Heart disease, stroke deaths continue to fall but costs remain high

In Heart Disease and Stroke Statistics -- 2011, published online in Circulation: Journal of the American Heart Association, the association reports that the death rate from heart diseases declined 27.8 percent from 1997 to 2007 (the most recent final data available), and the stroke death rate fell 44.8 percent.

However, during the same period, the total number of inpatient cardiovascular operations and procedures increased 27 percent. The estimated total cost from heart disease and stroke in the United States for 2007 (including health expenditures and lost productivity) was $286 billion. That's higher than any other diagnostic group. In 2008, the estimated cost of all cancer and benign tumors was $228 billion, according to the update.

The trend calls for not only tracking disease, but tracking risk factors and what it takes to remain free of heart disease and stroke, said Véronique L Roger, M.D., M.P.H., lead writer of the report.

"The mortality rate going down is good news; however, the fact that the burden of disease is so high indicates that we may have won a battle against mortality but have not won the war against heart disease and stroke," said Roger, professor of medicine and epidemiology at the Mayo Clinic College of Medicine and chair of health sciences research at the Mayo Clinic in Rochester, Minn. Heart disease and stroke remain among the leading killers of Americans, together accounting for one in every three deaths each year.

"We're seeing a decline in deaths for both, particularly for stroke," Roger said. "We can attribute much of that to improved quality of care, with heart and stroke patients getting the care and treatment they need to live longer. But unfortunately the prevalence of these diseases and their risk factors are still high. We need to energize our commitment to strategies that can prevent disease in the first place."

Of heart disease and stroke risk factors, according to the American Heart Association statistics:

• 33.5 percent of adults 20 years and older in America have high blood pressure; 80 percent are aware of their condition but less than half have their condition under control.
• 23.1 percent of men and 18.1 percent of women are cigarette smokers; 19.5 percent of students in grades 9 through 12 report current tobacco use.
• 15 percent of adults 20 and older have total serum cholesterol levels of 240 mg/dL or higher.
• 8 percent of adults have been diagnosed with diabetes mellitus; 36.8 percent have prediabetes.
• More than 67 percent of adults are overweight.
• During the past 30 years, the prevalence of obesity in children 6 to 11 years has increased from about 4 percent to more than 20 percent.

In future updates, the American Heart Association will track progress toward its 2020 Impact Goal: to improve the cardiovascular health of all Americans by 20 percent while reducing deaths from cardiovascular diseases and stroke by 20 percent.

"Our baseline data related to the 2020 goal in the new update indicate the need for substantial progress in order to meet those goals in the next decade," Roger said. "To achieve improvements in cardiovascular health, all segments of the population will need to focus on improved cardiovascular health behaviors, particularly with regard to diet and weight, as well as increasing physical activity and further reducing the prevalence of smoking."

The new version of the statistical update is the first to include a chapter detailing how family history and genetics play a role in cardiovascular disease risk.

According to the update:

• Parental history of an early heart attack doubles the risk of a heart attack in men and increases the risk in women by about 70 percent.
• Sibling history of heart disease doubles the odds of heart disease in both men and women.

"We make the point in the update that the increased risk of heart disease seen in persons with a family history of a heart attack is likely due in part to shared genetics," Roger said. "The role of genetic factors in the risk of cardiovascular disease will likely be a growing part of the report in the future."