CDC Reports Coronary Heart Disease Rates Continue to Fall

Prevalence of Coronary Heart Disease --- United States, 2006--2010

October 14, 2011 / 60(40);1377-1381
from CDC/MMWR

Age-adjusted mortality rates for coronary heart disease (CHD) have declined steadily in the United States since the 1960s (1). Multiple factors likely have contributed to this decline in CHD deaths, including greater control of risk factors, resulting in declining incidence of CHD, and improved treatment (2). Greater control of risk factors and declining incidence can reduce CHD prevalence, whereas improved treatment that results in lower mortality rates and more persons living with CHD can increase prevalence. To estimate state-specific CHD prevalence and recent trends by age, sex, race/ethnicity, and education, CDC analyzed data from Behavioral Risk Factor Surveillance System (BRFSS) surveys for the period
2006--2010. This report summarizes the results of that analysis, which determined that, although self-reported CHD prevalence declined overall, substantial differences in prevalence existed by age, sex, race/ethnicity, education, and state of residence. These data can enable state and national health agencies to monitor CHD prevalence as a measure of progress toward meeting the Healthy People 2020 objective to reduce the U.S. rate of CHD deaths 20% from the 2007 baseline (3).

BRFSS is a state-based, random-digit--dialed telephone survey of the U.S. civilian, noninstitutionalized population aged ≥18 years (4). The survey is administered in all 50 states, the District of Columbia (DC), and the U.S. territories of Guam, Puerto Rico, and the U.S. Virgin Islands. Since 2005, BRFSS has included two questions related to coronary heart disease: "Has a doctor, nurse, or other health professional ever told you that you had angina or coronary heart disease?" and "Has a doctor, nurse, or other health professional ever told you that you had a heart attack, also called a myocardial infarction?" Participants who answered "yes" to either of the questions were defined as having self-reported CHD. Those who answered "no" to both questions were defined as not having CHD. Those who answered "don't know," refused to answer the questions, or for whom responses were missing were excluded.

CHD prevalence data were analyzed by age group, sex, education, state, and racial/ethnic population (Hispanic, white, black, Asian or Native Hawaiian/Other Pacific Islander, or American Indian/Alaska Native).* All estimates were weighted to the state population, and analyses were conducted using statistical software to account for the complex sampling design. Age-adjusted prevalence of CHD, standardized to the 2000 U.S. standard population, was estimated for each year during the period 2006--2010. Orthogonal polynomial coefficients, which were calculated recursively, were used to determine the significance of linear trends. The number of BRFSS respondents ranged from 347,790 in 2006 to 444,927 in 2010 for all states. Sample sizes for states (including DC) ranged from 1,964 in Alaska in 2010 to 39,549 in Florida in 2007. Median BRFSS response rate during 2006--2010 was 52.3%.

From 2006 to 2010, age-adjusted CHD prevalence in the United States declined overall from 6.7% to 6.0% (Table 1). Similar declines were observed across age group, sex, and education categories. Among racial/ethnic populations, declines from 2006 to 2010 were observed among whites (6.4% to 5.8%) and Hispanics (6.9% to 6.1%) (Table 1).

In 2010, the prevalence of CHD was greatest among persons aged ≥65 years (19.8%), followed by those aged 45--64 years (7.1%) and those aged 18--44 years (1.2%). CHD prevalence was greater among men (7.8%) than women (4.6%), and among those with less than a high school education (9.2%), compared with high school graduates (6.7%), those with some college (6.2%), and those with more than a college degree (4.6%) (Table 1). Among racial/ethnic populations, CHD prevalence was greatest among American Indians/Alaska Natives (11.6%), followed by blacks (6.5%), Hispanics (6.1%), whites (5.8%), and Asians or Native Hawaiians/Other Pacific Islanders (3.9%). By race and sex in 2010, the greatest male prevalences were among American Indian/Alaska Natives (14.3%) and whites (7.7%), and the greatest females prevalences were among American Indian/Alaska Natives (8.4%) and blacks (5.9%) (Table 1).
By state, from 2006 to 2010, the greatest statistically significant linear declines in age-adjusted CHD prevalence were 23.1% in West Virginia (from 10.4% to 8.0%) and 22.1% in Missouri (from 7.7% to 6.0%) (Table 2). Although five states showed an increase in CHD prevalence from 2006 to 2010, none of the five showed a statistically significant linear increase. In 2010, CHD prevalence ranged from 3.7% in Hawaii and 3.8% in DC to 8.0% in West Virginia and 8.2% in Kentucky, with the greatest regional prevalences generally observed in the South (Figure).

Reported by
Jing Fang, MD, Kate M. Shaw, MS, Nora L. Keenan, PhD, Div for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion. Corresponding contributor: Jing Fang, jfang@cdc.gov, 770-488-5142.

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Author Interview: Claes Held MD Associate professor at Uppsala Clinical Research Center and the Cardiology department at Uppsala University Hospital in Sweden Publication: Physical activity levels, ownership of goods promoting sedentary behaviour and risk of myocardial infarction: results of the INTERHEART study Eur Heart J first published online January 11, 2012 doi:10.1093/eurheartj/ehr432 2012 doi:10.1093/eurheartj/ehr432 Claes Held, Romaina Iqbal, Scott A. Lear, Annika Rosengren, Shofiqul Islam,James Mathew, and Salim Yusuf What are the main findings of the study? The main findings are he following: It is well known that physical inactivity is a risk factor for developing cardiovascular disease. Our study shows that being physically active reduces the risk of having a heart attack. Older studies have mostly studied people in the developed countries. This study which has a global perspective and includes 52 countries from all continents, shows that physical inactivity reduces the risk also in both low- middle-and high-income countries. We also found that ownership of a car and TV was associated with a more than doubled risk of being sedentary and that in low- and middle income the risk for a heart attack was increased with 27 %. We can however, not conclude from this study that there is a causal relationship but it is an interesting finding.     Were any of the findings unexpected? We looked at the relationship between physical activity both at work and during leisure time. A bit surprising was that people with heavy physical labor did not have a reduction in the risk of heart attacks, whereas people with both mild and moderate intensity did. What should clinicians and patients take away from this study? The main findings above and also that physical activity with duration below the recommended 30 minutes/day does seem to prevent from heart attacks as well although not as much as when you do it according to guidelines. This may be a comfort to those who are completely sedentary and feel that it would be a too big step to move to the 30 minutes/day right away. All PA does a good job for the heart as compared to not doing anything at all!   What recommendations do you have for cardiology health care providers as a result of your study? It would be interesting to follow up on the ownership of car and TV and do a prospective study to see if the theory holds true. More Author Interview from Angina.com More on Exercise and Heart Disease More on Heart Attack Studies   3M Littmann Master Classic II Stethoscope

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