Three major medical studies released within the last 10 days demonstrate that while Americans have created the most technology-intensive health care system in existence, “old” diseases are still creating “new” problems. Two of these studies are, to an extent, interrelated in that both report on the prevalence of coronary heart disease (CHD, the type of heart disease that is usually due to blockages in the arteries that supply oxygen to the heart muscle). The third study indicates that the incidence of autism and “autism-spectrum” disorders may be increasing and that up to 1.5% (15 put 0f 100) of children entering school for the first time may be affected by these conditions. Each of these reports will be discussed on Associated Content beginning with this article, which reviews the report concerning the overall occurrence of heart disease on a state-by-state basis. The report concerning the newest evidenced-based guidelines for the prevention of heart disease in women will be presented in the second portion of this article.
Terms and Abbreviations Used
Angina: angina pectoris, the specific type of chest pain that is known to be associated with CHD and CVD.
CHD: Coronary Heart Disease, a medical condition that is related to the development of blockages inside the arteries that carry oxygen to the heart muscle. CHD may produce symptoms such as angina pectoris (“angina”).
CVA: Cerebro-vascular Accident, a “stroke.”
CVD: Cardio-Vascular Disease, medical conditions that involve the heart and/or blood vessels, including CHD, peripheral arterial disease, and CVA (“stroke”).
MI: Myocardial Infarction, “heart attack.”
I. The Prevalence of Heart Disease, United States, 20051
According to a report in the February 14th edition of the Centers for Disease Control (CDC) and Prevention’s Morbidity and Mortality Weekly Report entitled “Prevalence of Heart Disease, United States, 2005” the number of active cases of coronary heart disease (patients under medical care for confirmed or suspected coronary heart disease) may have been underestimated in past. The study notes that while valuable data relating to the incidence of coronary heart disease within defined ethnic, socioeconomic, or geographic subgroups has proven to be a vital factor in past efforts to combat this disease as the leading cause of death within the United States, the available data was subject to a potential major flaw: the data obtained was based on the number of deaths attributed to coronary heart disease without a provision for estimating the number of people living with the same diagnosis.
The CDC addressed this shortcoming by designing and implementing a modification to the survey questions used in the Behavioral Risk Factor Surveillance System, usually referred to as the BRFSS, which is the longest continually-operational “telephone health survey system, tracking health conditions and risk behaviors in the United States yearly since 1984.2 ” At the beginning of the reported study, the questionnaire was modified to include basic questions related to the presence of known or suspected CAD. The major findings for the year 2005 were reported as follows.
· 4.0% reported a history of MI, and 4.4% reported a history of angina/CHD
· 6.5% of respondents reported a history of one or more of MI, angina/CHD, or both. Men reported a significantly higher prevalence of MI than did women (5.5% versus 2.9%), angina/CHD (5.5% versus 3.4%), and one or more of these conditions (8.2% versus 5.0%).
· The prevalent history of MI, angina/CHD, and one or more of these conditions increased among successive age groups and decreased with higher education. Of persons with less than a high school diploma, 9.8% reported a history of one or more of the conditions, nearly twice the proportion among college graduates (5.0%).
· American Indians/Alaska Natives and multiracial persons (as distinct subgroups of the study population) had substantially higher incidences of MI, angina/CHD, and one or more of these conditions than did non-Hispanic whites.
· The reported incidences of all of these conditions among whites and blacks were similar.
II. Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update3
The opening paragraph of “Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women” should be chiseled into the facade over the entrance to every emergency department in the country.
“Worldwide, cardiovascular disease (CVD) is the largest single cause of death among women, accounting for one third of all deaths. In many countries, including the United States, more women than men die every year from CVD, a fact largely unknown to physicians…”
This same report goes on to state that the overall cost (direct and indirect, such as lost productivity etc.) of CVD among women in the United States is estimated to be $403 billion versus $190 billion for cancer or $29 billion for human immunodeficiency virus. Obviously, any interventions that impacted the natural history of CVD in women could have important long term benefits. That is the stated goal of these guidelines.
The guidelines were developed using the statistical principles known as meta-analysis. This involved reviewing the results of numerous previously published studies related to some facet of women’s cardiac health such as risk factors or exercise. These studies were then evaluated in terms of their impact on reducing some known risk factor or complication related to CVD in women.
It would be difficult, at best, to summarize the findings of this study. Instead, only the activities and lifestyle changes that can be implemented by individual initiative will be covered further.
1) Cigarette Smoking:
The authors of the Guidelines found that cigarette smoking was a major contributing factor in either the future development of CVD or the worsening of symptoms among those who continued to smoke after a significant cardiovascular event. The guidelines call for a complete cessation of smoking and avoidance of environmental tobacco smoke.
The Guidelines specifically state that “Women should accumulate a minimum of 30 minutes of moderate-intensity physical activity (e.g. brisk walking) on most, and preferably all, days of the week.” For women needing to lose weight, the Guidelines call for at least 60-90 minutes of such activity whenever possible and also preferably daily.
3) Dietary Intake:
Women should consume a diet rich in fresh fruits and vegetables and low in fats and fatty acids, particularly trans-fatty acids. Total cholesterol intake should be less than 300mg per day. There are numerous dietary guides presented free of charge via the Internet and the reader is encouraged to view a number of these for further guidance.
In closing, the readers of this article are strongly encouraged to review the information provided on the web pages and other resources4 cited in the references below.
This writer has 2 very good reasons (in his anything but humble opinion) for constantly calling attention to the staggering impact of heart disease on everything from Medicare premium charges to state taxation policies: 1) I have both coronary and peripheral arterial disease and 2), I’m doing what little I can do to prevent as many people as possible from joining me in this definitely unfavorable life style.
If we can just remember that heart disease among women is becoming a preventable disease, both of the above-mentioned reports could make a significant impact regarding reason #2.
References / For More Information
1. JR Neyer, KJ Greenlund, CH Denny, NL Keenan, DR Labarthe et al: Prevalence of Heart Disease — United States, 2005. Weekly Morbidity and Mortality Report: February 16, 2007 / 56(06); 113-118, Centers for Disease Control and Prevention. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5606a2.htm Last accessed February 21, 2007.
2. National Center for Chronic Disease Prevention and Health Promotion: The Behavioral Risk Factor Surveillance System. Available at http://www.cdc.gov/brfss/index.htm Last accessed February 21, 2007.
3. Lori Moscar, Chair, et al: Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women. Circulation: Online Rapid Access Edition DOI 10.1161 CIRCULATIONAHA.107.181546. Available online at http://circ.ahajournals.org/rapidaccess.shtml Last accessed February 21, 2007.
4. Centers for Disease Control and Prevention: WISEWOMAN (Well-integrated Screening and Evaluation for Women Across the Nation) ™ home pages. DHHS/CDC Available at http://www.cdc.gov/wisewoman/ Last accessed on February 21, 2007.
The information presented in this article and its included links is of an informational nature only and is not intended as a recommendation of any changes in the reader’s health care program. Before making any changes in diet, medications, or other treatments the reader is strongly advised to consult with their health care provider.