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Understanding Epidemiology of Cardiovascular Diseases

Explore the background, incidence/prevalence, attributes, costs, and interventions related to cardiovascular diseases like CHD, HF, Stroke, and PAD. Discover the impact of CVD on different demographics and regions, global perspectives, adverse behaviors, and economic burden. Learn about primary, secondary, tertiary, and community-level interventions to combat CVD.

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Understanding Epidemiology of Cardiovascular Diseases

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  1. Epidemiology of Cardiovascular Disease EPID 624 – Epidemiology of Chronic Diseases Sara Sigur

  2. Presentation Overview • Background • Incidence/Prevalence • Attributes associated with cardiovascular disease • Costs • Interventions • Current and future research

  3. Background Including incidence/prevalence

  4. Four Main Diseases • Coronary heart disease (CHD) • Heart failure (HF) • Stroke • Peripheral artery disease (PAD)

  5. Coronary Heart Disease • also known as ischemic heart disease, coronary artery disease • attributed to reduced blood flow to the heart • most often caused by atherosclerosis • results in angina (chest pain), myocardial infarction (a.k.a. heart attack), and death

  6. Atherosclerosis • thickening of artery walls —> narrowing of arteries —> decreased blood flow —> increased risk of embolism (blood clot) • factors that contribute to development: • inflammation • calcification • deposit of fat/cholesterol • process begins in childhood; fetal factors may be involved

  7. Incidence of CHD • “Every 43 seconds, someone in the United States has a heart attack” - Center for Disease Control • Every year there are approximately 1.2 million new or recurrent heart attacks in the U.S.

  8. Prevalence of CHD • An estimated 80 million Americans have one or more CVD • CHD accounts for 52% of CVD deaths • death rates from CHD peaked in 1963 and have steadily been decreasing since 1968 • 26% decline in death rates from CVD overall from 1995-2005

  9. Heart Failure • inability of either left or right ventricle to properly fill with or eject blood secondary to damaged or weakened heart muscles • shortness of breath + fatigue —> decreased exercise tolerance + fluid retention —> pulmonary and peripheral edema —> decreased quality of life • left vs right heart failure

  10. Incidence and Prevalence of HF • Approximately 25% of men and 45% of women will develop HF within 6 years of having a heart attack • HF is the one CVD that is increasing in incidence, prevalence, and mortality • CVD is the leading cause of disability in the U.S.

  11. Attributes associated with CVD

  12. Race/Ethnicity - CVD - leading cause of death in U.S. for whites, blacks, and American Indians - Age-adjusted CVD mortality rates (per 100,000) • 438 for African American men • 325 for white men • 319 for AA women • 230 for white women - Hispanics and Asian Americans appear to be at lower risk of heart disease and stroke mortality than whites http://www.cdc.gov/heartdisease/family_history.htm

  13. Age • Mortality greater among older adults • increases independent of other known risk factors • 55% of heart attacks are in those 65+; 85% of deaths from MI are in those 65+ • CHD incidence rates in women after menopause are 2-3x higher than those women pre-menopausal of the same age

  14. Sex • Age-adjusted mortality 45% higher in men • Still leading cause of death in U.S. women • CHD incidence for women lags behind men by 10 years

  15. Geography http://www.cdc.gov/dhdsp/maps/national_maps/hd_hospitalization_all.htm

  16. http://www.cdc.gov/dhdsp/maps/national_maps/hd65_all.htm

  17. http://www.cdc.gov/dhdsp/maps/sd_poverty.htm

  18. Socioeconomic Status • CHD incidence and mortality higher in those of lower SES • so far, greatest decline in CHD mortality has been seen in white men/women with the highest levels of education/income • living in “deprived” neighborhoods linked with increased risk factors

  19. Global Perspective • Mortality rates remain higher in U.S. than many other industrialized nations • 2020 Projections: • Latin America, the Middle East, and sub-Saharan Africa will have 3x the occurrence of heart disease from 1990-2020 • rates in developing countries will increase 120% for women, 137% for men

  20. Adverse Behaviors • Poor diet • Lack of physical activity • Smoking • Alcohol consumption All which can contribute to…obesity, diabetes, high blood pressure, high cholesterol

  21. Cost • $151.6 billion = 2004 estimated cost of medical care, lost earnings, and lost productivity • $475 billion = 2009 estimated direct and indirect costs of CVD per AHA • HF specifically - high hospitalization rates and poor prognosis, strain on Medicare • 3 most prominent factors influencing economic burden: • revascularization procedures • hospital care • prescription medications http://www.commed.vcu.edu/Chronic_Disease/Heart/prevstrat_21Cent.pdf

  22. http://www.commed.vcu.edu/Chronic_Disease/2010/orprevhtataglance.pdfhttp://www.commed.vcu.edu/Chronic_Disease/2010/orprevhtataglance.pdf

  23. Interventions Primary, secondary, tertiary, community-level

  24. Primary Prevention • Control of modifiable risk factors • decrease cholesterol/systolic BP/smoking/physical inactivity • recent efforts in this area have accounted for 44% decline in CHD mortality • efforts partially offset by increases in BMI and diabetes • Environmental changes • Million Hearts Initiative http://www.commed.vcu.edu/Chronic_Disease/Heart/2012/cvsnatpolicy.pdf

  25. http://millionhearts.hhs.gov/about-million-hearts/million-hearts.htmlhttp://millionhearts.hhs.gov/about-million-hearts/million-hearts.html

  26. Secondary Prevention • Screening for high blood pressure/cholesterol • Electrocardiograms for high risk individuals

  27. Tertiary Prevention • Revascularization - stents, coronary artery bypass grafts • Cardiac rehab - prevention of complications through diet, exercise, weight control, and smoking cessation • Medications - statins, diuretics, beta blockers • Mechanical assist devices - pacemakers, LVAD

  28. Community-level • use education and environmental changes to promote positive lifestyle and behavior changes • North Karelia Project • began in 1972 • studied risk factor interventions • interventions directed at the media and food producers/distributors

  29. http://www.commed.vcu.edu/Chronic_Disease/Heart/2014/commguideAHA2013.pdfhttp://www.commed.vcu.edu/Chronic_Disease/Heart/2014/commguideAHA2013.pdf

  30. Healthy People 2020 • Many goals related to heart disease, including: • reduce proportion of adults with hypertension (from 29.9 to 26.9%) • reduce proportion of adults with high total blood cholesterol levels (from 15.0 to 13.5%) https://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke/objectives?topicId=21

  31. ResearchCurrent/Future/Issues

  32. Framingham Heart Study • began in 1948, conducted by National Heart Institute • primary aim: identify factors and characteristics contributing to CVD • enrolled ~5,200 men and women with no overt signs/symptoms of disease, examining them every two years • allowed for the identification of key risk factors http://www.framinghamheartstudy.org/about-fhs/history.php

  33. Gene/Stem Cell Therapy • Interest in using both therapies to aid in repair of damaged tissue • controversial • needs further study in humans http://www.commed.vcu.edu/Chronic_Disease/Heart/2012/cvschallenges2011.pdf

  34. Link Between Cholesterol and CVD • Landmark study published in 1966 • Looked at link between HDL and heart disease • Importance of looking to past research to advance current knowledge • http://www.commed.vcu.edu/Chronic_Disease/Heart/revisiitingpastrsch.pdf

  35. Cholesterol in Children • Report from National Center for Health Statistics analyzing data from NHANES • Children 6-19 years old • Key findings: • Approximately 1/5 children and adolescents had at least one abnormal cholesterol measure (high total cholesterol, low HDL cholesterol, or high non-HDL cholesterol) • Those who were obese had 5x prevalence of low HDL levels compared to normal weight • American Academy of Pediatrics recommends monitoring cholesterol in all children • Long-term monitoring may inform public health interventions and prevent CVD as an adult http://www.cdc.gov/nchs/data/databriefs/db228.htm

  36. Diet Considerations • U.S. Dietary Guidelines Advisory Committee released 2015 Dietary Guidelines recommendations • May see dietary cholesterol removed from list of “nutrients of concerns” • Eliminate a limit on total fat consumption • type more important that quantity • http://www.commed.vcu.edu/Chronic_Disease/Heart/2016/BMJEditFoodObj.pdf

  37. Gaps in Knowledge • Role of genetics - inflammatory biomarkers and signaling pathways • Public health implementation science - role of social networks, transportation, media, etc. • more community-based studies needed • Population-based prevention research • especially for minority populations, women/children http://www.commed.vcu.edu/Chronic_Disease/Heart/2012/cvsnatpolicy.pdf

  38. Gaps, cont. • Understanding of causes of HF is still not well known; prognosis still very poor • Optimal range for BP meds and lipid-lowering meds still unclear • too lenient vs too aggressive http://www.commed.vcu.edu/Chronic_Disease/Heart/2012/cvschallenges2011.pdf

  39. Other Road Blocks • Delayed clinical implementation • ability to understand applicability of new findings/technologies • beta blockers - routinely prescribed 25 years after publication of definitive randomized trials on their benefits for post MI survivors • COST • of research itself - difficult and expensive to conduct large-scale randomized trials • of different primary prevention methods - prescribing more meds does not seem to be cost effective • Current agricultural policies http://www.commed.vcu.edu/Chronic_Disease/Heart/2012/cvschallenges2011.pdf http://www.commed.vcu.edu/Chronic_Disease/Heart/2012/cvsnatpolicy.pdf

  40. http://www.commed.vcu.edu/Chronic_Disease/Heart/2015/altresearchstrat..pdfhttp://www.commed.vcu.edu/Chronic_Disease/Heart/2015/altresearchstrat..pdf

  41. References Remington, P. L., Brownson, R. C., & Wegner, M. V. (2010). Chronic disease epidemiology and control. Washington, DC: American Public Health Association.

  42. Questions?

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