Source BRFSS, 2001-2005 adults 18 weighted
percents Trick question- not meant for
respondents to say yes to not a sign or
symptom of a heart attack.
29
Recognition of Stroke Signs Symptoms
Source BRFSS, 2001-2005 adults 18 weighted
percents Trick question- not meant for
respondents to say yes to not a sign or
symptom of a stroke.
30
Previous Heart Attack Stroke as Risk Factors
for Cardiovascular Disease

• 2 to 4 Times the Risk of Early Mortality- Prior
  to Average Life Expectancy (77.8 yrs. in VA in
  2004)

Source VDH, Division of Health Statistics most
recent year available.
31
Previous Heart Attack, VA

• Heart attack prevalence in 2001-2004 timeframe
  was 3.6.
• American Indian/Alaskan Natives (AI/AN) were 1.5
  times more likely to have a heart attack than any
  other race and ethnicity.
• Whites had the second highest heart attack rates.

Source BRFSS, 2001-2004 adults 18 weighted
percents based on aggregated rates due to low
sample size.
32
Previous Heart Attack, VA, 2001-2004
Source BRFSS, 2001-2004 adults 18 weighted
percents data are aggregated due to small
sample size.
33
Previous Stroke, VA

• Stroke prevalence in 2001-2004 timeframe in
  Virginia was 2.10.
• American Indian/Alaskan Natives (AI/AN) were 2.2
  times more likely to have a stroke than any other
  race and ethnicity.
• Blacks had the second highest stroke rates.

Source BRFSS, 2001-2005 adults 18 weighted
percents based on aggregated rates due to low
sample size.
34
Previous Stroke, VA, 2001-2004
Source BRFSS, 2001-2004 data are aggregated
due to small sample size adults 18 weighted
percents.
35
Tobacco Use
36
Impact of Smoking in U.S. VA, 2005

• Smoking causes coronary heart disease cigarette
  smokers are 24 times more likely to develop
  coronary heart disease than nonsmokers.
• 8.6 million people in the U.S. have a disease
  caused by smoking they will likely die from CVD,
  cancer, or a respiratory syndrome, as a result.
• Smoking is the leading cause of preventable
  death.
• 400,000 deaths annually from smoking, plus 38,000
  deaths from Second Hand Smoke (SHS) and 1,000
  from prenatal exposure.
• 9,300 deaths from smoking, plus 950 to 1,690
  deaths from SHS and prenatal smoking, in Virginia

Source CDC- http//www.cdc.gov/tobacco/health_eff
ects/heart.htm.
37
Adult Tobacco Use in VA, 2005

• 20.6 of adults currently smoke cigarettes in
  Virginia.
• Over half (53) of adults who smoked said that
  they started smoking regularly between the ages
  of 13 and 17.
• Smoking rates begin to decline starting at age
  50 40-49 year-olds have the highest rates.

Source BRFSS, 2005 adults 18 weighted
percents.
38
Obesity Overweight
39
Obesity Overweight in U.S., 2005

• Associated with increased risk for hypertension,
  dyslipidemia, type 2 diabetes, coronary heart
  disease, stroke, osteoarthritis, and certain
  cancers
• The second leading cause of preventable death
• A combined 61 of U.S. adults were either
  overweight, obese, or extremely obese (3.0 with
  a BMI of gt 40!)
• U.S. obesity and overweight rates were highest
  for men, Blacks, 50-59 year-olds
• Source MMWR, State-specific prevalence of
  obesity among adults, September 15, 2006 /
  55(36)985-988.

40
Obesity Overweight in VA, 2005

• A combined 60.6 of adults were either obese
  (25.1) or overweight (35.5).
• Prevalence rates tend to be higher in males,
  Blacks, and 55-64 year olds.

Source MMWR website, CDC, http//www.cdc.gov/mmwr
/ VA BRFSS, 2005 adults 18 weighted
percents.
41
Diet
42
Proper Nutrition

• Diets rich in foods containing fiber (fruits,
  vegetables, whole grains) may reduce the risk of
  coronary heart disease, stroke, type 2 diabetes,
  and certain cancers (oral cavity and pharynx,
  larynx, lung, esophagus, stomach, and
  colorectal).
• Diets rich in milk and milk products can reduce
  the risk of low bone mass throughout the life
  cycle.
• Source USDA Dietary Guidelines Fact Sheet,
  2005.

43
Eating Fruits Vegetables, U.S. VA, 2005

• In the U.S., the prevalence of eating fruits or
  vegetables 3-5 times per day was 27.2.
• Rates were higher among women, whites, and
  increased with increasing age. Hispanics had the
  lowest prevalence rate among any other race or
  ethnicity.
• In Virginia, the prevalence of eating fruits or
  vegetables 3-5 times per day was 37.5. Rates
  were higher among women and whites. Rates were
  lowest for 25-34 year-olds and Hispanics.

Source MMWR, Fruit and Vegetable Consumption
Among Adults- U.S., March 16, 2007/
56(10)213-217 VA BRFSS, 2005 adults 18
weighted percents.
44
Physical Activity (or, Not!)
45
Sedentary Lifestyle in U.S. VA, Adults, 2005

• Sedentary lifestyle is defined by the CDC as,
  not participating in any leisure time activity
  in 30 days.
• About 24 of U.S. adults reported being
  sedentary!
• 22.6 of adults in Virginia reported being
  sedentary. Black females and other non-Hispanic
  males had the highest rates of sedentary
  lifestyle.
• Sedentary lifestyle is associated with
  hyperlipidemia, hypertension, and obesity.

Source MMWR website, CDC, http//www.cdc.gov/mmwr
/ VA BRFSS, 2005 adults 18 weighted percents.
46
Physical Activity in Children Adolescents, VA,
2003

• 64 of high school students participated in
  vigorous physical activity most week days (at
  least 5)
• 27 of high school students participated in
  moderate physical activity most week days
• High school students attending physical education
  classes daily decreased from 42 in 1991, to 25
  in 1995, and to 33 in 2005.

Source VDH, WIC Program, An Examination of
Healthy Behaviors in Virginias Children, 2003.

47
Hypertension (High Blood Pressure)
48
High Blood Pressure in the U.S. VA, 2005

• Pre-hypertension defined as blood pressure gt
  120-139 (systolic) or gt 80-89 (diastolic)
  hypertension defined as anything higher than 140
  90 and probably requires medication
• In the U.S., about 1/3 of all adults has high
  blood pressure- 65 million! Highest prevalence in
  Blacks.
• Costly- cause of more doctors visits than any
  other condition 64 billion/yr. in medical costs
• 26.7 of all Virginia adults has high blood
  pressure and rates are similar to U.S.- highest
  prevalence in Blacks, no significant gender
  differences, and rates increase with increasing
  age.

Sources U.S. Department of Health and Human
Services, Controlling High Blood Pressure,
Legislator Policy Brief, 2007 BRFSS, 2005.
49
Hypertension-Related Deaths in VA, 2005

• Hypertension is considered both a risk factor and
  a form of heart disease.
• Also an underlying cause of death- the silent
  killer
• In 2005, hypertensive heart, hypertensive renal
  disease, and essential hypertension killed 1,050
  Virginians.

Source VDH Division of Health Statistics, 2005.
50
High Blood Pressure Trends in VA by
Race/Ethnicity, 2001-2004

Source American Indian/Alaskan Native BRFSS,
2001-2004 data aggregated due to small sample
size.
51
High Blood Pressure Prevalence Rates by VA Health
District, 2005

• The top three health districts with the highest
  prevalence rates of high blood pressure were
• 1. Pittsylvania-Danville (42.0)
• 2. Lenowisco (39.6)
• 3. Eastern Shore (38.5)

Source BRFSS, 2005 adults 18 weighted
percents.
52
Data note State rates listed here are based on
calculations ran by health district, if a data
point does not have a corresponding health
district location reported, the data point is not
included thus, these rates can vary slightly
from overall, state rates.
53
High Cholesterol
54
High Cholesterol in the U.S. VA, 2005

• Optimal cholesterol levels are
• LDL (Bad) lt100, HDL (Good) gt60, Total lt200,
• Triglycerides lt150
• In the U.S., 35.6 of all adults has high
  cholesterol.
• In the U.S., males have slightly higher rates
  than females, whites have the highest rates
  across race/ethnicity, and high blood pressure
  increases with increasing age.
• 36.2 of all Virginia adults had high cholesterol
  and rates were similar to U.S. rates across
  gender, race/ ethnicity, and age.

Sources U.S. Department of Health and Human
Services, National Institutes of Health- National
Heart, Lung, and Blood Institute, High Blood
Cholesterol- What You Need to Know, 2002 BRFSS,
2005.
55
High Cholesterol Trends in VA by Race/Ethnicity,
2001-2004
Source BRFSS, 2001-2004 adults 18 weighted
percents data aggregated due to small sample
size.
56
High Cholesterol Prevalence Rates by VA Health
District, 2005

• The top three health districts with the highest
  prevalence rates of high cholesterol were
• 1. Alleghany (45.1)
• 2. Lord Fairfax (43.4)
• 3. Chesterfield (43.2) Pittsylvania- Danville
  (43.1)

Source BRFSS, 2005 adults 18 weighted
percents.
57
Data note State rates listed here are based on
calculations ran by health district, if a data
point does not have a corresponding health
district location reported, the data point is not
included thus, these rates can vary slightly
from overall, state rates.
58
Diabetes Mellitus (DM)
Image retrieved from- http//www.fotosearch.com/ph
otos-images/diabetes.html.
59
Diabetes as an Independent Risk Factor for CVD

• Diabetes can lead to coronary heart disease,
  stroke, peripheral artery disease,
  cardiomyopathy, and congestive heart failure.
• People with diabetes are two to four times more
  likely to have a heart attack or stroke than
  people without diabetes.
• People with diabetes are more likely to die from
  a second heart attack than people with CVD who do
  not suffer from diabetes.
• A secondary diagnosis of CVD is found in about
  75 of all diabetes-coded deaths.

Source http//www.ndep.nih.gov/control/CVD.htm.
60
Diabetes as an Independent Risk Factor for
CVD,VA, 2005

• Persons with diabetes were 2.4 times more likely
  to be obese than persons without diabetes
• Persons with diabetes were 2.9 times more likely
  to have high blood pressure than persons without
  diabetes
• Persons with diabetes were 2.0 times more likely
  to have high cholesterol than persons without
  diabetes
• When looking at the above risk factors in
  combination with one another, obesity has the
  highest contribution to a diagnosis diabetes.

Source Gruss, S.M. Jennings, G.C., BRFSS data
analysis of risk factors for having diabetes,
2005.
61
Diabetes Prevalence Rates by VA Health District,
2005

• The top three health districts with the highest
  prevalence rates of diabetes were
• 1. Eastern Shore (15.4)
• 2. Lenowisco (14.2)
• 3. Crater (12.6)

Source BRFSS, 2005 adults 18 weighted
percents.
62
Data note State rates listed here are based on
calculations ran by health district, if a data
point does not have a corresponding health
district location reported, the data point is not
included thus, these rates can vary slightly
from overall, state rates.
63
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