Rates of CVD in the U.S. are climbing for the first time in decades, the American Heart Association announced Jan. 31 in its annual heart and stroke statistical update. The organization also said nearly half of the adult U.S. population has some form of heart disease.
The alarmingly high statistic of Americans living with CVD—48 percent, as reported by the AHA—was driven mostly by a shift in the definition of hypertension, the authors of the Circulation report said. In 2017, the AHA and American College of Cardiology redefined high blood pressure as a reading of 130/80 mmHg, a lower threshold than the previous standard of 140/90 mmHg.
In the report, cardiovascular disease was defined as coronary heart disease, heart failure, stroke or high blood pressure. When the authors excluded hypertension from the analysis, the prevalence of CVD in the U.S. was 9 percent.
“That might seem like good news, but 9 percent of the U.S. adult population represents more than 24.3 million Americans with coronary artery disease, heart failure or stroke,” Mariell Jessup, MD, chief science and medical officer at the AHA, wrote in a statement Jan. 31. “As you can imagine, the economic costs associated with these diseases are astronomical: the average annual cost (direct and indirect) of CVD and stroke in the United States was an estimated $351.2 billion in 2014-15.”
Those costs are also expected to increase slightly for middle-aged adults and sharply for seniors between 2015 and 2035, she said.
The AHA report pointed out that while annual CVD deaths on are the rise in America—they increased from 836,546 in 2015 to 840,678 in 2016—that isn’t the case globally. Worldwide, 17.9 million people died from cardiovascular disease in 2015, and 17.6 million died in 2016.
“Comparing health-adjusted life expectancy in different U.S. regions and other countries can help us identify health disparities and provide guidance for investing resources and implementing initiatives to improve health and achieve health equities,” Jessup said. “And that’s why—as we pursue longer, healthier lives for all—regularly assessing our progress with meaningful measures is critical.”
The report stated a large portion of CVD in the country is attributable to dietary risk, high systolic blood pressure, smoking, high body mass index (BMI), high total cholesterol, high fasting plasma glucose and low levels of physical activity. The authors estimated 47 percent of all Americans have at least one of the three well-established key risk factors for CVD, including high blood pressure, high cholesterol and smoking, and in 2005 high BP was the single largest risk factor for CV mortality in the U.S.
There’s good news, too, though—smoking rates are falling and the proportion of Americans engaging in physical activity is trending upward. The percentage of 12- to 17-year-olds who reported smoking in the past month dropped by two-thirds over the past 14 years (from 13 percent in 2002 to 3.4 percent in 2016), and in the past 50 years the number of adults who smoke decreased, too. Compared to 1965, at which point 51 percent of males reported smoking, just 16.7 percent said they smoked in 2015; the rate in women fell from 34 percent to 13.6 percent during the same time period.
Physical inactivity has decreased by more than a third, from 40.2 percent in 2005 to 26.9 percent in 2016, and more than half of students now say they participate in muscle-strengthening activities at least three days a week. Still, that might not be enough to combat obesity, which affects the lives of 39.6 percent of adults and 18.5 percent of kids and adolescents.
“There are no quick fixes to help more Americans achieve a healthy weight,” Jessup wrote. “The changes in culture, environments and policies that can improve our food and physical activity choices can take years to implement, and the status quo may be resistant to change. We must be steadfast in pursuing these changes to make communities safer, more walkable and bike-friendly.”
Read the full statistical update here.