New data on state-level disparities in heart disease raise caution, but can be used for good

Eduardo SanchezEduardo Sanchez, M.D., M.P.H., Chief Medical Officer for Prevention and Chief of the Centers for Health Metrics and Evaluation, American Heart Association

A geographic analysis published this week offers new insights – some positive, some concerning – about state-level differences in lost health from cardiovascular diseases (CVD).

The positive: The burden of CVD improved in all 50 states from 1990 to 2016.

The concerning: Large disparities exist in the total burden of CVD between states, and the total burden of CVD increased in 12 states from 2010 to 2016.

This news is even more troubling in light of other unsettling trends that have been observed across our country in recent years. For example, life expectancy among women has decreased in some counties and several studies have noted increasing all-cause mortality for some subgroups.

We’ve celebrated a decline in overall mortality from CVD over the past 50 years, due largely to advances in prevention and treatment. But the benefits have been unequal across economic, racial, and ethnic groups. And the revelation of recent increases in the CVD burden in some states may signal that the favorable overall trends could be in jeopardy.

These statistics serve as a call to action to seize opportunities to renew tested public health and clinical approaches, forge new partnerships, and test innovative interventions to prevent and control CVD.

One of our best bets is to focus on the social dynamic of CVD. In addition to the biological and genetic factors that influence cardiovascular health, all stakeholders – healthcare and public health professionals, hospital systems, health insurers, federal and local policymakers, advocacy groups, community organizations, employers and patients and their families – must better understand the undeniable influence of factors such as race, ethnicity, income, environment and education. In the new study, state-level disparities in lost health were strongly associated with socioeconomic factors.

As our nation’s demographic makeup becomes more diverse, it will become even more vital to address the social determinants of health. This has implications for how healthcare providers counsel and recommend treatment for patients, as well as for advocacy efforts that push for healthy changes in the places people live, work and play.

Risk factor reduction is critical

Researchers measured the burden of CVD in disability-adjusted life years (DALYs), which the World Health Organization describes as “a measurement of the gap between current health status and an ideal health situation where the entire population lives to an advanced age, free of disease and disability.” They also measured the relative contribution of different risk factors underlying the levels and trends in DALYs.

Differences in DALYs by state were largely a result of modifiable risk factors: dietary risks, high blood pressure, high body mass index, high total cholesterol, high fasting plasma glucose, tobacco smoking, and low physical activity levels, respectively. These seven metrics, AHA’s “Life’s Simple 7”, are key to optimizing cardiovascular health and potentially helping to prevent up to 80% of CVD – avoiding tobacco, eating a healthy diet, being physically active, and maintaining a healthy weight and healthy blood pressure, cholesterol and blood sugar levels.

The greatest CVD burden was observed in a group of states reaching from the Gulf Coast to West Virginia. Not surprisingly, previous reports have shown that, in many of the states, residents have a low prevalence of Life’s Simple 7 cardiovascular health metrics in the ideal range.

Now that we can better quantify the degree and drivers of regional variation in the CVD burden, we can intervene with more targeted strategies in the places that need it the most. States can use the data as a benchmark as they focus on addressing heart disease and stroke and their associated risk factors. State health officials can also consult the AHA’s new policy guide outlining components that state health departments should consider as they assess their CVD program infrastructure and identify ways to fund their work in this area.

Keys to preserving progress

We must sustain the gains we’ve made in achieving a long-term decline in CVD mortality. As the Centers for Health Metrics and Evaluation monitors the impact of the AHA’s programs and policies, we’ll synthesize those data to inform best practices for improving cardiovascular health. We know that “what gets measured, gets changed.” We will create a healthier nation by changing systems, environments and policies to help make healthier choices more affordable, accessible and attractive for all people everywhere and measuring progress along the way.

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