Hypertension And Smoking Top List Of Global Risk Factors 1

Screen Shot 2012-12-13 at 2.57.27 PMWorldwide, hypertension and tobacco smoking are the single largest causes of death and disability, according to findings from the Global Burden of Disease Study 2010 (GBD 2010), the largest ever assessment and analysis of global health and disease. In an unprecedented move, the Lancet devoted an entire issue to the study, including seven separate articles and eight comments.

GBD 2010 was led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. In a press release, IHME director Chris Murray said, “For decision-makers, health-sector leaders, researchers, and informed citizens, the global burden of disease approach provides an opportunity to see the big picture, to compare diseases, injuries, and risk factors, and to understand in a given place, time, and age-sex group, what are the most important contributors to health loss.”

Despite significant reductions in the rate of ischemic heart disease and stroke since 1990, overall these retained their position as the #1 and #2 worldwide causes of death. Among men 15-49 years of age, CV disease was the single largest cause of death, accounting for 12.8% of all deaths. For women of the same age CV disease was the third largest cause of death, following HIV/AIDS and other non-communicable diseases, accounting for 10.7% of all deaths.

Ischemic heart disease in 2010 now ranks as the largest single cause of global years of life lost. In 1990 it had ranked fourth, behind lower respiratory infections, diarrhea, and preterm birth complications. Stroke moved from fifth place to third place.

High blood pressure emerged as the single most important risk factor for death and disability, followed by tobacco smoking. In 1990 the top two risk factors were childhood underweight (#8 in 2010) and household pollution (#4 in 2010).

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State Of The Heart: AHA Publishes Year-End Statistical Update Reply

Although deaths from cardiovascular disease have been declining for many years, continued progress is threatened by disturbing trends in US lifestyles. That’s the clear message from the American Heart Association’s year-end report, “Heart Disease and Stroke Statistical Update 2013,” published in Circulation.

“Americans need to move a lot more, eat healthier and less, and manage risk factors as soon as they develop,” said Dr. Alan S. Go, the chairman of the report’s writing committee, in an AHA press release. “If not, we’ll quickly lose the momentum we’ve gained in reducing heart attack and stroke rates and improving survival over the last few decades.”

Here are some of the key statistics contained in the hefty report:

“The Epidemic of Poor Health Behaviors”

  • Among adults, 21.2% of men and 17.5% of women continued to smoke cigarettes. 18.1% of high school students are smokers.
  • Among high school students, 17.7% of girls and 10.0% of boys reported they had less than one hour of moderate-to-vigorous exercise.
  • Thirty-three percent of adults reported engaging in no aerobic leisure-time physical activity.
  • From 1971 to 2004, calorie intake increased from 1542 to 1886 kcal/d (22%) in women and from 2,450 to 2,693 kcal/d (10%) in men. Most of the change is due to an increased consumtpion of starches, refined grains, and sugars.
  • 68.2% of adults are overweight or obese. 34.6% are obese.
  • 31.8% of children 2-19 years of age are overweight or obese. 16.9% are obese.

“Prevalence and Control of Health Factors and Risks Remains an Issue for Many Americans”

  • 13.8% of US adults have serum serum cholesterol levels ≥240 mg/dL.
  • 33.0% of US adults have hypertension. About 82% are aware of their condition, 75% receive antihypertensive therapy, but only a little more than half (53%) have achieved target blood pressure levels.
  • 8.3% of US adults have been diagnosed with diabetes. 38.2% have abnormal fasting glucose levels (prediabetes).

CV Disease and Mortality

  • Although the percentage of deaths attributable to CV disease has been declining for decades, in 2009 CV disease  was responsible for nearly one-third (32.3%) of all deaths in the US.
  • About 635,000 people have a first MI or CHD death each year. About 280,000 have a second MI.
  • About 795,000 people have a new or recurrent stroke each year.
  • The 2009 total direct and indirect estimated cost of CVD and stroke:  $312.6 billion.
  • The 2008 total direct and indirect estimated cost of all cancer and benign neoplasms: $228 billion

Click here to read the AHA press release:

PCI Utilization Lower In States With Public Reporting Of Outcomes Reply

In patients with acute MI, utilization of percutaneous coronary intervention (PCI) is lower in states that publicly report outcomes data, according to a new study published in JAMA. Despite the difference in utilization, however, there was no difference in mortality between reporting and nonreporting states.

Karen Joynt and colleagues used Medicare data to analyze PCI utilization and mortality in acute MI patients in three states with public reporting of PCI outcomes (New York, Massachusetts, and Pennsylvania) and other states in the same region without public reporting. The differences in utilization were greatest in patients at highest risk, who presented with ST-segment elevation MI (STEMI), cardiogenic shock, or cardiac arrest.

  • Overall unadjusted PCI rate: 37.7% for reporting states versus 42.7% for nonreporting states
  • Risk-adjust odds ratio: 0.82, CI 0.71-0.93, p=0.003)

Overall mortality did not differ between the reporting and nonreporting states (12.8% and 12.1%, respectively; adjusted OR 1.08 (CI 0.96-1.20], p=0.20), although there was a significant mortality difference in the STEMI subgroup (13.5% vs. 11.0%; OR 1.35, CI 1.10-1.66, p=0.004).

In Massachusetts, where outcomes reporting was initiated during the course of the study period, PCI utilization was at first no different from the other nonreporting states, but was significantly lower than nonreporting states after the change.

The authors offer two potential explanations for the findings:

…the foregone procedures were futile or unnecessary, and public reporting focused clinicians on ensuring that only the most appropriate procedures were performed. Alternatively, public reporting may have led clinicians to avoid PCI in eligible patients because of concern over the risk of poor outcomes.

The mortality findings, they write, suggest “that the foregone procedures might have been a mix of appropriate and inappropriate PCIs.”

In an accompanying editorial, Mauro Mosucci writes that the mortality finding may be due to “a conscious or unconscious ‘futility assessment’” in states with public reporting,” leading to “avoidance of PCI for patients who are less likely to benefit.” Alternatively, “public reporting might have resulted in a drive toward improved quality of care and improved outcomes in patients receiving PCI, offsetting the adverse effect of not performing PCI in high-risk patients.” Mosucci also points out that the data may be skewed because public reporting might result in “gaming” the coding of cases.

Click here to read the press release from JAMA…