Dr. David Satcher,
Assistant Secretary for Health and Surgeon General, will be joined by a
panel of experts representing the public and private health sectors. Dr.
Edward Sondik, Director of the National Center for Health Statistics, CDC,
and Dr. Claude Lenfant, Director of the National Heart, Lung, and Blood
Institute, NIH, will review the progress towards meeting the goals and
targets for the Heart Disease and Stroke priority area of Healthy People
2000. The participants will then engage in a discussion that focuses on
three main topics.
The
application of knowledge in preventing or lowering cardiovascular disease
(CVD) risk for all Americans;
Eliminating
disparities in CVD risk among various population groups; and
Presentation
made by:
Edward J. Sondik, Ph.D.
Director
National Center for Health Statistics
February 3, 1999
Wilson Hall
NIH, Campus
Thank you.
As Dr. Lenfant noted, we've made great progress in reducing deaths from
heart disease and stroke, and in both understanding and treating these
diseases. Yet, despite this progress, there is, arguably, still no more
important component of Healthy People than these major cardiovascular
conditions.
SLIDE
1 (Impact) Just consider: Heart disease and cerebrovascular disease
together accounted for nearly 900,000 deaths in 1997. In fact, if we could
eliminate heart disease, U.S. life expectancy at birth would increase by
almost 5 years. Over 20 million Americans report that they have heart
disease and, as a result a quarter of them experience limitations of
activity. In addition, some 3 million Americans report they've had a
stroke and for many the resulting disability affects their daily lives.
SLIDE
2 (Health care) - And consider, too, the health care resources involved:
Heart disease accounts for 23 percent of hospice care, 28 percent of home
health care, 29 percent of all hospitalizations and over a third of all
nursing home care. Now to see how well we've met the challenges of this
Healthy People component, let's turn to the 17 objectives which make up
this chapter.
SLIDE
3 (Blank) Dr. Lenfant painted the overall picture of our progress against
heart disease and stroke. I'd like to focus now on some of the specifics.
I'll cover many of the objectives today, but not all of them in detail.
More information's available on the Healthy People Web site
and the Web sites at NCHS and NHLBI.
SLIDE
4. (Moving to target) This slide summarizes those objectives that are
moving toward their year 2000 targets, although for some progress is less
than we would have hoped. The objectives include targeted changes in
mortality, change in risk factors -- 7 objectives are shown here -- and
changes in primary care regimens, worksite programs and laboratory
accuracy -- all these objectives are showing progress. But we can't
say the same about reductions in disparities by race and ethnicity.
There are some gains here but the picture is more mixed and we'll discuss
that in a moment or two. Let's look first at coronary heart disease.
SLIDE
5. (Heart disease) - On the positive side, the coronary heart disease
death rate is nearing the Year 2000 target, but the rate for black
Americans is still considerably higher than the other race/ethnic groups
shown in light blue on this slide. And the higher death rate for men has
continued even as the rates for both men and women have declined.
SLIDE
6. (Stroke) Similarly, as Dr. Lenfant mentioned, stroke death rates are
dramatically higher for African Americans than the white population. In
fact, rates for the black population are double the rates for any other
population group. The gap between African Americans and all others was
present at the Healthy People 2000 baseline and has not narrowed over the
past decade.
SLIDE
7. (heart disease state map) Looking beyond the national figures for both
heart disease and stroke, there are significant state differences. In
1996, about a third of the states met the target to reduce coronary heart
disease death rates, as shown in dark and light blue on this map. States
with the highest rates are shown in red. And if we look more closely at
smaller regions, we can see an even more complex mortality pattern.
SLIDE
8. (Heart disease Atlas) In this slide from the "Atlas of United
States Mortality" we grouped 5 years of data for more than 800 county
clusters. The map shows heart disease death rates for white males, with
the highest rates shown in dark brown; the lowest in dark green. This
allows us to see patterns that were masked when reporting on a
state-by-state basis as in the previous slide.
SLIDE
9. (Heart disease - SE states) For example, in this closeup of the
southeastern states, we see that areas within the state of Georgia where
rates range from 10 percent below the national average to 50 percent above
the average.
SLIDE
10. (Stroke map) Turning now to stroke deaths, only three states, as shown
in blue on this map, have met the target of 20 deaths per 100,000 persons.
You'll also notice that what had been the "stroke belt"--a band
of southeastern states with traditionally higher stroke death rates--has
shifted in recent years, with high rates now observed in states to the
north and west of the original cluster.
SLIDE
11. (Blank) Let's turn to five critical risk factors that affect these
death rates. First, high cholesterol, then, high blood pressure, smoking,
being overweight and, finally, lack of exercise. Dr. Lenfant has described
the very significant progress in reducing cholesterol and blood pressure
levels. Now we'll look at the other three important risk factors.
Turning
first to smoking. Twenty five percent of American adults are smokers.
Smoking contributes to more deaths in this country than any one single
behavior. The long-term national trend in smoking has been down, but
recently progress has stalled, with virtually no change between 1990 and
1995.
SLIDE
12. (Cigarette smoking) On a state-by-state basis, in 1997, only Utah
reached the target of a smoking rate of 15 percent. Several other states
and the District of Columbia, (shown in light blue) are close, but many
miss the mark substantially. And speaking of missing the mark, let me
focus for a moment on teen smoking.
SLIDE
13. (Smoking--teens) After decades of decline, recent data show an upturn
in smoking among teens. Today almost a third of white high school seniors
are smoking. The rates for African American 12th graders, while much
lower, have almost doubled in just the past few years and the rates for
young Hispanics are also moving steadily upward.
SLIDE
14. (smoking boys & girls) And the trends are the same for both boys
and girls. This upturn in teen smoking is more than a cause for concern,
it's a call for even greater action. The progress we've seen in the past
for heart disease and stroke may be reversed if we are not able to reach
teenagers and convince them not to smoke.
SLIDE
15. (Overweight prev) Another important risk factor is being overweight.
More Americans today are overweight than at any time in our history. The
data show that there's been an increase in overweight for men and women,
adults and adolescents, as well as for Mexican and African
Americans--being overweight is truly an equal opportunity challenge.
However, this chart isn't the whole story. A new definition of overweight,
to be used in Healthy People 2010, lowers the threshold for being
overweight. Under this newly adopted definition, more than half of all
adults in this country are now considered overweight.
SLIDE
16. (Overweight map) In 1997, overweight prevalence varied considerably by
state, but no state--even under the old definition--had reached the target
of reducing overweight to 20 percent of the population. In general, states
with high rates of overweight, smoking and other risk factors have the
highest death rates for stroke and heart disease.
SLIDE
17. (Physical activity) The increase in overweight has resulted in a call
for Americans to exercise more. For example, less than a quarter of
American adults engage in moderate exercise 5 or more times a week. With
little change over the past decade, it appears that even the modest Year
2000 goals in physical activity will not be achieved.
SLIDE
18. (End-stage renal) We have already mentioned the importance of
hypertension, but high blood pressure is a risk factor for more than just
heart disease and stroke, it is one of the major causes of End Stage Renal
Disease or ESRD. One of our objectives has been to lower the incidence of
ESRD, yet the incidence actually doubled in the past decade for both ESRD
due to hypertension and ESRD related to diabetes.
SLIDE
19. (renal - race/ethnicity) No group has reached the target set for
reducing end stage renal disease, and the rates for blacks and American
Indians and Alaska Natives are exceptionally high. In fact, the rate for
African Americans has more than doubled since 1987.
SLIDE
20. (BLANK) We can certainly be proud of our progress in heart disease and
stroke, but we shouldn't be complacent. Second to cancer, heart disease
and stroke together account for more potential years of life lost than any
other cause of death, exceeding such killers of our young people as HIV,
injuries and violence.
Heart disease death rates are higher for the U.S. population than in 20
other countries and if we compare rates just for the U.S. black population
with other countries, the rate for Black America ranks 39th. These same
countries that have lower heart disease death rates also exceed our nation
in average life expectancy, since life expectancy is so dependent upon
death rates from the major cardiovascular diseases.
SLIDE
21 (summary) This afternoon we've reviewed where we've made progress--the
significant reductions in high cholesterol and high blood pressure and
we've examined the bottom line--the decline in heart disease and stroke
death rates. Together these results are proof that we can inform our
citizens of health hazards and that they can and will take action. Today,
we've also noted where progress has stalled--cigarette smoking in
particular--and that lack of progress may endanger this new generation.
And I've mentioned a continuing challenge for many of us--being overweight
and not exercising.
In
conclusion, the campaign against heart disease and stroke can achieve even
greater success but we must deal with serious and pervasive health
behavior problems if the progress of the next decade is to match that of
past decades.