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Annual Report

Cardiovascular Disease Kills Almost One Million, 84 Percent Senior Citizens

American Heart Association Report Says Mexican Americans Most at Risk for Strokes

Dec. 31, 2004 - Cardiovascular disease (CVD) – still the nation’s No. 1 killer – claimed 927,448 American lives in 2002 and approximately 84 percent of those who died were senior citizens, 65 and older, according to the American Heart Association’s Heart Disease and Stroke Statistics – 2005 Update released today.

This year, an estimated 700,000 Americans will have a coronary attack.  About 500,000 will have a recurrent attack.

The 2005 Update compiles statistics for 2002 or the most recent year that data are available.

Cardiovascular diseases include high blood pressure, coronary heart disease (heart attack and angina), congestive heart failure, stroke and congenital heart defects, among others. 

The update includes recently published data from the 1999–2002 National Health and Nutrition Examination Survey (NHANES) showing that about 65 million Americans had high blood pressure in 2002 – which represents a 30 percent increase over the previous survey from 1988–94.

Coronary heart disease alone is the single largest killer of Americans.  There were 494,382 coronary heart disease deaths in 2002, including 179,514 deaths from heart attack. 

Stroke accounted for 162,672 deaths in 2002 and 942,000 hospital discharges.

Since 1991, the prevalence of obesity among American adults has increased 75 percent. 

New data from the Framingham Heart Study that are included in the 2005 Update show that overweight and obesity were associated with large decreases in life expectancy. 

A 40-year-old, non-smoking woman stands to lose 3.3 years of life for being overweight, and 7.1 years because of obesity.  A man the same age loses 3.1 years for being overweight and 5.8 years for obesity.  

The metabolic syndrome increases the risk for Type 2 diabetes, which is also known as “adult-onset” diabetes.  Diabetes is a disease in which the body doesn’t produce or properly use the hormone insulin.  This causes blood sugar levels to build up too high.  Diabetes is defined as fasting blood glucose of 126 mg/dL or more. 

The 2005 Update reports that nearly 14 million American adults had physician-diagnosed diabetes in 2002.  The report also estimates the prevalence of undiagnosed diabetes at nearly 6 million people (2.8 percent).  Pre-diabetes (also called impaired fasting glucose), defined as fasting blood glucose of 100-125 mg/dL, was found in 14.5 million American adults.

Since 1990, the prevalence of adults diagnosed with diabetes increased 61 percent.

“Intervention is urgently needed for high risk people to reverse the alarming and epidemic increases in diabetes, obesity and metabolic syndrome, particularly in young people,” O’Donnell concluded.

The update also includes a new section on the metabolic syndrome (MetS) in adolescents that indicates that rates of controllable risk factors for cardiovascular diseases are increasing among America’s young people.

 “While heart attacks and stroke remain the leading causes of death in men and women, we see in the 2005 Update that many risk factors for these conditions are common, preventable and occur well before the onset of disease,” said Christopher O’Donnell, M.D., associate director of the National Heart, Lung and Blood Institute’s Framingham Heart Study, and chair of the American Heart Association’s statistics committee.  “These risk factors, including abnormal blood lipids and high blood pressure, often present early in life even before middle age, when preventative measures might make a large difference.”

About 1 million 12–19-year-olds in the United States (or 4.2 percent overall) have MetS.  Many controllable risk factors for heart disease are encompassed in the metabolic syndrome: abnormal blood lipids, high glucose (blood sugar), high blood pressure and overweight/obesity.  MetS during adolescence was defined in the 1988-1994 NHANES data as three or more of these abnormalities:

   > Blood triglyceride level of 110 milligrams per deciliter (mg/dL) or higher.
   > High-density lipoprotein (HDL, the “good” cholesterol) levels of 40 mg/dL or lower. .
   > Elevated fasting glucose of 110 mg/dL or higher. .
   > Blood pressure above the 90^th percentile for age, sex and height. .
   > Waist circumference at or above the 90^th percentile for age and sex.

The most common risk factor found in adolescents with MetS is being overweight.  Not all overweight adolescents will have MetS, which was present in just under 30 percent of overweight adolescents.  However, of those with MetS, nearly two-thirds were overweight.  Overweight in this age group means that body mass index (BMI), a measure of body fatness, was at or above the 95th percentile according to the Centers for Disease Control growth charts for children of similar age and sex.

The new statistics show that nearly 4 million children ages 6–11 and 5.3 million adolescents ages 12–19 were overweight or obese in 2002.  In addition, more children are overweight or obese at very young ages.  More than 10 percent of preschool children between the ages of two and five were overweight in 2002 – up from 7 percent in 1994.

“Childhood risk factors carry over into adulthood, and may eventually translate into heart disease and other medical problems such as diabetes.  Obesity is a major risk factor for heart disease that should be controlled early in life,” said Robert H. Eckel, M.D., an endocrinologist at the University of Colorado Health Science Center, Division of Endocrinology, Metabolism and Diabetes, and president-elect of the American Heart Association.

Editor’s note:  The Statistical update and fact sheets compiled by populations, risk factors, etc., will be available online in January at www.americanheart.org/statistics.

Mexican Americans Have 20 Percent Higher Chance of Stroke

Dec. 31, 2004 - Mexican Americans have about a 20 percent higher incidence of stroke than non-Hispanic whites, the American Heart Association reported in its Heart Disease and Stroke Statistics – 2005 Update released today. 

Most of the information on Mexican Americans and stroke comes from the Brain Attack Surveillance in Corpus Christi Project.  About 168 of every 10,000 Mexican Americans had a stroke from 2000–2002, compared to 136 of 10,000 non-Hispanic whites.  After adjusting for age, Mexican Americans have a higher incidence of intracerebral hemorrhage and subarachnoid hemorrhage than non-Hispanic whites.  Mexican Americans also have an increased incidence of ischemic stroke and transient ischemic attack (TIA) at younger ages when compared with non-Hispanic whites.

“These are the first stroke incidence data for Mexican Americans, one of the largest minority populations in the United States,” said Virginia Howard, MSPH.  She is an assistant professor of epidemiology in the School of Public Health at the University of Alabama at Birmingham, and chair of the American Heart Association’s stroke statistics subcommittee.

The overall stroke death rate for all race-ethnic groups was 56.2 per 100,000 in 2002.   For whites, the death rate was 54.5 for women and 56.5 for men; for blacks, 73.7 for women, and – most alarming – 85.4 for men.  Among Hispanics, the death rate was 40 per 100,000 for 1999 (the most recent data available). 

Stroke is the third leading cause of death in the United States.   Each year about 700,000 people experience a new or recurrent stroke.  In adults over age 55, the lifetime risk for stroke is greater than one in six people. 

Blood pressure is a powerful determinant of stroke risk, according to the Update.  People with blood pressure less than 120/80 mm Hg have about half the lifetime risk of stroke of those with high blood pressure (greater than 140/90 mm Hg).  Between one-quarter and one-third of Mexican Americans in the United States have high blood pressure, yet this group’s level of blood pressure awareness, treatment and control is lower than that of non-Hispanic whites and non-Hispanic blacks according to the 1999-2000 National Health and Nutrition Examination Survey.

“Prevention strategies must be targeted for each segment of the population,” Howard said.

Older Americans and Cardiovascular Diseases — Statistics

Cardiovascular Disease (CVD)

• About 84 percent of cardiovascular disease deaths occur in people age 65 and older.

• In 2001, 6,226,000 Americans were discharged from short-stay hospitals with a first listed diagnosis of CVD. Of these, 64.5 percent were age 65 and older.

Coronary Heart Disease (CHD)

• For non-black men the annual rates per 1,000 population of new and recurrent heart attacks are

. 23.0 for ages 65-74.

. 35.3 for ages 75 and older.

For non-black women the rates are

. 9.8, for ages 65-74.

. 24.9 for ages 75 and older.

For black men the rates are

. 21.9, for ages 65-74.

. 31.4 for ages 75 and older.

For black women the rates are

. 13.8 for ages 65-74.

. 28.1 for ages 75 and older.

(ARIC/CHS, NHLBI)

• About 84 percent of people who die of CHD are age 65 or older.

• In part because women have heart attacks at older ages than men do, they’re more likely to die from them within a few weeks.

• In 2001, 2,090,000 Americans were discharged from short-stay hospitals with a first listed diagnosis of CHD. Of these, 58 percent were age 65 or older.

Angina Pectoris (ICD/10 code I20) (ICD/9 code 413)

• The annual rates per 1,000 population of new and recurrent episodes of angina (chest pain or discomfort caused by reduced blood supply to the heart muscle) for non-black men are

. 44.3 for ages 65-74.

. 56.4 for ages 75-84.

. 42.6 for age 85 and older.

For non-black women the rates are

. 18.8 for ages 65-74.

. 30.8 for ages 75-84.

. 19.8 for age 85 and older.

For black men the rates are

. 26.1 for ages 65-74.

. 52.2 for ages 75-84.

. 43.5 for age 85 and older.

For black women the rates are

. 29.4 for ages 65-74.

. 37.7 for ages 75-84.

. 15.2 for age 85 and older.

• In 2001, 74,000 Americans were discharged from short-stay hospitals with a first listed diagnosis of angina pectoris. Of these, an estimated over 50 percent were age 65 or older.

Stroke (ICD/10 codes I60-I69) (ICD/9 codes 430-438)

• A transient ischemic attack (TIA) is a warning stroke or “mini-stroke” that lasts less than 24 hours. The prevalence of TIA in men is

. 2.7 percent for ages 65-69.

. 3.6 percent for ages 75-79.

For women, the TIA prevalence is

. 1.6 percent for ages 65-69.

. 4.1 percent for ages 75-79.

(CHS, NHLBI)

• Stroke is a leading cause of serious, long-term disability in the United States.

• About 88 percent of stroke deaths occur in people age 65 and older.

• 22 percent of men and 25 percent of women who have an initial stroke die within a year. This percentage is higher among people age 65 and older. (FHS, NHLBI)

• In 2000, 981,000 Americans were discharged from short-stay hospitals with a first listed diagnosis of stroke. Of these, 74 percent were age 65 and older.

High Blood Pressure (HBP)

• The following have high blood pressure (defined as systolic pressure of 140 mm Hg or higher or diastolic pressure of 90 mm Hg or higher, or taking antihypertensive medicine):

. At ages 55-64, 43.0 percent of men and 58.0 percent of women.

. At ages 65-74, 54.9 percent of men and 65.2 percent of women.

. At age 75 and older, 59.0 percent of men and 71.3 percent of women.

(NHANES IV [1999-2004], Health, United States, 2003, CDC/NCHS)

• 73 percent of Japanese-American men ages 71-93 have HBP. (HHP, NHLBI)

• In 2001, 486,000 Americans were discharged from short-stay hospitals with a first listed diagnosis of HBP.

Arrhythmias (ICD/10 codes I46-I49) (ICD/9 codes 426, 427)

• The rate of AF increases from less than 1 percent among persons less than 60 years to about 10 percent among persons age 80 and older.

• Among older adults the prevalence is higher in whites than in blacks.

Congestive Heart Failure (CHF) (ICD/10 code I50.0) (ICD/9 code 428.0)

• The incidence of heart failure approaches 10 per 1,000 population after age 65. (FHS, NHLBI)

• After CHF is diagnosed, survival is poorer in men than in women, but fewer than 15 percent of women survive longer than 8-12 years. The 1-year mortality rate is high with 1 in 5 dying. (FHS, NHLBI)

• The annual rates per 1,000 population of new and recurrent CHF events for non-black men are

. 21.5 for ages 65-74.

. 43.3 for ages 75-84.

. 73.1 for age 85 and older.

For non-black women in these age groups the rates are

. 11.2 for ages 65-74.

. 26.3 for ages 75-84.

. 64.9 for age 85 and older.

For black men the rates are

. 21.1 for ages 65-74.

. 52.0 for ages 75-84.

. 66.7 for age 85 and older.

For black women the rates are

. 18.9 for ages 65-74.

. 33.5 for ages 75-84.

. 48.4 for age 85 and older.

(CHS, NHLBI)

• In 2001, 995,000 Americans were discharged from short-stay hospitals with a first listed diagnosis of congestive heart failure. Of these, about 77 percent were age 65 and older.

Tobacco

• In 2001, studies show that 11.5 percent of men and 9.2 percent of women age 65 and older smoke. (Health, United States, 2003, CDC/NCHS)

High Blood Cholesterol and Other Lipids

• In adults, total cholesterol levels of 240 mg/dL or higher are considered high risk. Levels from 200 to 239 mg/dL are considered borderline-high risk.

• Among people ages 65-74, the following have total blood cholesterol 200 mg/dL or higher.

. 60.2 percent of men.

. 76.7 percent of women.

Older Americans and Cardiovascular Diseases — Statistics 4

For age 75 and older the percentages are

. 42.7 percent of men.

. 66.1 percent of women.

(NHANES IV [1999-2000], CDC/NCHS)

• Among people ages 65-74, the following have total blood cholesterol 240 mg/dL or higher:

. 19.2 percent of men.

. 37.4 percent of women.

For age 75 and older the percentages are

. 10.1 percent of men.

. 27.6 percent of women.

(NHANES IV [1999-2000], CDC/NCHS)

• Among elderly Japanese-American men, 42 percent have total cholesterol of 200 mg/dL or higher or are taking cholesterol-lowering drugs. (HHP, Fourth Examination [1991-93], NHLBI)

Overweight and Obesity

• Among people age 60 and older, the following are overweight or obese, defined as a BMI (body mass index) of 25.0 kg/m2 and higher:

. 74.3 percent of non-Hispanic white men.

. 65.8 percent of non-Hispanic white women.

. 69.1 percent of non-Hispanic black men.

. 81.7 percent of non-Hispanic black women.

. 79.6 percent of Mexican-American men.

. 77.5 percent of Mexican-American women.

(NHANES [1999-2000], CDC/NCHS)

• Among people age 60 and older, the following are obese, defined as a BMI of 30.0 kg/m2 and higher:

. 34.3 percent of non-Hispanic white men.

. 33.3 percent of non-Hispanic white women.

. 26.4 percent of non-Hispanic black men.

. 50.2 percent of non-Hispanic black women.

. 29.7 percent of Mexican-American men.

. 41.0 percent of Mexican-American women.

(NHANES IV [1999-2000], CDC/NCHS)

Diabetes Mellitus (ICD/9 code 250) (ICD/10 codes E10-E14)

• In people ages 60-74, the following have physician-diagnosed diabetes:

. 11.8 percent of men.

. 13.3 percent of women

For age 75 and older the prevalences of physician-diagnosed diabetes are

. 13.8 percent of men.

. 12.8 percent of women.

(Among Japanese-American men ages 71-93, . 17 percent have recognized diabetes. . 19 percent have unrecognized diabetes. . 32 percent have impaired glucose tolerance (pre-diabetes). (HHP [1991-93], NHLBI) • In 2001, 562,000 Americans were discharged from short-stay hospitals with a first listed diagnosis of diabetes. Of these, 36.6 percent were age 65 and older.

Surgery • According to data from the National Center for Health Statistics, 54 percent of bypass and 51 percent of PTCA procedures in 2001 were done on patients age 65 and older. • In 2002, 50 percent of heart transplant recipients were ages 50-64.

Source Footnotes CDC/NCHS – Centers for Disease Control and Prevention/National Center for Health Statistics CHS – Cardiovascular Health Study FHS – Framingham Heart Study HHP – Honolulu Heart Program NHANES III (1988-94) – National Health and Nutrition Examination Survey NHANES IV (1999-2000) – National Health and Nutrition Examination Survey IV NHLBI – National Heart, Lung, and Blood Institute

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