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• W2328766729 abstract "Healthcare costs are skyrocketing, and cardiovascular disease (CVD), the leading cause of death, constitutes almost one-fifth of healthcare expenditures in the United States.1 Despite 4 decades of declines in age-standardized CVD and stroke death rates, the burden of CVD and stroke in terms of life-years lost, diminished quality of life, and direct and indirect medical costs remains enormous.2 In fact, in the past 10 years, the medical costs of CVD have increased at an average annual rate of 6%.3 Downward shifts in population levels of cholesterol, blood pressure, and smoking alongside broader use of effective treatments among persons with existing CVD have contributed to decline in CVD deaths.2 However, these improvements have been offset by increasing prevalence of obesity and diabetes.2 To guide CVD prevention and health promotion efforts, future prevalence and medical costs of hypertension, coronary heart disease (CHD), heart failure, stroke, and all other CVDs from 2010 to 2030 were forecasted.4 The projections serve to illustrate what is likely to happen to CVD prevalence and costs if no change to current policy is made and no further action is taken to reduce the disease and economic burden of CVD.4 Based on data from the nationally representative National Health and Nutrition Examination Survey (NHANES) 1999–2006, the prediction model assumed no change in policy but did reflect changing demographics over time. People older than 65 years (especially those >80 years) have a higher prevalence of all CVDs, and this population segment will grow significantly in the next 2 decades. These increases translate to an additional 27 million people with hypertension, 8 million with CHD, 4 million with stroke, and 3 million with heart failure in 2030 relative to 2010.4 By 2030, 40.5% of the US population is projected to have some form of CVD. Between 2010 and 2030, the total direct medical costs of CVD are projected to triple, from $272.5 billion to more than $818 billion. In the same period, indirect costs for all CVDs due to morbidity and premature mortality are estimated to increase from $171.7 billion to $275.8 billion. By 2030, this adds up to a projected total cost of CVD, including direct and indirect costs, exceeding $1 trillion! The aging of the population, along with the growth in per capita medical spending, is the primary driver of increased CVD costs, which are expected to grow fastest for those 65 years or older.4 Heidenreich et al4 warn that the prevalence of CVD will increase by approximately 10% in the next 20 years under status-quo CVD prevention and treatment trends, whereas the direct costs will increase almost 3-fold. The data also indicate that non-Hispanic blacks will continue to bear a disproportionate burden of morbidity and mortality attributable to CVD. These projections assume no change in policy over the time period but do reflect the demographics of an aging population and a relative increase in the proportion of Hispanic individuals. To make matters worse, if diabetes and obesity prevalences continue to rise dramatically, we likely will see an even greater increase in CVD prevalence and the associated costs. Moreover, recent forecasts predict that current adolescent overweight will increase future adult obesity by 5% to 15% by 2035, further compounding the problem.5 Clearly, the forecast indicates a substantial increase in CVD prevalence and costs in the United States by 2030. In the face of this formidable forecast, the American Heart Association established strategic impact goals for 2020 and beyond.2 The bold objective of these goals is to improve the cardiovascular health of all Americans by 20% while reducing deaths from CVDs and stroke by 20% by 2020. The new construct of ideal cardiovascular health was defined as (1) the simultaneous presence of 4 favorable health behaviors (abstinence from smoking within the last year, ideal body mass index, physical activity at goal, and consumption of a dietary pattern that promotes cardiovascular health), (2) the simultaneous presence of 4 favorable health factors (abstinence from smoking within the last year, untreated total cholesterol <200 mg/dL, untreated blood pressure <120/<80 mm Hg, and absence of diabetes mellitus), and (3) the absence of clinical CVD (including CHD, stroke, heart failure, etc).2 Definitions of the 7 metrics that comprise cardiovascular health were expanded to encompass the entire spectrum of cardiovascular health, from ideal to intermediate to poor. The spectrum of levels for each metric is represented within each of 3 cardiovascular health categories for adults and children (Table).TABLE: Definition of Poor, Intermediate, and Ideal Cardiovascular Health for Each Goal/Metric for AHA 2020 Strategic Impact GoalsA recent study by Shay et al6 reported the prevalence estimates of the components of cardiovascular health, as well as each of the 7 health metrics, according to poor, intermediate, and ideal. The study included 14 515 adults (>20 years of age) from the NHANES 2003–2008. Participants were stratified by young (20–39 years), middle (40–64 years), and older (≥65 years) ages. Fewer than 1% of adults exhibited ideal cardiovascular health for all 7 metrics. Among cardiovascular health behaviors, nonsmoking was most prevalent (range, 60.2%–90.4%) and ideal Healthy Diet Score was least prevalent (range, 0.2%–2.6%) across groups. The prevalences of ideal body mass index (range, 36.5%–45.3%) and ideal physical activity levels (range, 50.2%–58.8%) were higher in young adults compared with middle-age or older age adults. Ideal total cholesterol level (range, 23.7%–36.2%), blood pressure (range, 11.9%–16.3%), and fasting blood glucose level (range, 31.2%–42.9%) were suboptimal in all groups and lower in older adults compared with young and middle-aged adults. A high proportion of adults with poor and intermediate health factors (ie, blood pressure, total cholesterol, and fasting plasma glucose) were untreated or not treated to goal, with young adults constituting the greatest proportions of adults with untreated poor and intermediate health factors. Yang et al7 recently published a study that included a sample of 44 959 US adults using data from the NHANES 1988–1994, 1999–2004, and 2005–2010 and the NHANES III Linked Mortality File (through 2006). Similar to the findings by Shay et al,6 fewer than 2% of adults demonstrated ideal cardiovascular health. Although the prevalence of ideal cardiovascular health was extremely low (<2%), a greater number of cardiovascular health metrics were associated with a lower risk of total and CVD mortality. Furthermore, participants who met 6 or more versus 1 or fewer cardiovascular health metrics had 51% lower risk of all-cause mortality, 76% lower risk of CVD mortality, and 70% lower risk of ischemic heart disease mortality.7 The forecast for CVD prevalence and cost, along with recent data on the extremely low prevalence of ideal cardiovascular health, is cause for great alarm. However, all components of cardiovascular health are modifiable through adequate lifestyle and treatment. The prevalence estimates of cardiovascular health, recently reported by Shay et al6 and Yang et al,7 represent a starting point from which the effectiveness of current and future efforts to promote cardiovascular health and prevent CVD can be monitored and compared in US adult populations. The opportunities to further improve cardiovascular health and reduce CVD are enormous, and simultaneously controlling costs is paramount." @default.
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• W2328766729 date "2012-11-01" @default.
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• W2328766729 title "Heads Up" @default.
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