Progress Against Cardiovascular Disease

Abstract

The JAMA theme issue on cardiovascular disease (CVD) recognizes the progress made in CVD but also acknowledges the challenges that remain. On the positive side, from 2000 to 2010 age-adjusted death rates attributable to overall CVD in the United States declined by more than 30%. Yet CVD continued to account for a third (787 650) of the 2.5 million deaths in the United States per year, an average of 1 death every 40 seconds. 1 Worldwide, the picture is more concerning. The incidence of CVD is increasing rapidly in low-or-moderate income countries, and according to current World Health Organization statistics, ischemic heart disease and stroke were the number 1 and number 2 leading causes of death in the world in 2012. 2 With renewed interest in noncommunicable diseases, there has been greater focus on CVD.This theme issue includes reports addressing several important aspects of CVD including atherosclerotic disease, heart failure, valvular heart disease, and atrial fibrillation. For example, in one report from a large observational Swedish heart failure registry, patients with heart failure and preserved ejection fraction (HFPEF) showed possible benefit of β-blocker treatment in reducing all-cause mortality. 3 These observational results suggest a rationale for a clinical trial of β-blockers in HFPEF. Another article describes an unblinded trial of patients with nonvalvular atrial fibrillation at elevated risk for stroke who were followed up for 3.8 years. Compared with patients who received warfarin, those who received percutaneous left atrial appendage closure met criteria for both noninferiority and superiority for preventing the combined outcome of stroke, systemic embolism, and cardiovascular death, as well as superiority for cardiovascular and all-cause mortality. 4 A research letter in this issue shows both positive and negative trends in mortality rates for specific cardiovascular diseases between 2000 and 2010. The report confirms the wellknown statistic that overall CVD mortality remains the leading cause of death in the United States despite major declines in mortality rate, driven mostly by a decrease in coronary heart disease mortality. Less well-recognized, as indicated in the report by Ritchey et al, 5 is the increase in heart disease deaths attributable to hypertensive heart disease and arrhythmia in this same period. As signified by the research reports in this issue, there is good news because of some successes, but substantial ongoing challenges remain. Keeping both sides of the story in focus is necessary to understand the full picture.A prime example of both the promise and problems in addressing CVD has played out this past year in the area of CVD prevention. Since the time of the 2013 JAMA CVD theme is-Opinion

Trends in 10-Year Cardiovascular Disease Risk Among Adults in The United States From 1999–2016

“…Elevated blood lipid levels [21], hypertension [22], elevated blood glucose levels, overweight [23], unhealthy dietary habits, cigarette smoking and insu cient regular exercise were established primary causal factors of CVD [5]. Moreover, the incidence of CVD increased rapidly in low or moderate income countries [7]. It is consistent with our ndings in this study.…”