Trends and Disparities in Coronary Heart Disease, Stroke, and Other Cardiovascular Diseases in the United States

Abstract

Abstract-A workshop was held September 27 through 29, 1999, to address issues relating to national trends in mortality and morbidity from cardiovascular diseases; the apparent slowing of declines in mortality from cardiovascular diseases; levels and trends in risk factors for cardiovascular diseases; disparities in cardiovascular diseases by race/ethnicity, socioeconomic status, and geography; trends in cardiovascular disease preventive and treatment services; and strategies for efforts to reduce cardiovascular diseases overall and to reduce disparities among subpopulations. The conference concluded that coronary heart disease mortality is still declining in the United States as a whole, although perhaps at a slower rate than in the 1980s; that stroke mortality rates have declined little, if at all, since 1990; and that there are striking differences in cardiovascular death rates by race/ethnicity, socioeconomic status, and geography. Trends in risk factors are consistent with a slowing of the decline in mortality; there has been little recent progress in risk factors such as smoking, physical inactivity, and hypertension control. There are increasing levels of obesity and type 2 diabetes, with major differences among subpopulations. There is considerable activity in population-wide prevention, primary prevention for higher risk people, and secondary prevention, but wide disparities exist among groups on the basis of socioeconomic status and geography, pointing to major gaps in efforts to use available, proven approaches to control cardiovascular diseases. Recommendations for strategies to attain the year 2010 health objectives were made. Key Words: cardiovascular diseases Ⅲ epidemiology Ⅲ prevention T he 20th century witnessed dynamic, worldwide changes in cardiovascular disease (CVD) mortality, including death from coronary heart disease (CHD), stroke, and other CVDs. Many Western countries documented a rise in mortality from CVD until the 1960s and 1970s, with substantial declines since those peaks. Other parts of the world have shown different patterns, including high rates of CVD mortality in Eastern Europe that continue to rise and an ominous epidemic of CHD and stroke emerging in developing countries. 1 In the United States, recent evidence has suggested that the decline in CHD mortality since the late 1960s has slowed. This may be especially true in specific subgroups (defined by socioeconomic status, race or ethnicity, and region), whose declines have lagged. This has led to relatively higher CVD rates, which constitute a major challenge to reaching the Healthy People 2010 Objectives set for the American people. 2 The causes of these disparities in CVD burden are primarily environmental and likely include differences in CVD risk factors, lifestyle, and the availability and use of primary and secondary preventive services.The National Conference on CVD Prevention was a transagency conference convened at the encouragement of the US Congress 3 from September 27 through 29, 1999, in Bethesda, Maryland to as...

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