what is the data telling us?. how big a problem is it? a third of all texas deaths are due to cvd...
Post on 27-Mar-2015
216 Views
Preview:
TRANSCRIPT
What is the data telling us?
How big a problem is it?
• A third of all Texas deaths are due to CVD (2006):– Heart disease: 41,000
– Stroke: 9,900
• Hospitalizations in Texas (2006): >265,000– $11.4 billion
– >$1 million every hour
• Texas adults (2008): have had a heart attack – Men: 4.6% Women: 3.4%
• Texas adults (2008): have had a stroke– Men: 2.2% Women: 2.7%
What can we do about it?
• Prevent risk factors that lead to conditions that lead to heart disease (2008 BRFSS)– Inadequate fruits and vegetables: 74.8% (2007)
– Overweight and obesity: 66.2%
– No physical activity: 28.5%
– Smoking: 18.5%
• Detect & manage conditions leading to heart disease– High cholesterol: 38.5%
– High blood pressure: 27.8%• Poor control, 60+ years: men-36%, women-54%
– Diabetes: 10.3%
– Elevated global CVD risk: aspirin chemoprophylaxis
• Manage heart disease
(NHANES : 1999-2004). (NHANES : 1999-2004). Source: NCHS and NHLBI.Source: NCHS and NHLBI.
52.3
35.8
24.6
62.5
39.8
68.474.6 75.3
34.3
01020304050607080
Awareness Treatment Controlled
Pe
rce
nt
of
Po
pu
lati
on
Wit
h
Hy
pe
rte
ns
ion
20-39 40-59 60+
Extent of awareness, treatment and control of Extent of awareness, treatment and control of high blood pressure by agehigh blood pressure by age
(NHANES: 1999-2004).(NHANES: 1999-2004).Source: NCHS and NHLBI.Source: NCHS and NHLBI.
63.4
37.2
66.9
33.6
49.1
25.1
72.9 76.9
62.4
0
10
20
30
40
50
60
70
80
90
Awareness Treatment Controlled
Pe
rce
nt
of
Po
pu
lati
on
Wit
h
Hy
pe
rte
ns
ion
NH Whites NH Blacks Mexican Americans
Awareness, Treatment and Control of Awareness, Treatment and Control of High Blood Pressure by Race/EthnicityHigh Blood Pressure by Race/Ethnicity
Diabetes Prevalence in Texas, 2007 BRFSS
Race/ethnic group Age Group Prevalence
White 18 to 44 3.0%
African-American 18 to 44 3.7%
Hispanic 18 to 44 6.8%
Other 18 to 44 3.8%
White 45 to 64 10.9%
African-American 45 to 64 17.6%
Hispanic 45 to 64 20.2%
Other 45 to 64 21.1%
Prevalence of Prediabetes or DM, NHANES US
Age PreDM Pre or DM
20 to 39 17.9% 21.1%
40 to 59 30.6% 47.0%
60 to 74 36.8% 66.7%
Pre-Diabetes• Prevalence (20+ years):
– White: 29.3%– Black: 25.1%– Mexican-American: 31.7%
• Among adults with pre-diabetes, the prevalence of cardiovascular (heart) disease risk factors was high: – 94.9% had dyslipidemia (high blood cholesterol); – 56.5% had hypertension (high blood pressure); – 13.9% had microalbuminuria, a protein found in
blood plasma and urine that can signal kidney disease; and
– 16.6% were current smokers.
Diabetes Care, February 2009
Diabetes Prevention• Diabetes prevention studies for persons with
pre-diabetes and overweight/obesity avoids about half of disease onset
• Structured programs that emphasize lifestyle changes and – regular physical activity (150 min/week),– dietary strategies including reduced calories and
reduced intake of dietary fat– include moderate weight loss (7% body weight)
• Individuals at high risk for type 2 diabetes should be encouraged to eat– dietary fiber (14 g fiber/1,000 kcal) and – foods containing whole grains (one-half of grain
intake)
AHA Clinical Performance Measures for Primary Prevention CVD
• Screen: risk factors
• Counsel: healthy eating
• Counsel: regular PA
• Screen: tobacco use
• Tobacco cessation
• Screen: obesity, abd
• Counsel: healthy weight
• Screen: hypertension
• BP control
• Screen: dyslipidemia • LDL control
• Screen: global CVD risk
• Aspirin prophylaxis
Clinical Preventive Services CPB CE Total
Discuss daily aspirin use—men 40+, women 50+ Childhood immunizations Smoking cessation advice and help to quit—adults
555
555
10
Alcohol screening and brief counseling—adults 4 5 9
Colorectal cancer screening—adults 50+ Hypertension screening and treatment—adults 18+ Influenza immunization—adults 50+ Vision screening—adults 65+
4543
4345
8
Cervical cancer screening—women Cholesterol screening and treatment—men 35+, women 45+ Pneumococcal immunizations—adults 65+
453
324
7
High Value Preventive Services
What can we do about it?• A: Avoid tobacco • B: Be more active: 30 minutes of walking
– Improves blood pressure by 4-9 “points”– 75 calories most days: 5 pounds a year
• C: Choose healthier foods: more fiber, less saturated fat, less salt– Improves blood pressure: 10-15 “points”– Improves bad cholesterol: 20 “points”– 10 pound weight loss improves bad
cholesterol by 10 “points”
What can “we” do about it?
• Make healthier choices the easier choices
• More convenient • Lower cost• More access• More support
What can we do about it?
• A: Avoid tobacco
• B: Be more active
• C: Choose healthier foods
• Behavior change is more likely when benefits are likely and quickly visible, and
• Reasons for change are more important than reasons for not changing, and
• Confidence to make the change
Decreasing sodium intake• 60% of adults have elevated blood pressure
• Average intake: 4000 mg (~75% added) 2300 mg
• Adequate intake: 1500 mg for healthy, 19-50 years
• AMA adopts directives at annual meeting 2006
• FDA has been asked to revoke the "generally recognized as safe" status to a “food additive”
– a stepwise 50% reduction
– improve labeling to assist consumers in understanding the amount of sodium
– social marketing for consumer awareness
• 150,000 fewer deaths a year by decreasing hypertension by 20% in ages 25-55 with a 50% reduction in sodium
AHA 2006: Dietary approaches to prevent and treat HTN
• Available data strongly support population-wide recommendations to lower salt intake.
• Consumers should choose foods low in salt and limit the amount of salt added to food.
• However, because >75% of consumed salt comes from processed foods
– any strategy to reduce salt intake must involve the efforts of food manufacturers and restaurants
– should progressively reduce the salt added to foods by 50% over the next 10 years.
Population-based Strategy Effects of Lowering SBP Distributions
Population-based Strategy Effects of Lowering SBP Distributions
Stamler J. Hypertension 1991;17:I-16–I-20. Stamler J. Hypertension 1991;17:I-16–I-20.
Reduction in BPmm Hg
2
3
5
Reduction in BPmm Hg
2
3
5
% Reduction in Mortality % Reduction in Mortality
Reduction in BP
Reduction in BP
After interventionAfter intervention Before interventionBefore intervention
Stroke CHD Total
-6 -4 -3
-8 -5 -4
-14 -9 -7
Copyright ©2006 American Heart Association
Appel, L. J. et al. Hypertension 2006;47:296-308
Mean systolic BP changes in the DASH-Sodium trial
Relative Risk of Developing CHD vs. Systolic Blood Pressure
0
1
2
3
4
5
<110 110-119 120-129 130-139 140-149 150-159 160+
Adju
sted
Rel
ativ
e Ri
sk fo
r CHD
Systolic Blood Pressure
Neaton JD. Arch Int Med 1992; 152:56-64.
Reduce adult obesity
10
12
14
16
18
20
22
24
26
28
30
2000 2001 2002 2003 2004 2005 2006 2007
Year
Per
cen
t o
bes
e
US Texas HP 2010 goal
HP 2010 goal 15%
Reduce adult obesity, Texas, 2007
25.7
38.7
32.7
16.0
25.2
29.2
32.4
23.1
28.628.5
32.2 33.130.7
21.2
35.3
28.3
25.5
28.5
32.0
0
5
10
15
20
25
30
35
40
45
Wh
ite
Afr
Am
His
pan
ic
Oth
er
18
to 2
9
30
to 4
4
45
to 6
4
65+
Ma
le
Fem
ale
< H
igh
Sch
oo
l
Hig
h S
choo
l G
rad
uat
e
Som
e C
olle
ge
Co
lleg
e G
rad
uate
< $
25
,00
0
$25
,000
to
< $
50,
00
0
$50
,000
+
Has
HI
No
HI
Per
cent
ob
ese
HP 2010 goal 15%
Adult obesity, Texas, 2007
23.3 23.3
26.227.7 28.6
29.731.9
33.731.3
0
5
10
15
20
25
30
35
40
45D
all
as-
Pla
no
-Ir
vin
g
Au
stin
-Ro
un
dR
ock
Ho
ust
on
-Su
ga
rL
an
d-B
ay
tow
n
El
Pa
so
Ft.
Wo
rth
-A
rlin
gto
n
Sa
n A
nto
nio
Oth
er M
SA
s
Mic
rop
oli
tan
Ba
lan
ce o
f S
tate
Per
cen
t o
bes
e
HP 2010 goal 15%
Reduce youth obesity, YRBS
0
2
4
6
8
10
12
14
16
18
2001 2003 2005 2007
Year
Per
cent
US Texas HP 2010 goal
HP 2010 goal 5%
Reduce youth obesity Texas 2007 YRBS
0
2
4
6
8
10
12
14
16
18
20
White Black Hispanic Other Male Female
Per
cent
obe
se
HP 2010
goal 5%
Increase adult physical activity
38
40
42
44
46
48
50
52
2001 2003 2004 2005 2007
Year
Per
cent
phy
sica
lly a
ctiv
e
US TX HP 2010 goal
HP 2010 goal 50%
Increase adult physical activity, Texas, 2007
49.7
40.5
44.3
39.7
58.8
47.2
42.9
36.4
47.945.1
38.7
45.047.9
50.6
40.5
45.8
51.8
48.247.3
0
5
10
15
20
25
30
35
40
45
50
55
60
65W
hite
Afr
Am
His
pani
c
Oth
er
18 t
o 29
30 t
o 44
45 t
o 64 65
+
Mal
e
Fem
ale
< H
igh
Scho
ol
Hig
h Sc
hool
Gra
duat
e
Som
e C
olle
ge
Col
lege
Gra
duat
e
< $2
5,00
0
$25,
000
to <
$50
,000
$50,
000+
Has
HI
No
HI
Per
cent
phy
sica
lly a
ctiv
e
HP 2010 goal 50%
Adult adequate physical activity, Texas, 2007
45.7 46.6 47.049.1 49.7 51.0
47.543.4 44.2
0
5
10
15
20
25
30
35
40
45
50
55
60
65D
alla
s-P
lano
-Irv
ing
Ft.
Wor
th-
Arl
ingt
on
Hou
ston
-Su
gar
Lan
d-B
ayto
wn
Aus
tin-
Rou
nd R
ock
El P
aso
San
Ant
onio
Oth
er M
SAs
Mic
ropo
litan
Bal
ance
of
Stat
e
Per
cent
phy
sica
lly a
ctiv
e
HP 2010 goal 50%
Increase youth physical activity, YRBS
40
45
50
55
60
65
70
75
80
85
90
2001 2003 2005 2007
Year
Per
cent
Texas US HP 2010 goal
HP 2010 goal 85%
Increase youth physical activity, Texas 2007 YRBS
0
10
20
30
40
50
60
70
80
90
White Afr Am Hispanic Other Male Female
Per
cent
phy
sica
lly a
ctiv
e
HP 2010 goal 85%
Reduce adult smoking, 2007 BRFSS
0
5
10
15
20
25
30
35
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Per
cent
US Texas HP 2010 goal
HP 2010 goal 12%
Reduce adult smoking – Texas 2007 BRFSS
0
5
10
15
20
25
30W
hite
Afr
ican
Am
His
pani
c
Oth
er
18-2
9
30-3
4
45-6
4
65+
Mal
e
Fem
ale
No
HS
dipl
oma
HS
grad
Som
e co
llege
Col
lege
+
< $2
5K
$25k
to
< $5
0K
$50K
+
Has
HI
No
HI
Per
cen
t cu
rren
t sm
oker
s
HP 2010
goal 12%
Reduce youth tobacco use, YRBS
0
5
10
15
20
25
30
35
1999 2001 2003 2005 2007
Year
Per
cent
US Texas HP 2010 goal
HP 2010 goal 16%
Reduce Texas youth smoking 2007 YRBS
0
5
10
15
20
25
30
35
White Afr Am Hispanic Male Female
Per
cen
t cu
rren
t sm
oker
s
HP 2010
goal 16%
Preventive Services, TX, 2007 BRFSS
• Tobacco smokers
– Advised to quit: 40% (Hispanic 27%)
– Offered NRT: 22% (Hispanic 11%)
• Cholesterol screening, men: 78% (Hispanic 63%)
• Received weight advice
– Obese: 34%
– Overweight: 13%
Smoking
• Smoking costs an estimated $92 billion per year in lost productivity in the US.
– Lost productivity due to smoking and smoking related illnesses cost employers $1,897 per smoking employee per year (2002 dollars)
– If 20% of 250,000 employees smoke (50,000) then the annual loss is over $ 100 M per year
– If 20% of 12,000 employees smoke (2,400) then the annual loss is over $4.5 M per year
Physical Inactivity
• Regular physical activity reduces the risk of developing diabetes, high blood pressure and some cancers and promotes psychological wellbeing.
• Productivity costs in 250,000: $579 M per year
• Productivity costs in 12,000: $27.8 M
http://www.ecu.edu/picostcalc/
Review• CVD
– Common– Costly– Can be prevented
• Environmental change and behavior change– Non-pharmacotherapy is key to prevention and
management of conditions leading to CVD
• Opportunities for improvement• Engage community stakeholders
top related