Southern US remains 25 years behind most heart-healthy states in CVD impact

Large disparities remain in the impact of cardiovascular disease (CVD) around the United States—mostly due to risk factors that can be changed, according to new research published in JAMA Cardiology on April 11.

Overall early death and illness due to CVD decreased across the nation from 1990 to 2016. But significant gaps remained from state to state. Twelve states experienced an increase in CVD burden over the 26-year period.

“We are seeing dangerous disparities among states,” said co-researcher Christopher Murray, MD, PhD, of the Institute of Health Metrics and Evaluation at the University of Washington. “Unless and until leaders of our health care system work together to mitigate risks, such as tobacco, alcohol, and diet, more Americans will die prematurely, and in many cases, unnecessarily.”

States whose residents suffered from increased rates of CVD in 1990 achieved increased rates of healthy life in 2016. The data showed states like Kentucky, West Virginia, Alabama, Arkansas, Louisiana, Tennessee and Oklahoma had similar levels of cardiovascular burden in 2016 as Massachusetts, Connecticut and New Jersey did in 1990.  

More than 80 percent of CVD burden in 2016 could be attributed to 10 modifiable risk factors—dietary risks, high systolic blood pressure, high body mass index, high total cholesterol level, high fasting plasma glucose level, tobacco smoking, low levels of physical activity, air pollution, impaired kidney function, and alcohol use. For nearly all states, diets were responsible for the greatest proportion of age-standardized CVD DALYs.

“As our nation’s demographic makeup becomes more diverse, it will become even more vital to address the social determinants of health,” said Eduardo Sanchez, MD, MPG, of the American Heart Association in an editorial. “This has implications for how healthcare providers counsel and recommend treatment for patients, as well as for advocacy efforts that push for healthy changes in the places people live, work and play.”

Using the Global Burden of Disease methodology, researchers analyzed cardiovascular disease mortality from various causes including rheumatic heart disease, ischemic heart disease, stroke, hypertensive heart disease, and atrial fibrillation.

The total number of CVD-related disability-adjusted life years (DALYs) increased in more than half the states during the study period. The age-standardized rate of CVD DALYs declined in all states during the study period but varied regionally.

Nationally, the CVD DALY rate decreased by 38 percent during the study period—New York saw a decline of 46 percent, while Oklahoma only saw a decline of 22 percent. Mississippi had the highest CVD DALY rate in 2016, while Minnesota had the lowest.