A Public Health Action Plan to Prevent Heart Disease and Stroke

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Appendix A: Glossary

The following brief definitions or explanations apply to technical or common terms used specifically in the Action Plan. For more detailed definitions, standard reference works should be consulted.

acute case management: an intervention approach in which individual cardiovascular disease (CVD) events (e.g., heart attack, heart failure, stroke) are treated as they occur.

age–adjusted death rate: the number of deaths occurring per 100,000 population per year, calculated in accordance with a standard age structure to minimize the effect of age differences when rates are compared between populations or over time.

Alzheimer's disease: the most common cause of dementia, or decline in mental function, characterized by degeneration of nerve cells and loss of brain substance, most common among people older than age 65 years.

assessment: the obligation of every public health agency to monitor the health status and needs of its community regularly and systematically; one of the three core functions of public health.

assurance: the guarantee of governments that agreed–upon, high–priority, personal and community health services will be provided to every member of the community by qualified organizations; one of the three core functions of public health.

atheroma: a concentrated area of mushy material within the wall of an artery, often encrusted or hardened (sclerosed) by deposited calcium, that is the pathological hallmark of atherosclerosis.

atherosclerosis: a pathological condition affecting the medium–sized and larger arteries, especially those that supply the heart (the coronary arteries), the brain (the carotid and cerebral arteries), and the lower extremities (the peripheral arteries), as well as the aorta; underlies the occurrence of heart attacks, many strokes, peripheral arterial disease, and dissection or rupture of the aorta.

behavioral change: an intervention approach that uses public information and education to promote behavioral patterns favorable to health for the population as a whole; also includes interventions (e.g., counseling) at the group or individual level for the same purpose.

behavioral patterns: habits of living (e.g., diet, physical activity, smoking) that influence health.

blood cholesterol: the blood concentration of a family of lipid or "fatty" molecular compounds obtained directly from the diet or produced in the body from fatty dietary components; a necessary factor in development of atherosclerosis; total cholesterol concentration is classified as "high" if it is greater than or equal to 200 mg/dl. Subtypes of cholesterol differ in their relation to CVD risk, with high–density lipoprotein (HDL) cholesterol considered "good," and low–density (LDL) cholesterol considered "bad."

blood pressure: see high blood pressure.

cardiovascular disease prevention: a set of interventions designed to prevent first and recurrent CVD events (e.g., heart attack, heart failure, stroke). For CVD, primary prevention refers to detection and control of risk factors, whereas secondary prevention includes long–term case management for survivors of CVD events. CVD prevention complements cardiovascular health (CVH) promotion.

cardiovascular disease(s): may refer to any of the disorders that can affect the circulatory system, but often means coronary heart disease (CHD), heart failure, and stroke, taken together.

cardiovascular health: a combination of favorable health habits and conditions that protects against development of cardiovascular diseases.

cardiovascular health promotion: a set of interventions designed to reduce a population's risk for CVD through policy, environmental, and behavioral changes; also supports other approaches that apply to people who have suffered recognized CVD events (e.g., by facilitating public access to emergency care or by fostering social/environmental and behavioral changes that reinforce secondary CVD prevention); sometimes identified with primordial CVD prevention; complements CVD prevention.

carotid arteries: the four main arteries of the head and neck, which supply blood to the brain and elsewhere in the head.

case fatality rate: the proportion of cases of a disease event ending in death within a defined interval (e.g., 41% of those experiencing a first heart attack die within 28 days of onset of the attack).

cerebral arteries: blood vessels connecting the internal carotid arteries with the brain. Cerebral hemorrhage: rupture of a cerebral blood vessel, characterized by accumulation of blood at the site of the rupture and loss of blood supply beyond the point of rupture, often leading to a sudden focal loss of brain function or stroke.

cerebral hemorrhage: rupture of a cerebral blood vessel, characterized by accumulation of blood at the site of the rupture and loss of blood supply beyond the point of rupture, often leading to a sudden focal loss of brain function or stroke.

cholesterol: see blood cholesterol.

chronic kidney (renal) disease: long–term impairment of kidney function often leading to high blood pressure or kidney failure; may be treated with medication, kidney transplantation, or dialysis.

circulatory system: the network of arteries, veins, capillaries, and lymphatic vessels throughout the body, including the heart, that pumps blood to the lungs and peripheral tissues.

comprehensive public health strategy: an approach to a major health problem in the population that identifies and employs the full array of potential public health interventions, including health promotion and disease prevention.

congestive heart failure: see heart failure.

core functions of public health: the three main areas of responsibility of official public health agencies as defined by the Committee for the Study of the Future of Public Health: assessment, policy development, and assurance.

coronary arteries: the arteries that supply blood to the heart muscle and whose narrowing or occlusion constitutes coronary heart disease and can precipitate a heart attack.

coronary heart disease: heart disease caused by impaired circulation in one or more coronary arteries; often manifests as chest pain (angina pectoris) or heart attack.

CVD prevention: see cardiovascular disease prevention.

CVH promotion: see cardiovascular health promotion.

diabetes (or diabetes mellitus): a metabolic disorder resulting from insufficient production or utilization of insulin, commonly leading to cardiovascular complications.

diastolic blood pressure: see high blood pressure.

dietary imbalance: a pattern of dietary intake that lacks a desirable combination and overall intake of foods and nutrients to promote good health (e.g., excessive intake of saturated fat, salt, total calories).

disparities: see health disparities.

economic development: the long–term process of economic growth in developing countries or economically disadvantaged areas of developed countries; can influence the health of residents favorably or unfavorably.

emergency care: treatment for people who have experienced a first or recurrent acute CVD event (e.g., heart attack, heart failure, stroke) designed to increase their probability of survival and to minimize associated damage or disability.

end–of–life care: treatment for late or terminal complications of CVD designed to minimize suffering and preserve the dignity of those treated.

epidemiology: the study of the causes and prevention of disease in populations or communities, making it the main source of evidence for public health decision making.

evidence–based medicine: the use of agreed–upon standards of evidence in making clinical decisions for treating individual patients or categories of patients.

evidence–based public health: the use of agreed–upon standards of evidence in making decisions about public health policies and practices to protect or improve the health of populations.

health disparities: differences in the burden and impact of disease among different populations, defined, for example, by sex, race or ethnicity, education or income, disability, place of residence, or sexual orientation.

Healthy People 2010: a document that presents health–related goals and objectives for the United States to be achieved by the year 2010.

Healthy People 2010 Heart and Stroke Partnership: established to achieve the Healthy People 2010 goal for preventing heart disease and stroke. The members of the partnership divided this goal into four separate ones: prevention of risk factors, detection and treatment of risk factors, early detection and treatment of heart attacks and strokes, and prevention of recurrent cardiovascular events. This partnership was established by the American Heart Association/American Stroke Association, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, National Institutes of Health, and Office of Public Health and Science, U.S. Department of Health and Human Services.

heart attack: an acute event in which the heart muscle is damaged because of a lack of blood flow from the coronary arteries, typically accompanied by chest pain and other warning signs but sometimes occurring with no recognized symptoms (i.e., "silent heart attack").

heart disease: any affliction that impairs the structure or function of the heart (e.g., atherosclerotic and hypertensive diseases, congenital heart disease, rheumatic heart disease, and cardiomyopathies).

Heart Disease and Stroke Control Program: a program established by the National Heart Act of 1948 through which the federal government supported state efforts to prevent and control heart disease and stroke; terminated in 1970.

Heart Disease and Stroke Prevention Program: a CDC program initiated in 1998 that supports states in their efforts to prevent heart disease and stroke; for more information see www.cdc.gov/dhdsp/state_program/index.htm.

heart failure: impairment of the pumping function of the heart as the result of heart disease; heart failure often causes physical disability and increased risk for other CVD events.

high blood pressure: a condition in which the pressure in the arterial circulation is greater than desired; associated with increased risk for heart disease, stroke, chronic kidney disease, and other conditions; blood pressure is considered "high" if systolic pressure (measured at the peak of contraction of the heart) is greater than or equal to 140 mm Hg or if diastolic pressure (measured at the fullest relaxation of the heart) is greater than or equal to 90 mm Hg.

high-risk approach: an intervention strategy that targets only people with the highest levels of recognized CVD risk factors for the purpose of reducing their level of risk to that of the most favorable level in the population; distinct from and complementary to the populationwide approach.

hypertension: see high blood pressure.

hypertensive heart disease: abnormality in the structure and function of the heart caused by long-standing high blood pressure; often manifests as heart failure.

incidence: the number of new cases of disease occurring in a population of given size within a specified time interval (e.g., the average annual incidence of stroke for women in Rochester, Minnesota, during 1985:C1989 was approximately 120/100,000 population).

individual approach: see high–risk approach.

Inter–Society Commission for Heart Disease Resources: a commission established under U.S. Public Law 89–239 as part of the Regional Medical Programs Service; responsible for producing guidelines defining optimal medical resources and care for the prevention and treatment of cardiovascular diseases in the United States.

life cycle: the course of human development from conception until death, including gestation; infancy; childhood; adolescence; and early, middle, and late adulthood; important for targeting health promotion and disease prevention efforts to the distinct needs of people in each phase.

long-term case management: an intervention approach that targets survivors of CVD events; designed to reduce disability and the risk for recurrent events.

modifiable characteristics: factors related to CVD risk that are amenable to change (e.g., diet, physical activity, smoking), in contrast to those that are intrinsic to the individual (e.g., age, sex, race, genetic traits).

mortality: rate of death expressed as the number of deaths occurring in a population of given size within a specified time interval (e.g., 265 annual deaths from heart disease per 100,000 U.S. Hispanic women, 1991–1995).

obesity: usually defined in terms of body mass index (BMI), which is calculated as body weight in kilograms (1 kg = 2.2 lbs) divided by height in meters (1 m = 39.37 in) squared; adults with a BMI of greater than or equal to 30.0 kg/m2 are considered "obese," and those with a BMI of 25–29.9 kg/m2 are considered "overweight." In children, overweight is defined as BMI greater than the 95th percentile value for the same age and sex group.

overt disease: for CVD, disease with signs or symptoms that are recognizable by the affected individual or health care provider.

overweight: see obesity.

peripheral arteries: arteries in the upper and lower extremities (arms and legs).

peripheral arterial disease: mainly atherosclerosis of the extremities; especially important in the lower extremities; also called peripheral vascular disease.

physical inactivity: lack of habitual activity sufficient to maintain good health, resulting in an unfavorable balance between energy intake and expenditure and fostering the development of overweight or obesity and other risk factors for heart disease and stroke.

plaque: the characteristic manifestation of atherosclerosis located in the arterial wall and extending into the lumen or channel of the artery; plaque can disturb or restrict blood flow and is prone to fissure or rupture, thus precipitating formation of blood clots that can cause an acute coronary event.

policy and environmental change: an intervention approach to reducing the burden of chronic diseases that focuses on enacting effective policies (e.g., laws, regulations, formal and informal rules) or promoting environmental change (e.g., changes to economic, social, or physical environments).

population–based observations: health data that pertain to a defined, usually large, population (e.g., vital statistics, surveillance, results of population surveys).

population–wide approach: an intervention strategy that targets the population as a whole without regard to the risk levels of various subgroups; distinguished from and complementary to the high-risk approach.

prevalence: the frequency of a particular condition within a defined population at a designated time (e.g., 12.6 million Americans living with heart disease in 1999 or 36.4% of African American men aged 20–74 years found to have hypertension in a survey conducted in 1988–1994).

prevention research: aims to prevent disease and promote health by developing and disseminating strategies applicable to public health programs and policies.

preventive dose: the intensity and duration of appropriate public health interventions needed to achieve their goals; similar to the dose and duration of medical treatment sufficient to control or cure an illness.

primary CVD prevention: a set of interventions, including the detection and control of risk factors, designed to prevent the first occurrence of heart attack, heart failure, or stroke among people with identifiable risk factors; this approach corresponds most directly to the objectives of goal 2 for preventing heart disease and stroke of the Healthy People 2010 Heart and Stroke Partnership.

primordial CVD prevention: a set of interventions targeting people without risk factors or CVD (including the maintenance or restoration of favorable social and environmental conditions and the promotion of healthy behavioral patterns) to prevent development of risk factors; this approach corresponds most directly to the objectives of goal 1 for preventing heart disease and stroke of the Healthy People 2010 Heart and Stroke Partnership. Although this approach was originally intended to apply to whole societies to prevent the first appearance of epidemic levels of risk factors, the term is commonly used in the sense of "early intervention" to prevent risk factors in individuals even in populations where risk factors are already epidemic; in the Action Plan, "CVH promotion" is used as equivalent to "primordial prevention."

priority populations: groups at especially high risk for CVD (e.g., those identified by sex, race or ethnicity, education, income, disability, place of residence, or sexual orientation).

randomized controlled trial: an experimental study of an intervention, most often a medical treatment, in which study participants are randomly assigned to treatment or comparison groups; much less often, communities rather than individuals are the units used to form treatment and comparison groups.

rehabilitation: an intervention approach designed to limit disability among survivors of CVD events and reduce their risk for subsequent events.

risk behavior: a behavioral pattern associated with increased frequency of specified health problems; for example, high salt intake, smoking, and binge drinking are all associated with CVD.

risk factor: an individual characteristic associated with increased frequency of specified health problems; for example, high LDL cholesterol, high blood pressure, and diabetes are all associated with CVD.

risk factor detection and control: an intervention approach that targets people with identifiable risk factors; includes both screening or other methods of detection and long–term disease management through changes in lifestyle, behavior, medication (when necessary).

secondary CVD prevention: a set of interventions aimed at survivors of acute CVD events (e.g., heart attack, heart failure, stroke) or others with known CVD in which long–term case management is used to reduce disability and risk for subsequent CVD events; this approach corresponds most directly to the objectives of goal 4 for preventing heart disease and stroke of the Healthy People 2010 Heart and Stroke Partnership.

stroke: sudden interruption of blood supply to the brain caused by an obstruction or the rupture of a blood vessel.

subclinical disease: presence of one or more forms of CVD (e.g., atherosclerosis, coronary heart disease) detectable only by special examination (e.g., ankle–arm blood pressure ratio, carotid artery ultrasound examination, electrocardiogram) and not recognizable from signs or symptoms expressed by the affected person.

survival: remaining alive for a specified period (e.g., beyond the 28–day definition of case fatality) after a CVD event.

tertiary CVD prevention: an intervention approach included in secondary prevention, as it is used in the Action Plan; sometimes distinguished as reducing disability among survivors of CVD events through rehabilitation; this approach combined with secondary prevention corresponds most directly to the objectives of goal 4 for preventing heart disease and stroke of the Healthy People 2010 Heart and Stroke Partnership.

vascular cognitive impairment: loss of mental function that occurs in association with a stroke, sometimes followed by dementia.

Next Section: Appendix B: National Goals and Objectives

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Page last reviewed: April 21, 2008
Page last modified: April 21, 2008
Content source: Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion