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 But even if every state brought levels of those risk factors – such
as obesity and smoking - down to the best level any state has so far
achieved, less than 10 percent of heart disease deaths would be
prevented, the researchers estimated.
Unexpectedly, “there wasn’t a huge difference” in
cardiovascular-related deaths “between best off and worst off
states,” said lead author Shivani A. Patel of the Rollins School of
Public Health at Emory University in Atlanta, Georgia.
Although the death toll has steadily declined over the past 30 years
due to prevention and treatment measures, heart disease is still the
leading cause of death in the U.S., causing one in every four
deaths, or 610,000 deaths each year, according to the Centers for
Disease Control and Prevention.
To estimate how many heart disease deaths are due to preventable
factors, Patel and her coauthors analyzed responses from more than
500,000 people, ages 45 to 79, to a landline phone-based behavioral
risk factor survey in 2009 and 2010, as well as data from the
National Health and Nutrition Examination Survey.
The researchers write in Annals of Internal Medicine that had it
been possible to completely eliminate every case of high
cholesterol, high blood pressure, diabetes, obesity and smoking in
the U.S., 54 percent of heart disease deaths among men and almost 50
percent of heart disease deaths among women in 2010 could have been
prevented.
They also estimated, in a more feasible scenario, that if all states
could have brought the levels of those five risk factors down to the
levels achieved by the five best-performing states in the U.S., that
would have prevented about five percent of heart disease deaths.
“Even the best states aren’t doing that well,” Patel said.
High blood pressure and smoking were tied to the highest proportion
of preventable deaths.
In 2009 and 2010, the states with the lowest levels of risk factors
were in the West, like Colorado, and those with the highest levels
were in the South, including Kentucky, West Virginia, Mississippi,
Alabama and Louisiana.
About 80 percent of people reported exposure to at least one of the
five risk factors.
“By the time they’re in this age range what we’re seeing is it
doesn’t matter what state you’re in, you’re very likely to have at
least one of these risk factors,” Patel said.
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Risk factors cluster, so many Americans actually have more than one
risk factor, said Dr. Blair J. O'Neill of Alberta Health Services in
Canada, who was not part of the U.S. study.
“Although not measured in this study, risk factors are more
prevalent in poorer, less well educated populations, likely
accounting for the greater burden in Southern and Midwestern
states,” O’Neill told Reuters Health by email.
But great progress has been made in reducing cardiovascular disease
and death since the 1960’s, he said.
“Tobacco legislation has helped tremendously through taxation levels
sufficient enough to reduce adolescent smoking,” he said. “Healthy
food availability in schools and workplaces improves nutrition.
Mandatory salt and trans-fat reductions in food also has reduced
hypertension and cholesterol levels.”
“I think the message is that there is still room for improvement,”
Gabriela Vazquez Benitez of HealthPartners Institute for Education
and Research in Minneapolis, Minnesota, told Reuters Health by
email.
Smoking is on the decline, and obesity and diabetes may soon become
the number one risk factors for cardiovascular disease, Patel said.
Health care providers should work to not only treat these risk
factors, but also prevent them by intervening with patients at an
early age, she said.
SOURCE: http://bit.ly/1Nv68qW Annals of Internal Medicine, online
June 29, 2015.
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