| The Assistant Secretary for Health and Surgeon General
chaired the third and final review of progress in achieving Healthy People 2000 objectives
for Heart Disease and Stroke. The review was organized by the National Heart, Lung, and
Blood Institute, National Institutes of Health, which serves as the lead agency for this
priority area, designated as chapter 15 in the Healthy People 2000 (HP2000) document. The
discussions addressed three principal topics—1) expanding the application of
knowledge to prevent or lower cardiovascular disease (CVD) risk; 2) eliminating
disparities in CVD risk among population groups; and 3) assessing the impact on CVD risk
of increasing overweight/obesity. Through broadcast facilities on the National Institutes
of Health campus, viewers at remote sites were linked with the participants and could pose
questions by telephone and facsimile transmission. During the overview and discussion,
attention was focused on the following HP2000 objectives: 15.1 For the total population, the
age-adjusted death rate from coronary heart disease decreased from 135 per 100,000 in 1987
to 105 in 1996. The HP2000 target is 100. For Blacks, the rate decreased from 168 per
100,000 in 1987 to 140 in 1996 (target, 115).
15.2 For stroke, the
age-adjusted death rate for the total population decreased from 30.4 per 100,000 in 1987
to 25.9 in 1997 (preliminary data). The HP2000 target is 20.0. The rate for Blacks
decreased from 52.5 per 100,000 in 1987 to 42.0 in 1997 (preliminary data). The target is
27.0.
15.3 From 14.4 cases per 100,000
in 1987, the incidence of end-stage renal disease increased to 27.6 cases per 100,000 in
1996. The HP2000 target is 13.0. For Blacks, the incidence increased from 34.0 per 100,000
in 1987 to 65.1 in 1996 (target, 30.0)
15.5 The proportion of people
aged 18 and over who took action to control their high blood pressure remained at about 71
percent between 1991 and 1994. The HP2000 target is 90 percent. The proportion of white
hypertensive males aged 18-34 who did so decreased from 34 percent in 1991 to 30 percent
in 1994. Among black hypertensive males aged 18-34, the proportion taking action increased
from 40 percent in 1991 to 50 percent in 1994. The target for both male groups is 80
percent.
15.6 The mean serum cholesterol
level among adults aged 20-74 decreased from 213 mg/dL in 1976-80 to 203 mg/dL in 1988-94.
The HP 2000 target is 200 mg/dL.
15.7 The prevalence of blood
cholesterol levels of 240 mg/dL in adults aged 20-74 decreased from 27 percent in 1976-80
to 19 percent in 1988-94, thus meeting the HP2000 target of 20 percent.
15.10 The prevalence of
overweight has increased among the total population, as well as in several select
population groups. In 1988-94, the age-adjusted prevalence of overweight or obesity
(BMI³25) was 54.9 percent—up from 46 percent in 1976-80 and 1971-74 and 43.3
percent in 1960-62. Among men, the age-adjusted prevalence increased from 48.2 percent in
1960-62 to 59.4 percent in 1988-94; among women, overweight increased from 38.7 percent to
50.7 percent. Among black men and women, the prevalence increased from 43.1 to 56.5
percent and from 57.0 to 65.8 percent, respectively.
15.11 In the past decade, less
than one-quarter of people aged 18-74 engaged in light to moderate physical activity for
at least 30 minutes, 5 or more times per week. The proportion has shown little change
since early in the decade. The HP2000 target is 30 percent.
15.12 The prevalence of
cigarette smoking among people 18 years of age and older decreased from 27 percent in 1992
to 25 percent in 1995. This represents a decrease from 29 to 27 percent in males and from
25 to 23 percent in females. The HP2000 target is 15 percent. For select population groups
aged 18 and over, the highest cigarette smoking prevalence rates in 1995 were—36
percent for blue-collar workers, 35 percent for American Indians/Alaska Natives, and 32
percent for military personnel. The target for each of these groups is 20 percent. In
1995, Blacks aged 18 and over showed a prevalence of 26 percent (target, 18 percent).
Eighteen percent of Hispanics in that age group smoked cigarettes in 1995 (target, 15
percent).
15.14 The overall aim of this
objective is for 75 percent of people aged 18 and over to have had their blood pressure
checked within the preceding 5 years. The most recent year for which these data are
available is 1993, when the proportion was 66 percent. However, the proportion of people
aged 18 and over whose blood pressure had ever been checked increased from 59 percent in
1988 to 75 percent in 1995.
HIGHLIGHTS
- The ongoing Framingham Heart Study, which marked its 50th
anniversary in 1998, has demonstrated that lifestyle-related risk factors, such as high
blood pressure, high blood cholesterol, and smoking, greatly increase the risk of
developing CVD.
- In 1983, two years prior to the start of the National
Cholesterol Education Program, only 35 percent of American adults had their cholesterol
checked. This rose to 75 percent in 1995.
- Recent clinical trials employing one of the statin drugs
(lovastatin, pravastatin, simvastatin) and trials of blood pressure lowering in older
people have provided conclusive evidence that cholesterol and blood pressure lowering
reduces CVD events and deaths and total deaths in people with and without CVD.
- Obesity is a major risk factor for CVD. The recent increase
in the prevalence of obesity in most population groups cannot be ascribed to genetic
changes, but rather to the cumulative effects of inactivity, increased caloric intake, and
environmental changes in the activities of daily living, all of which in combination
create an imbalance in energy expenditure.
- Life insurance companies will reduce premiums to customers
who succeed in lowering their blood pressure.
- Only 50 percent of people who have undergone angioplasty
comply with post-surgical regimens for diet and exercise recommended by their physicians.
- In June 1998, the National Heart, Lung, and Blood Institute
issued Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight
and Obesity in Adults, which provides a new approach for physicians to use in assessing
overweight and establishes principles of safe and effective weight loss.
- While there was a 59 percent decline in the death rate from
CVD between 1950 and 1996, heart disease is still the leading cause of death for adults
over 45.
- The death rate from stroke is nearly 80 percent greater in
Blacks than in Whites. This disparity has not narrowed over the decade.
- The so-called "stroke belt"—formerly a band
of southeastern states with stroke death rates consistently higher than those in the rest
of the country—has shifted in recent years to the north and west of the original
cluster.
- In addition to being a risk factor for CVD and stroke,
hypertension is one of the major causes of end-stage renal disease (ESRD). The incidence
of ESRD due to hypertension appears to have leveled and may be declining, while the
diabetes contribution may be increasing.
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