Heart Disease and Stroke Statistics—2016 Update

Mozaffarian, Dariush; Benjamin, Emelia J.; Go, Alan S.; Arnett, Donna K.; Blaha, Michael J.; Cushman, Mary; Das, Sandeep R; Ferranti, Sarah D. de; Després, Jean; Fullerton, Heather J.; Howard, Virginia J.; Huffman, Mark D.; Isasi, Carmen R.; Jiménez, Monik C.; Judd, Suzanne E.; Kissela, Brett M.; Lichtman, Judith H.; Lisabeth, Lynda D.; Liu, Simin; Mackey, Rachel H.; Magid, David J.; McGuire, Darren K.; Mohler, Emile R.; Moy, Claudia S.; Muntner, Paul; Mussolino, Michael E.; Nasir, Khurram; Neumar, Robert W.; Nichol, Graham; Palaniappan, Latha; Pandey, Dilip K.; Reeves, Mathew J.; Rodríguez, Carlos J.; Rosamond, Wayne D.; Sorlie, Paul D.; Stein, Joel; Towfighi, Amytis; Turan, Tanya N.; Virani, Salim S.; Woo, Daniel; Yeh, Robert W.; Turner, Melanie B.

doi:10.1161/cir.0000000000000350

Cited by 5,022 publications

(3,102 citation statements)

References 1,650 publications

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“…Despite declines in cardiovascular mortality over the past 50 years, cardiovascular disease (CVD) remains the leading cause of death in the United States across all racial and ethnic groups 1. There are significant racial and sex differences in the burden of CVD.…”

Section: Introductionmentioning

confidence: 99%

Trends in Racial/Ethnic Disparities in Cardiovascular Health Among US Adults From 1999–2012

Pool

Ning

Lloyd‐Jones

et al. 2017

JAHA

156

105

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BackgroundIn the United States, there are persistent racial and ethnic disparities in cardiovascular disease morbidity and mortality. National efforts have focused on reducing these disparities; however, little is known about the long‐term trends in racial/ethnic disparities in cardiovascular health (CVH).Methods and ResultsWe included 11 285 adults aged ≥20 years from the National Health and Nutrition Examination Surveys survey cycles 1999/2000 through 2011/2012. CVH includes 7 health factors and behaviors—diet, physical activity, smoking status, body mass index, blood pressure, blood glucose, and total cholesterol—each scored as ideal (2 points), intermediate (1 point), or poor (0 points). Overall CVH is a summation of these scores (range, 0–14) points. Age‐adjusted mean CVH scores were calculated by race/ethnicity (non‐Hispanic black, non‐Hispanic white, or Mexican American) and sex for each survey cycle. Non‐Hispanic black women had significantly lower mean CVH scores as compared with non‐Hispanic white women at each survey cycle (difference=0.93; P=0.001 in 2011/2012) and Mexican‐American women had significantly lower mean score as compared with non‐Hispanic white women at almost all survey cycles (difference=0.71; P=0.02 in 2011/2012). Differences between racial/ethnic groups were smaller for men and were mostly nonsignificant.ConclusionsFrom 1999/2000 to 2011/2012, there were enduring disparities in CVH for non‐Hispanic black and Mexican‐American women as compared with non‐Hispanic white women. Disparities that were present in 1999/2000 were present in 2011/2012, though no racial/ethnic differences became more pronounced over time. These findings provide US nationally representative data to evaluate health factors and behaviors of particular concern regarding racial/ethnic disparities in cardiovascular health.

show abstract

Section: Introductionmentioning

confidence: 99%

Trends in Racial/Ethnic Disparities in Cardiovascular Health Among US Adults From 1999–2012

Pool

Ning

Lloyd‐Jones

et al. 2017

JAHA

156

105

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“…Adjusted cumulative incidence rates for SCD were computed for levels of aggregate risk factor burden for each index age and sex. Significant secular trends in risk factor burden and in rates of overall CVD and CHD death over the last several decades have been notable, with lower overall CVD death rates and generally lower prevalence of elevated or adverse risk factors 3. Therefore, the overall pattern of our results may be more important than the absolute precision of the lifetime risk estimates for more contemporary population samples.…”

Section: Methodsmentioning

confidence: 87%

“…SCD most commonly occurs in those with no previous overt symptoms of cardiovascular disease (CVD) and is an especially important cause of premature deaths 2. Up to 25% of out‐of‐hospital sudden cardiac arrests occur in individuals who were asymptomatic before to the event 3. Most of those who experience SCD have underlying coronary heart disease (CHD), but other variables, such as environmental exposures and gene expression, have been shown to be associated with SCD events 3, 4.…”

Section: Introductionmentioning

confidence: 99%

“…Up to 25% of out‐of‐hospital sudden cardiac arrests occur in individuals who were asymptomatic before to the event 3. Most of those who experience SCD have underlying coronary heart disease (CHD), but other variables, such as environmental exposures and gene expression, have been shown to be associated with SCD events 3, 4. A widely used SCD risk stratification method, classifying based on ejection fraction, often misses patients who ultimately experience SCD, but a better method that accurately predicts patients who will experience SCD over a specified time frame does not exist 2, 5.…”

Section: Introductionmentioning

confidence: 99%

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Lifetime Risk for Sudden Cardiac Death in the Community

Bogle¹,

Ning²,

Mehrotra

et al. 2016

JAHA

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BackgroundSudden cardiac death (SCD) is a leading cause of death in the United States and often occurs without previous cardiac symptoms. Lifetime risk for SCD and the influence of established risk factors on lifetime risks for SCD have not been estimated previously.Methods and ResultsWe followed Framingham Heart Study participants who were free of cardiovascular disease before their earliest examination. SCD was defined as death attributed to coronary heart disease within 1 hour of symptom onset without another probable cause of death, as adjudicated by a panel of 3 physicians. Lifetime risk for SCD was estimated to 85 years of age for men and women, with death attributed to other causes as the competing risk, and stratified by risk factor levels. We followed 2294 men and 2785 women for 160 396 person‐years; 375 experienced SCD. At 45 years of age, lifetime risks were 10.9% (95% CI, 9.4–12.5) for men and 2.8% (95% CI, 2.1–3.5) for women. Greater aggregate burden of established risk factors was associated with a higher lifetime risk for SCD. Categorizing men and women solely by blood pressure levels resulted in a clear stratification of lifetime risk curves.ConclusionsWe present the first lifetime risk estimates for SCD. Greater aggregate risk factor burden, or blood pressure level alone, is associated with higher lifetime risks for SCD. This high risk of premature death attributed to SCD (approximately 1 in 9 men and 1 in 30 women) should serve as a motivator of public health efforts in preventing and responding to SCD.

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“…US adults age <50 years and with diabetes mellitus or a history of stroke represent substantial segments of the US adult population. There are more than 120 million US adults age <50 years, 20 million US adults with diabetes mellitus, and 6 million US adults with a history of stroke 8, 9…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Eligibility Criteria for the Systolic Blood Pressure Intervention Trial in US Adults Among Excluded Groups: Age <50 Years, Diabetes Mellitus, or a History of Stroke

Bress

Tanner

Hess

et al. 2016

JAHA

Self Cite

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BackgroundAdults <50 years old, with diabetes mellitus, or a history of stroke were not enrolled in the Systolic Blood Pressure Intervention Trial (SPRINT). Estimating the size and characteristics of these excluded groups who meet the other SPRINT eligibility criteria may provide information on the potential impact of providers extending the SPRINT findings to these populations.Methods and ResultsWe analyzed the National Health and Nutrition Examination Survey 2003–2012 (n=25 076) to estimate the percentage and characteristics of US adults ≥20 years in 3 populations (age <50 years, diabetes mellitus, or history of stroke) excluded from SPRINT who otherwise meet the trial eligibility criteria: age ≥50 years, systolic blood pressure (SBP) 130–180 mm Hg, high cardiovascular disease risk, and not having trial exclusion criteria. Overall, 1.0% (95% CI 0.8–1.3) of US adults age <50 years, 25.4% (95% CI 23.4–27.6) with diabetes mellitus, and 19.0% (95% CI 16.0–22.4) with history of stroke met the other SPRINT eligibility criteria. Among US adults with SBP ≥130 mm Hg, other SPRINT eligibility criteria were met by 7.5% (95% CI 6.1–9.2) of those age <50 years, 32.9% (95% CI 30.5–35.4) with diabetes mellitus, and 23.0% (95% CI 19.4–27.0) with history of stroke. Among US adults meeting the other SPRINT eligibility criteria, antihypertensive medication was being taken by 31.0% (95% CI 23.9–41.3) of those <50 years, 63.0% (95% CI 58.2–67.6) with diabetes mellitus, and 68.9% (95% CI 59.4–77.1) with a history of stroke.ConclusionsA substantial percentage of US adults with diabetes mellitus or history of stroke and a small percentage <50 years old meet the other SPRINT eligibility criteria.

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Heart Disease and Stroke Statistics—2016 Update

Cited by 5,022 publications

References 1,650 publications

Trends in Racial/Ethnic Disparities in Cardiovascular Health Among US Adults From 1999–2012

Trends in Racial/Ethnic Disparities in Cardiovascular Health Among US Adults From 1999–2012

Lifetime Risk for Sudden Cardiac Death in the Community

Prevalence of Eligibility Criteria for the Systolic Blood Pressure Intervention Trial in US Adults Among Excluded Groups: Age <50 Years, Diabetes Mellitus, or a History of Stroke

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