Matthew Ritchey

Heart Disease and Stroke Statistics'2017 Update: A Report from the American Heart Association

WRITING GROUP MEMBERS Emelia J. Benjamin, MD, SCM, FAHA Michael J. Blaha, MD, MPH Stephanie E. Chiuve, ScD Mary Cushman, MD, MSc, FAHA Sandeep R. Das, MD, MPH, FAHA Rajat Deo, MD, MTR Sarah D. de Ferranti, MD, MPH James Floyd, MD, MS Myriam Fornage, PhD, FAHA Cathleen Gillespie, MS Carmen R. Isasi, MD, PhD, FAHA Monik C. Jiménez, ScD, SM Lori Chaffin Jordan, MD, PhD Suzanne E. Judd, PhD Daniel Lackland, DrPH, FAHA Judith H. Lichtman, PhD, MPH, FAHA Lynda Lisabeth, PhD, MPH, FAHA Simin Liu, MD, ScD, FAHA Chris T. Longenecker, MD Rachel H. Mackey, PhD, MPH, FAHA Kunihiro Matsushita, MD, PhD, FAHA Dariush Mozaffarian, MD, DrPH, FAHA Michael E. Mussolino, PhD, FAHA Khurram Nasir, MD, MPH, FAHA Robert W. Neumar, MD, PhD, FAHA Latha Palaniappan, MD, MS, FAHA Dilip K. Pandey, MBBS, MS, PhD, FAHA Ravi R. Thiagarajan, MD, MPH Mathew J. Reeves, PhD Matthew Ritchey, PT, DPT, OCS, MPH Carlos J. Rodriguez, MD, MPH, FAHA Gregory A. Roth, MD, MPH Wayne D. Rosamond, PhD, FAHA Comilla Sasson, MD, PhD, FAHA Amytis Towfighi, MD Connie W. Tsao, MD, MPH Melanie B. Turner, MPH Salim S. Virani, MD, PhD, FAHA Jenifer H. Voeks, PhD Joshua Z. Willey, MD, MS John T. Wilkins, MD Jason HY. Wu, MSc, PhD, FAHA Heather M. Alger, PhD Sally S. Wong, PhD, RD, CDN, FAHA Paul Muntner, PhD, MHSc On behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart Disease and Stroke Statistics—2017 Update

Heart Disease and Stroke Statistics—2018 Update: A Report From the American Heart Association

Each chapter listed in the Table of Contents (see next page) is a hyperlink to that chapter. The reader clicks the chapter name to access that chapter. Each chapter listed here is a hyperlink. Click on the chapter name to be taken to that chapter. Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together in a single document the most up-to-date statistics related to heart disease, stroke, and the cardiovascular risk factors listed in the AHA’s My Life Check - Life’s Simple 7 (Figure1), which include core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure [BP], and glucose control) that contribute to cardiovascular health. The Statistical Update represents …

Trends in mortality rates by subtypes of heart disease in the United States, 2000-2010.

Methods | Mortality data were obtained from the US Centers for Disease Control and Prevention WONDER database, which contains death certificate information collected, via the National Vital Statistics System, from every US state and the District of Columbia.2 Deaths were included that occurred during 20002010 among US residents aged 35 years or older with an underlying cause of death International Classification of Diseases, Tenth Revision code for CHD, heart failure, hypertensive HD (HHD), valvular HD, arrhythmia, pulmonary HD, or other HD (Table). This study was determined to be exempt from review by an institutional review board. Each HD subtype’s percentage contribution to total HD deaths was calculated by age group. Mortality rates were direct age standardized to the 2000 US standard population2 and stratified by subtype, sex, non-Hispanic white and nonHispanic black, and age group; temporal trends were characterized by fitting log-linear regression models using Joinpoint software version 4.0.1 (National Cancer Institute).3 Joinpoint identifies trend breaks if significant variation in trends exist (P < .05).3 The slopes of the models were used to calculate annual percent change (APC) for each trend segment and the average APC (AAPC), which is the weighted average of the APCs. Statistical significance of AAPCs compared with the null hypothesis (slope = 0) and differences among groups were assessed (P < .05).3 All statistical tests were 2-sided.

Predicted 10-Year Risk of Developing Cardiovascular Disease at the State Level in the U.S.

BACKGROUND Cardiovascular disease (CVD) is the leading cause of death in the U.S. State-specific predicted 10-year risk of developing CVD could provide useful information for state health planning and policy. PURPOSE To estimate state-specific 10-year risk of developing CVD. METHODS Using the updated non-laboratory-based Framingham CVD Risk Score (RS), this study estimated 10-year risk of developing CVD; coronary heart disease (CHD); and stroke, stratified by demographic factors and by state among 2009 Behavioral Risk Factors Surveillance System participants aged 30-74 years. Data analysis was completed in June 2014. RESULTS The age-standardized mean CVD, CHD, and stroke RSs for adults aged 30-74 years were 14.6%, 10.4%, and 2.3% among men, respectively, and 7.5%, 4.5%, and 1.8% among women. RSs increased significantly with age and were highest among non-Hispanic blacks, those with less than high school education, and households with incomes <

Vital Signs: Predicted Heart Age and Racial Disparities in Heart Age Among U.S. Adults at the State Level.

35,000. State-specific age-standardized CVD, CHD, and stroke RS ranged, among men, from lows in Utah (13.2%, 9.6%, and 2.1%, respectively) to highs in Louisiana (16.2%, 11.7%, and 2.6%), and among women, from lows in Minnesota (6.3%, 3.8%, and 1.5%) to highs in Mississippi (8.7%, 5.3%, and 2.1%). CONCLUSIONS The predicted 10-year risk of developing CVD varies significantly by age, gender, race/ethnicity, educational attainment, household income, and state of residence. These results support the development and implementation of targeted prevention programs by states to address the risk of developing CVD, CHD, and stroke among their populations.

Plasma trans-Fatty Acid Concentrations Continue to Be Associated with Serum Lipid and Lipoprotein Concentrations among US Adults after Reductions in trans-Fatty Acid Intake

INTRODUCTION Cardiovascular disease is a leading cause of morbidity and mortality in the United States. Heart age (the predicted age of a persons vascular system based on their cardiovascular risk factor profile) and its comparison with chronological age represent a new way to express risk for developing cardiovascular disease. This study estimates heart age and differences between heart age and chronological age (excess heart age) and examines racial, sociodemographic, and regional disparities in heart age among U.S. adults aged 30-74 years. METHODS Weighted 2011 and 2013 Behavioral Risk Factor Surveillance System data were applied to the sex-specific non-laboratory-based Framingham risk score models, stratifying the results by age and race/ethnic group, educational and income level, and state. These results were then translated into age-standardized heart age values, mean excess heart age was calculated, and the findings were compared across groups. RESULTS Overall, average predicted heart age for adult men and women was 7.8 and 5.4 years older than their chronological age, respectively. Statistically significant (p<0.05) racial/ethnic, sociodemographic, and regional differences in heart age were observed: heart age among non-Hispanic black men (58.7 years) and women (58.9 years) was greater than other racial/ethnic groups, including non-Hispanic white men (55.3 years) and women (52.5 years). Excess heart age was lowest for men and women in Utah (5.8 and 2.8 years, respectively) and highest in Mississippi (10.1 and 9.1 years, respectively). CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE The predicted heart age among U.S. adults aged 30-74 years was significantly higher than their chronological age. Use of predicted heart age might 1) simplify risk communication and motivate more persons to live heart-healthy lifestyles and better comply with recommended therapeutic interventions, and 2) motivate communities to implement programs and policies that support cardiovascular health.

Association of Antihypertensive Medication Adherence With Healthcare Use and Medicaid Expenditures for Acute Cardiovascular Events.

Background: High intakes of trans-fatty acids (TFAs), especially industrially produced TFAs, can lead to unfavorable lipid and lipoprotein concentrations and an increased risk of cardiovascular disease. It is unknown how this relation might change in a population after significant reductions in TFA intake.Objective: This study, which used a new analytical method for measuring plasma TFA concentrations, clarified the association between plasma TFA and serum lipid and lipoprotein concentrations before and after the US FDA enacted TFA food-labeling regulations in 2006.Methods: Data were selected from the NHANES of 1999-2000 and 2009-2010. Findings on 1383 and 2155 adults, respectively, aged ≥20 y, were evaluated. Multivariable linear regressions were used to examine the associations between plasma TFA concentration and lipid and lipoprotein concentrations. The outcome measures were serum concentrations of total cholesterol (TC), LDL cholesterol, HDL cholesterol, and triglycerides and the ratio of TC to HDL cholesterol.Results: The median plasma TFA concentration decreased from 80.6 μmol/L in 1999-2000 to 37.0 μmol/L in 2009-2010. Plasma TFA concentration continued to be associated with serum lipid and lipoprotein concentrations after significant reductions in TFA intake in the population. For example, by comparing the lowest with the highest quintiles of TFA concentration in 1999-2000, adjusted mean (95% CI) LDL-cholesterol concentrations increased from 118 mg/dL (112, 123 mg/dL) to 135 mg/dL (130, 141 mg/dL) (P-trend < 0.001). The corresponding values for 2009-2010 were 102 mg/dL (97.4, 107 mg/dL) and 129 mg/dL (125, 133 mg/dL) for LDL cholesterol (P-trend < 0.001). Differences between the highest and lowest quintiles were consistent across age groups, sexes, races/ethnicities, and other covariates.Conclusions: Despite a 54% reduction in plasma TFA concentrations in US adults from 1999-2000 to 2009-2010, concentrations remained significantly associated with serum lipid and lipoprotein concentrations. There does not appear to be a threshold under which the association between plasma TFA concentration and lipid profiles might become undetectable.

Hypertension Control Cascade: A Framework to Improve Hypertension Awareness, Treatment, and Control.

Objectives:We assessed the impact of antihypertensive medication (AHM) adherence on the incidence and associated Medicaid costs of acute cardiovascular disease (CVD) events among Medicaid beneficiaries. Methods:The study cohort (n=59,037) consists of nonelderly adults continuously enrolled (36 mo and above) in a Medicaid fee-for-service program. AHM adherence was calculated using the medication possession ratio (MPR) and stratified to low (MPR<60%), moderate (60%⩽MPR<80%), and high (MPR≥80%) levels. We used a proportional hazard model to estimate risk for acute CVD events and generalized linear models to estimate Medicaid per-patient-per-year costs. Results:Low and moderate adherence subgroups had about 1.8 and 1.4 times higher risk of acute CVD events, compared with high adherence subgroup. By adherence level, Medicaid per-patient per-year costs for (1) CVD-related emergency department visits and hospitalizations were

Medication Adherence and Incident Preventable Hospitalizations for Hypertension

661 (low),

Lead Poisoning Among Burmese Refugee Children—Indiana, 2009

479 (moderate), and