2008 Public Health Action Plan Update: Celebrating Our First Five Years

Action Plan Return to Action Plan Main Page  Sections Overview Milestones/Landmark Events Key Messages Action Plan: Celebrating 5 Years Reflections from the Chair of the Forum Commentary from AHA Commentary from ASTHO Commentary from NACDD and CHC Reducing Heart Disease and Stroke in the U.S. Burden and Disparities Today Making Connections Mission Statements/Strategies Review of  Components and Recommendations Action Framework Implementation Group's Priorities for 2008/2009 Appendix A Appendix B

Reducing Heart Disease and Stroke in the United States: Making Progress or Losing Ground?

David C. Goff, Jr., MD, PhD

Is the glass half empty or half full? Several trends support the optimist’s view that the glass is half full.

During the past century, death rates for both heart disease and stroke in the United States declined sharply. Continued advances in biomedical and community health sciences, especially prevention research, strongly support the argument that much of the burden of heart disease and stroke can be prevented. In the United States, age-adjusted death rates for both conditions are at their lowest since early in the 20th century.

The incidence of the major risk factors for heart disease and stroke has generally improved in recent decades. During the 20th century, the prevalence of smoking declined for men and women, and average cholesterol levels and prevalence of high blood pressure also declined.

Tremendous progress was made in acute care and secondary prevention for people with heart disease or stroke, especially during the last decade. Quality improvement led to great advances in evidence-based treatments, especially in hospitals. More widespread adoption of quality assurance programs and adaptation of these programs to the outpatient setting will expand these gains.

Unfortunately, not all the news is good; viewed from another perspective, the water level in the glass is dipping.

Recent slowing of favorable mortality trends for coronary heart disease and flattening of mortality trends for stroke could indicate trouble. The increasing incidence of obesity and diabetes—with their associated disturbances of blood pressure and lipid regulation—is cause for concern. Failure to address the twin epidemics of obesity and diabetes places at risk the hard-won gains of the past several decades in quantity and quality of life.

Much is known about the individual behavioral basis for obesity, hypertension, and dyslipidemia, but much less is known about which policies would help prevent these conditions at a population level. With regard to heart disease and stroke, however, researchers have identified some promising population-based approaches to preventing these conditions. For example, several recent studies in the United States and Italy documented a reduction in admissions for myocardial infarction following passage and implementation of comprehensive smoke-free policies. Clearly, more research on policy approaches to support population-based prevention of heart disease and stroke is needed.

Despite the progress of the past several decades, disparities related to ethnicity, sex, age, socioeconomic status, and other characteristics persist. The growth and aging of the population, combined with successes in acute care and secondary prevention, contributed to increases in the prevalence and number of people with chronic cardiovascular disease, even in the face of declining mortality. Both the absolute number and the proportion, or prevalence, of people living with chronic cardiovascular conditions are likely to continue increasing during the coming decades. The rising levels of obesity and diabetes, if unabated, will reinforce this trend.

Great progress has been made. Yet more remains to be done and new threats have emerged. The level in the glass hovers at the half-way mark. Although gaps in scientific knowledge exist, we know enough to reduce the burden of heart disease and stroke through both prevention and treatment.

The work of the National Forum for Heart Disease and Stroke Prevention and its implementation groups can have a significant influence on reversing the adverse trends, reinforcing favorable ones, and reducing both the burden of heart disease and stroke and the associated disparities related to race, sex, age, socioeconomic status, and other characteristics.

We have the scientific knowledge to create a world in which most cardiovascular disease could be eliminated.

—2000 Victoria Declaration

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Page last reviewed: August 8, 2008
Page last modified: August 8, 2008
Content source: Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion