CHRONIC DISEASES: Cardiovascular Disease (HEART DISEASE AND STROKE)

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1 Cardiovascular Disease CHRONIC DISEASES: Cardiovascular Disease (HEART DISEASE AND STROKE) Cardiovascular disease (CVD) is a general category of diseases that affect the heart and the circulatory system. Specific CVD categories included in this chapter are coronary heart disease (CHD), congestive heart failure (CHF) and, cerebrovascular disease (stroke). According to the New York State Department of Health, CVD was the primary cause of death for New York s citizens, both men and women, as well as all races in CHD was the number one killer in New York State. CHF currently accounts for 2% of all deaths in NYS and 4% of all CVD deaths. However, it is one of the fastest growing subgroups of CVD and it has been increasing over the last 20 years. Finally, stroke was the third leading cause of death in New York in Trends and Issues In New York State, more people are living with CVD than ever before, as reported by the State Health Department. For every death due to a heart attack or angina in 1999, there were almost 18 people living with one of these conditions. For every death due to stroke, there were seven people coping with the disease. Coronary heart disease (CHD), sometimes called ischemic heart disease, refers to atherosclerosis of the arteries that supply the heart muscle. Atherosclerosis is a broad term that refers to the thickening and hardening of the arteries. Insufficiency of blood supply may result from a reduction of blood flow through one or more of these arteries. Heart cells are dependent on blood flow through these arteries to provide oxygen and to carry away metabolic products. Without an adequate flow of blood, these cells can become injured or die. When this occurs, immediate emergency treatment is necessary to stop the injury from widening, killing additional heart cells, and increasing the risk of complications or death. In Figure 1, there is a slight but consistent increase in the percentage of New York State residents with high blood pressure, and a varying increase in high cholesterol during Figure 1. Trends in High Blood Pressure and High Cholesterol in New York State, Source: The Burden of Cardiovascular Disease in New York. 1

2 Healthy People 2010 and Cardiovascular Disease The following chart presents the Healthy People 2010 targets for the objectives pertinent to cardiovascular disease, along with baseline data for the year(s) indicated. This chapter examines Chautauqua County data for the indicators listed in bold type and selected other indicators. Healthy People 2010 Baselines and Targets for Cardiovascular Disease Objective CARDIOVASCULAR (HEART DISEASE AND STROKE) 1998 Baseline* 2010 Target 12.1 Reduce coronary heart disease deaths. (per 100,000 population) (developmental) Increase the proportion of adults aged 20 years and older who are aware of early warning symptoms and signs of heart attack and the importance of accessing rapid emergency care by calling (developmental) Increase the proportion of eligible patients with heart attacks who receive artery-opening therapy within an hour of symptom onset (developmental) Increase the proportion of adults aged 20 years and older who call 911 and administer cardiopulmonary resuscitation (CPR) when they witness an out-of-hospital cardiac arrest (developmental) Increase the proportion of eligible persons with witnessed out-of-hospital cardiac arrest who receive their first therapeutic electronic shock within 6 minutes after collapse recognition Reduce hospitalizations of older adults with congestive heart failure as the principle diagnosis. (per 100,000 population) 1997 Baseline* 2010 Target 12.6a 12.6b 12.6c Adults aged 65 to 74 years Adults aged 75 to 84 years Adults aged 85 years and older Reduce stroke deaths. (per 100,000 population) 12.8 (developmental) Increase the proportion of adults who are aware of the early warning symptoms and signs of a stroke. 60 (1998) Reduce the proportion of adults with high blood pressure. Increase the proportion of adults with high blood pressure who blood pressure who blood pressure is under control. 28% of adults ages 20 years and older ( ) 16% 18% of adults ages 18 years and older ( ) 50% Increase the proportion of adults with high blood pressure who are taking action ( for example, losing weight, increasing physical activity, or reducing sodium intake) to help control their blood pressure. 82% of adults ages 18 years and older (1998) 95% Increase the proportion of adults who have had their blood pressure measured within the preceding two years and can state weather their blood pressure was normal or high. 90% of adults ages 18 years and older (1998) 95% Reduce the mean total blood cholesterol levels among adults Reduce the proportion of adults with high total blood cholesterol levels. 206 mg/dl of adults ages 20 years and older ( ) 199 mg/dl 21% of adults ages 20 years 17% 2

3 12.15 Increase the proportion of adults who have had their blood cholesterol checked within the preceding 5 years (developmental) Increase the proportion of persons with coronary heart disease who have had their LDL-cholesterol level treated to a goal of less than or equal to 100 mg/dl. and older ( ) 67% of adults ages 18 years and older (1998) 80% A. Health Data 1. Cardiovascular Disease (CVD) Risk Factors Figure 2: Percent of Adults Aged 18 and Older Who Had Cholesterol Checked in the Past 5 Years, New York State, ( As shown in Figure 2, the percentage of New York State adults who have had their cholesterol checked within the last 5 years has increased from 72.7% in 1995 to 77.7% in As of 2003, shown by Table 1 below, the percentage of Chautauqua and Cattaraugus County adults who had done so (73.0%) was lower than the overall percentage for New York State (76.5%). Neither the counties nor the state reached the Healthy People 2010 target of 80% of adults having their cholesterol checked in the last 5 years. Table 1: Percentage of Adults Who Had Cholesterol Checked in the Last 5 Years, 2003 % of adults with cholesterol checked in the last 5 years Chautauqua and 73.0 Cattaraugus County New York State (Total) 76.5 HP 2010 Target 80.0 ( 3

4 From 1996 to 2005 the percent of adults who have been diagnosed with high blood pressure in New York State has increased slightly from 23.4% in 1996 to 25.5% in See Figure 3 below. Figure 3: Percent of Adults Diagnosed with High Blood Pressure, New York State ( As shown in Table 2, the percent of adults in Chautauqua and Cattaraugus Counties who have ever been told they have high blood pressure was higher in 2003 than for New York State (33.2 and 25.3, respectively). The rate for Chautauqua and Cattaraugus County is over twice the Healthy People 2010 Target of 16%. Table 2: Percentage of Adults Who Have Ever Been Told They Have High Blood Pressure, 2003 % of adults ever told they have high blood pressure Chautauqua and 33.2 Cattaraugus County New York State (Total) 25.3 HP 2010 Target 16.0 ( 4

5 2. Cardiovascular Disease (CVD) Mortality in Chautauqua County Table 3 shows that Chautauqua County has a higher mortality rate from CVD ( per 100,000 residents) than across western New York (414.76) or New York State (355.81). Table 3. Cardiovascular Disease Mortality* in Chautauqua County, Western New York**, and New York State per 100,000 Residents, Chautauqua County Western New York HSA** Total New York State Total Counts Rate (100,000) , , *ICD 10: I00-I99. ** Western New York HSA includes Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, and Wyoming Counties Figure 4 provides comparative rates by county for CVD mortality in The rate in Chautauqua County is comparable to the rates of nearby counties, but clearly is above the state rate. Figure 4. Average Death Rates from Cardiovascular Disease Mortality* in Chautauqua County and New York State per 100,000 Residents, *ICD 10: I00-I99. ( 5

6 Though Chautauqua County has a higher adjusted mortality rate than western New York and New York State, as seen in Table 4, there has been a decrease in CVD deaths in Chautauqua County between 2002 and Decreases have also been evident for Western New York and for New York State during the same time period. Table 4. Trends in Deaths from Cardiovascular Disease in Chautauqua County and New York State per 100,000 Residents, Deaths Population Crude Adjusted Rate Total 2003 Rate Chautauqua County , , Western New York Region Total 7,085 6,748 6,118 19,951 1,577, New York State Total 67,862 66,346 62, ,933 19,190, Healthy People 2010 Target Source: Vital Statistics Data as of September, 2006 Adjusted rates are age adjusted to the 2000 United States Population ( ). In Table 5, the Chautauqua County rate is higher for all diseases of the heart (see definition in table notes) than the rates for western New York or New York State. Table 5. Deaths from All Diseases of the Heart* in Chautauqua County and New York State per 100,000 Residents, Chautauqua County Western New York HSA** Total New York State Total Counts Rate (100,000) , , Healthy People 2010 Target -- *ICD 10: I00-I09, I11, I13, I20-I51. ** Western New York HSA includes Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, and Wyoming Counties ( 6

7 Figure 5 illustrates how Chautauqua County compares with other counties on all diseases of the heart (see table definition), and reveals a pattern similar to the above-average CVD mortality rate in Figure 4. Figure 5. Average Death Rates from All Diseases of the Heart* in Chautauqua County and New York State per 100,000 Residents, *ICD 10: I00-I09, I11, I13, I20-I

8 Similar to previous mortality tables presented in this chapter, coronary heart disease mortality in Chautauqua County shown by Table 6 is higher than in western New York or New York State. The county rate mirrors the higher rates of nearby counties (see Figure 6). The Healthy People 2010 target is 166 deaths per 100,000 residents, so the county rate (115.69) currently is below the 2010 target. Table 6. Deaths from Coronary Heart Disease* in Chautauqua County and New York State per 100,000 Residents, Chautauqua County Western New York HSA** Total New York State Total Counts Rate (100,000) , , Healthy People 2010 Target 166 *ICD 10: I (Acute Myocardial Infarction) ** Western New York HSA includes Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, and Wyoming Counties. ( Figure 6. Average Death Rates from Coronary Heart Disease* in Chautauqua County and New York State per 100,000 Residents, ICD 10: I21, I22. ( 8

9 Turning to cerebrovascular disease (stroke), Table 7 reveals that the 2003 death rate is higher in Chautauqua County (61.04 per 100,000 population) than in New York State (38.63), and is marginally lower than the western New York rate (62.14). The county exceeds the 2010 target of 48 deaths per 100,000 population. Table 7. Deaths from Cerebrovascular Disease in Chautauqua County and New York State per 100,000 Residents, Chautauqua County Western New York HSA** Total New York State Total Counts Rate (100,000) , , Healthy People 2010 Target 48 *ICD 10: I ** Western New York HSA includes Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, and Wyoming Counties ( Although deaths from strokes are higher in Chautauqua County than New York State in 2003, Table 8 reveals that the stroke death count declined between 2002 and 2004 for the state, the region and for the county. Table 8. Trends in Deaths from Cerebrovascular Disease in Chautauqua County and New York State per 100,000 Residents, Deaths Population Crude Adjusted Total 2003 Rate Rate Chautauqua County , Western New York Region Total 1,064 1, ,988 1,577, New York State Total 7,529 7,219 6,855 21,603 19,190, Source: Vital Statistics Data as of September, 2006 Adjusted rates are age adjusted to the 2000 United States Population ( B. Unmet Needs Summary: Cardiovascular Disease (CVD) in Chautauqua County Chautauqua County has a higher mortality rate from cardiovascular disease, coronary heart disease, and cerebrovascular disease than New York State. The rates in the county are roughly comparable to the rates of nearby counties some are slightly lower and some are slightly higher but are all above the state rates. Chautauqua County rates are also above the Healthy People 2010 targets of both coronary heart disease deaths and cerebrovascular deaths. When looking at risk factors for cardiovascular disease, the percentage of adults who have ever been told they have high blood pressure in Chautauqua and Cattaraugus Counties is more than twice the Healthy People 2010 target of 16%. New York State as a whole has not met this target either. In addition, neither New York State nor Chautauqua and Cattaraugus County have met the HP 2010 target of 80% of adults having their cholesterol checked within the last 5 years. 9

10 Healthy People 2010 As discussed in the Healthy People 2010 Initiative, Extensive progress has been made in reducing deaths from and risk factors for heart disease and stroke, but significant challenges remain. The Initiative further notes that the Healthy People 2000 objectives on CHD and stroke did not reach the year 2000 targets, and the disparities between African Americans and whites were not reduced. Progress occurred in reducing high blood cholesterol and controlling high blood pressure. Yet, the age-adjusted prevalence of overweight or obesity increased from 26 percent in to 35 percent in The percentage of the population who engaged in light to moderate physical activity remained stable at around 22 percent between 1985 and Caloric intake from fat as a percentage of total calories consumed declined (36 percent in to 34 percent in ), but fell short of the target of 30 percent. Smoking among adults declined steadily from the mid-1960s through the late 1980s, and has leveled off in the 1990s. C. Resources in Chautauqua County The following are some of the Chautauqua County organizations, agencies and programs that offer health services and other forms of assistance related to heart disease and stroke and healthful lifestyles. Allied health organizations (selling nebulizers), Allied Health Care Systems Asthma Coalition of Western New York Asthma Connections hotline: American Lung Association of Western New York Baby and Me Tobacco Free Program CACPF (reimburses daycare facilities and similar programs for providing appropriate nutrition) Cardiologists Catholic Health System of Western New York Chautauqua Alcoholism and Substance Abuse Council (CASAC), Dunkirk Chautauqua County Community Prevention Coalition, Jamestown Chautauqua County Dental Advisory Committee, Mayville Chautauqua County Department of Social Services (food stamps) Chautauqua County Rural Ministries: Emergency food bank, food pantry Chautauqua County Tobacco Control Coalition Community Health Network of Western New York,, Gowanda Chautauqua Opportunities, Inc. (summer lunch program) Child Health Plus 2 Community Kitchens providing free meals (Dunkirk and Jamestown) 18 Congregate meal sites providing senior nutrition Dental Hygiene Program: Jamestown Community College 10

11 Eat Well, Play Hard 5 Farmer s markets Food pantries (Salvation Army) Four Hospitals: Brooks Memorial Hospital, Lakeshore Hospital, WCA Hospital, Westfield Memorial Hospital Fruit/vegetable stands (numerous) Health insurance plans providing payment for diabetes counseling and monitoring LinCare Office for the Aging Pediatric practices (dieticians available for counseling) Registered Dieticians Respiratory Technologists School nurses Steps Consortium Success by Six Support Groups: Westfield Memorial Hospital, WCA Hospital Temporary health care agencies (providing equipment setup) Tobacco Free Moms Visiting Nurse Association Western New York Public Health Coalition, Mayville WIC Nutrition Program WillCare YMCA, Jamestown D. Opportunities for Action Opportunities for action in Chautauqua County pertinent to cardiovascular health, adapted from the Healthy People 2010 Initiative, include the following. Strengthen education about lifestyle interventions from birth that promote heart-healthy behaviors as a major strategy to reduce the development of heart disease or stroke. Increase the level of aerobic physical activity and encourage maintaining a healthy weight. Educate individuals about limiting the consumption of alcohol to moderate levels for those who drink, reducing salt and sodium intake, and eating a reduced-fat diet high in fruits, 11

12 vegetables, and low-fat dairy food. Promote diets low in saturated fat, dietary cholesterol, and total fat to lower blood cholesterol levels. Educate the public and health care providers about the benefits of leisure-time physical activity for specific populations: females, African Americans and Hispanics, among older adults, and among the less affluent. Expand smoking cessation programs in schools and in the community. Expand primary prevention efforts to reduce smoking in elementary and secondary schools and at the college level. Support nationwide mass media campaigns, community-based programs, and other communication efforts to give groups better access to information and programs. These programs should promote heart-healthy behaviors at the community level as well as detect and treat existing risk factors. Promote and/or increase screening for cardiovascular disease risk factors, particularly for high blood pressure and high blood cholesterol. Support dietary and pharmacologic therapy to reduce CHD and stroke risk factors, especially high blood pressure and high blood cholesterol. Support large-scale public outreach and education campaigns to promote the detection, treatment, and control of high blood pressure. Promote education that teaches people to recognize that systolic blood pressure is a more important predictor of CHD than diastolic blood pressure, especially in older adults. Foster campaigns to lower high blood cholesterol in both persons with and without existing CHD. Support Federal guidelines provided by the NHLBI Obesity Education Initiative, in cooperation with the National Institute of Diabetes and Digestive and Kidney Diseases, on clinical practices to help physicians in their identification and treatment of overweight and obesity. Strengthen efforts in the medical community to treat patients within 6 to 12 hours after the onset of a heart attack. Support research and interventions to foster a growing interest in detecting the earliest warning, or prodromal, symptoms of a heart attack, thus providing the lead time needed to treat heart attack patients as quickly and effectively as possible. Support efforts in the medical community to treat patients with clot-dissolving therapy within 3 hours of a thrombotic stroke. Organize current efforts into a unified, cohesive system in communities. Educate the general public about the benefits of early access to emergency health care services for victims of out-of-hospital cardiac arrest, such as CPR and defibrillation. Develop and maintain programs for easier identification and treatment of individuals with Acute MI and out-of-hospital cardiac arrest. Encourage health care providers to counsel their patients about the symptoms and signs of a heart attack or stroke and appropriate actions to take, such as accessing emergency medical services. The goal should be, at a minimum, aimed at reducing delays in seeking treatment for those individuals who are at high risk for a future cardiovascular event for example, those with existing CHD and multiple CHD risk factors. 12

13 Expand efforts to control risk factors in patients with CHD, such as lowering blood pressure. Expand efforts to educate health care practitioners and support clinical trials about therapeutic interventions for older adults with heart failure. Strengthen support systems (family, community and others) that encourage patients to successfully carry out their prescribed treatment regimen. Support research studies to better understand the determinants of adherence to ensure that patients stay with their prescribed therapy. Support population-based research studies for noninvasive and painless technologies that screen for signs of developing atherosclerosis. Ensure that all segments of the population are included in research on risk-factor reduction. Strengthen public outreach and community health intervention efforts, such as those that encourage persons to lower their high blood pressure or to get their cholesterol checked or to help people stop smoking. Promote culturally and linguistically appropriate counseling by health care providers. 13