Mariell Jessup, M.D., FAHA; Chief Science and Medical Officer, American Heart Association
At the American Heart Association, we subscribe to the adage: “What gets measured, gets changed.”
That’s why today we’re releasing our annual “Heart Disease and Stroke Statistics – Update 2019.” This frequently-cited public health resource provides the most current and robust epidemiological data on a wide range of cardiovascular disease-related topics, including heart disease and stroke.
We pour so much effort into our update each year because we believe in the transformative power of continuously and systematically collecting, analyzing and interpreting these important data. They hold us accountable and help us chart our progress and determine if and how we need to adjust our efforts. By quantifying the impact of our collective work, we learn how to better invest our resources as we pursue longer, healthier lives for all.
Nearly half (48 percent) of U.S. adults 20 years and older have some form of cardiovascular disease, including coronary heart disease, heart failure, stroke and/or hypertension. If we exclude from that number those Americans with only the diagnosis of hypertension, the figure drops from 48 percent to 9 percent! That might seem like good news, but 9 percent of the US adult population represents more than 24.3 million Americans with coronary artery disease, heart failure, or stroke.
As you can imagine, the economic costs associated with these diseases are astronomical: the average annual cost (direct and indirect) of CVD and stroke in the United States was an estimated $351.2 billion in 2014-15. Between 2015 and 2035, these costs are projected to increase slightly for middle-aged adults (45-64 years old) and increase sharply for older adults (65+ years).
Assessing the Status of Selected Measures
Among the many statistics in the AHA 2019 update, some indicate progress and others suggest opportunities for improvement.
Smoking and Tobacco Use
- Fifteen-and-a-half percent of adults and 3.4 percent of adolescents smoked cigarettes in the past month.
- Rates of tobacco use are higher among American Indian/Alaska Natives and lesbians, gays, bisexuals and transgender people.
- E-cigarette use among high school students has increased sharply to 11.3 percent compared to a few years ago. But it’s lower than it was during the past two years.
In several cities where laws increased the minimum tobacco-buying age from 18 to 21 years, smoking prevalence among high school students dropped 47 percent. If enacted nationwide, we could avoid 249,000 premature deaths, 45,000 lung cancer deaths and 4.2 million lost life-years.
Sugar-sweetened Beverage (SSB) Tax
- In Mexico, SSB purchases went down by 5.5 percent one year after implementing the 1 peso per liter tax, and by 9.7 percent after two years. In households of the lowest socioeconomic status, declines at each time point were even greater.
- A similar 1 cent per ounce excise tax on SSBs in Berkeley, California resulted in a 9.6 percent decline in SSB sales after one year.
WIC Food Packages
The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) food packages were revised in 2009 to include more fruits, vegetables, whole grains and lower-fat milk. These updates were associated with improved diet quality among program participants, based on the Healthy Eating Index (a measure of diet quality). The food packages are evaluated every 10 years, and further nutritional improvements were recommended in the latest (2017) review. If more changes are made in the coming years, participants’ diet quality should benefit right away.
- Rates of obesity and severe obesity in youth (ages 2-19 years) didn’t increase significantly from 2007-08 to 2015-16, but the prevalence remains high at 18.5 percent.
- Among older children and adolescents (12-19 years), the prevalence of ideal BMI (<25 kg/m2) declined 14.3 percent from 1999-2000 to 2015-16.
- For adults, prevalence of obesity and severe obesity significantly increased over the last decade. The 2015-16 estimates indicate that nearly 40 percent of adults are obese and 7.7 percent of those are at a level of obesity classified as “severe.”
- Obesity is associated with a shorter lifespan and living a longer percentage of life with CVD. Higher BMI is associated with a significantly higher risk of death caused by CVD.
- One bright spot: The percent of inactive adults dropped from 40 in 2007 to about 30 in 2016.
There are no quick fixes to help more Americans achieve a healthy weight. The changes in culture, environments and policies that can improve our food and physical activity choices can take years to implement, and the status quo may be resistant to change. We must be steadfast in pursuing these changes to make communities safer, more walkable and bike-friendly. We also need to continue progressing toward making healthy foods and beverages more available, affordable and prominent in corner stores, vending machines, school, workplace cafeterias and other public places.
Beginning in 2020, we’ll chart our progress with a metric called healthy life expectancy. Also known as health-adjusted life expectancy (HALE), it captures the number of years a person can expect to live in good health based on current patterns of mortality and morbidity. The lay public may find HALE a more meaningful and relatable metric than statistics about death rates and risk factors.
Comparing HALE in different U.S. regions and other countries can help us identify health disparities and provide guidance for investing resources and implementing initiatives to improve health and achieve health equities. And that’s why — as we pursue longer, healthier lives for all — regularly assessing our progress with meaningful measures is critical.
- Full report: Heart Disease and Stroke Statistics – 2019 Update
- Fact sheet: At-A-Glance Heart Disease and Stroke Statistics 2019
- Infographic: Heart Disease and Stroke Statistics 2019 Infographic
- News release: Nearly half of all U.S. adults have some form of CVD