2. Types of Cardiovascular Disease and Associated Risks Jill Birnbaum, State Advocacy Consultant, National Center, American Heart Association

3. About the American Heart Association The American Heart Association is a not-for-profit, voluntary health organization funded by private contributions. Our mission is to reduce disability and death from cardiovascular diseases and stroke.The American Heart Association is a not-for-profit, voluntary health organization funded by private contributions. Our mission is to reduce disability and death from cardiovascular diseases and stroke. Preventing heart disease and stroke is — and always has been — our first priority. We’ve funded about $2 billion in heart and blood vessel research since 1949. Nearly 30 percent of our yearly expenses supports research.Preventing heart disease and stroke is — and always has been — our first priority. We’ve funded about $2 billion in heart and blood vessel research since 1949. Nearly 30 percent of our yearly expenses supports research.

4. A complete version of this update is available on our Web site, www.americanheart.org/statistics www.americanheart.org/statistics Click on “Heart Disease and Stroke Statistics — 2006 Update”

5. Prevalence of Cardiovascular Diseases (CVD) 71.3 million Americans have some type of CVD (~1 in 3 adult men & women) – –High Blood Pressure………...65,000,000 – –Coronary Heart Disease…….13,200,000 – –Heart Attack…7,200,000 – –Chest Pain…...6,500,000 – –Heart Failure…….5,000,000 – –Stroke…………………………...5,500,000 – –Congenital Heart Disease……1,000,000+

6. Deaths in Thousands Leading Causes of Death for All Males and Females United States: 2003* A Total CVD B Cancer C Accidents D Chronic Lower Respiratory Diseases E Diabetes Mellitus F Alzheimer’s Disease Source: CDC/NCHS and NHLBI. *Preliminary

7. Deaths From Diseases of the Heart* United States: 1900–2003* Source: CDC/NCHS. *Preliminary.

8. Cardiovascular Disease is an Equal Opportunity Employer 426,772 male deaths per year 483,842 female deaths per year

9. Cardiovascular Disease Mortality Trends for Males and Females United States: 1979-2003* Source:CDC/NCHS. * Preliminary 0

10. Cardiovascular Diseases Coronary heart diseaseCoronary heart disease StrokeStroke High blood pressureHigh blood pressure Heart failureHeart failure Congenital cardiovascular defectsCongenital cardiovascular defects

11. Percentage Breakdown of Deaths From Cardiovascular Diseases United States:2003* 0.5% Heart Failure 0.4% Source: CDC/NCHS and NHLBI. *Preliminary Coronary Heart DiseaseStroke Heart FailureHigh Blood Pressure Diseases of the ArteriesCongenital Cardiovascular Defects Rheumatic Fever/Rheumatic Heart DiseaseOther

12. Coronary Heart Disease Acute myocardial infarctionAcute myocardial infarction Other acute ischemic (coronary) heart diseaseOther acute ischemic (coronary) heart disease Angina pectorisAngina pectoris Atherosclerotic cardiovascular diseaseAtherosclerotic cardiovascular disease All other forms of chronic ischemic heart diseaseAll other forms of chronic ischemic heart disease

13. Coronary Artery Disease Results from blocked arteries that feed the heart muscle. Complete blockage will lead to a heart attack.

15. Heart Attack Death of, or damage to, part of the heart muscle due to an insufficient blood supply. Medical term is myocardial infarction (MI)

16. Incidence This year an estimated 1,200,000 Americans will have a new or recurrent coronary attack.This year an estimated 1,200,000 Americans will have a new or recurrent coronary attack. –700,000 will have a new coronary attack. –500,000 will have a recurrent attack. It is estimated that an additional 175,000 silent first heart attacks occur each year.It is estimated that an additional 175,000 silent first heart attacks occur each year. About every 26 seconds an American will suffer a coronary event, and about every minute someone will die from one.About every 26 seconds an American will suffer a coronary event, and about every minute someone will die from one. About 40 percent of the people who experience a coronary attack in a given year will die from it.About 40 percent of the people who experience a coronary attack in a given year will die from it.

17. Annual Number of Americans Having Diagnosed Heart Attack by Age and Sex ARIC: 1987-2000 Source: Extrapolated from rates in the NHLBI’s ARIC surveillance study, 1987-2000. These data don’t include silent MIs.

18. Warning Signs of a Heart Attack Chest discomfort – most attacks have discomfort in the center of the chest that lasts more than a few minutes, or goes away and comes back. Can feel like uncomfortable pressure, squeezing, fullness or pain Discomfort in other areas of the upper body – can include pain in one or both arms, back, neck, jaw or stomach Shortness of breath – may occur with or without chest discomfort Other signs – may include breaking out in cold sweat, nausea or lightheadedness Heart attack is a medical emergency – call 9-1-1

19. M ajor Risk Factors for Heart Attack Heredity (including race) Male Sex Increasing Age Those that can’t be changed:

20. M ajor Risk Factors for Heart Attack Tobacco Smoke High Blood Pressure High Blood Cholesterol Levels Physical Inactivity Obesity and Overweight Diabetes Mellitus Those that can be controlled, treated or modified:

21. Arrhythmias and Sudden Cardiac Death It’s the sudden, abrupt loss of heart function (i.e., cardiac arrest) in a person who may or may not have diagnosed heart disease. The time and mode of death are unexpected. Arrhythmias are disorders of the regular rhythmic beating of the heart. About 330,000 people a year in the USA die of coronary heart disease (CHD) either without reaching the hospital or in the emergency room. Not all of these are sudden deaths, but many are. In fact, some estimates show that almost ½ of all deaths from CHD are sudden cardiac deaths.

22. Heart Failure Chronic heart failure (CHF) is epidemic in the United StatesChronic heart failure (CHF) is epidemic in the United States It is estimated that 5 million Americans currently have CHF (2003) with 550,000 new cases added each year.It is estimated that 5 million Americans currently have CHF (2003) with 550,000 new cases added each year. Five-year survival of CHF patients is less than 50%.Five-year survival of CHF patients is less than 50%. There are several suggested reasons for the increasing burden of CHF in the U.S. population, including improved survival after acute myocardial infarction results in more patients with damaged myocardium who are prone to developing CHF.There are several suggested reasons for the increasing burden of CHF in the U.S. population, including improved survival after acute myocardial infarction results in more patients with damaged myocardium who are prone to developing CHF.

23. Prevalence of Heart Failure by Age and Sex NHANES: 1999-2002 Source: CDC/NCHS and NHLBI.

24. Hospital Discharges for Heart Failure by Sex United States: 1979-2003 Note: Hospital discharges include people discharged alive and dead. Source: National Hospital Discharge Survey, CDC/NCHS and NHLBI.

25. Stroke On average, someone in the United States suffers a stroke every 45 seconds; every 3 minutes someone dies of one. 700,000 new/recurrent strokes in 2003.

26. Stroke Happens when a blood vessel in the brain bursts or is blocked by a blood clot or some other particle

27. Sometimes a part of a blood vessel can “balloon out” (called an aneurysm) and burst. This causes a hemorrhagic stroke.

28. If a blood vessel in the brain becomes blocked, an ischemic stroke occurs

29. Aftermath Stroke is the leading cause of serious, long- term disabilityStroke is the leading cause of serious, long- term disability The length of time to recover from a stroke depends on its severity.The length of time to recover from a stroke depends on its severity. –Between 50 and 70 percent of stroke survivors regain functional independence, but 15 to 30 percent are permanently disabled, and 20 percent require institutional care at three months after onset. 14% of those who survive a stroke will have another one within one year14% of those who survive a stroke will have another one within one year

30. Prevalence of Stroke by Age and Sex NHANES: 1999-2002 Source: CDC/NCHS and NHLBI.

31. Warning Signs of Stroke Sudden weakness or numbness of the face, arm or leg, especially on one side of the body Sudden confusion, trouble speaking or understanding Sudden trouble seeing in one or both eyes Sudden, severe headaches with no known cause Sudden trouble walking, dizziness, loss of balance or coordination STROKE IS A MEDICAL EMERGENCY – CALL 9-1-1

32. Risk Factors for Stroke Age Prior stroke or heart attack Family history and ethnicity Those that can’t be changed:

33. Risk Factors for Stroke High blood pressure Cigarette smoking Diabetes mellitus Carotid or other artery disease Heart disease Transient ischemic attacks (TIAs) High red blood cell count Sickle cell anemia Atrial fibrillation High blood cholesterol Those that can be controlled, treated or modified:

34. Blood Pressure The force created by the heart as it pumps blood into the arteries and through the circulatory system. High Blood Pressure Chronic increase in blood pressure above its normal range (less than 140/90 mm Hg in adults).

35. Impact Nearly one in three adults has HBP.Nearly one in three adults has HBP. The prevalence of hypertension in blacks in the United States is among the highest in the world.The prevalence of hypertension in blacks in the United States is among the highest in the world. Listed as a primary or contributing cause of death in about 277,000 deaths in 2003.Listed as a primary or contributing cause of death in about 277,000 deaths in 2003. The estimated direct and indirect cost for HBP in 2006 is $63.5 billion.The estimated direct and indirect cost for HBP in 2006 is $63.5 billion.

36. Prevalence of High Blood Pressure in Americans by Age and Sex NHANES: 1999-2002 Source: CDC/NCHS and NHLBI.

37. Congenital Heart and Blood Vessel Defects Congenital cardiovascular defects, also known as congenital heart defects, are structural problems arising from abnormal formation of the heart or major blood vesselsCongenital cardiovascular defects, also known as congenital heart defects, are structural problems arising from abnormal formation of the heart or major blood vessels At least 15 distinct types of congenital defects are recognized, with many additional anatomic variations.At least 15 distinct types of congenital defects are recognized, with many additional anatomic variations.

38. Impact About 1 million Americans have a congenital cardiovascular defect.About 1 million Americans have a congenital cardiovascular defect. 9.0 defects per 1,000 live births are expected, or 36,000 babies per year in the United States.9.0 defects per 1,000 live births are expected, or 36,000 babies per year in the United States. Congenital cardiovascular disease is the most common cause of infant death from birth defects; one in three infants who die from a birth defect have a heart defect.Congenital cardiovascular disease is the most common cause of infant death from birth defects; one in three infants who die from a birth defect have a heart defect.

39. Peripheral Arterial Disease Peripheral arterial disease (PAD) in the legs is due to atherosclerosis causing narrowing or obstruction in the major arteries serving the lower limbs.Peripheral arterial disease (PAD) in the legs is due to atherosclerosis causing narrowing or obstruction in the major arteries serving the lower limbs. Affects about 8 million Americans and is associated with significant morbidity and mortality.Affects about 8 million Americans and is associated with significant morbidity and mortality. Affects 12 to 20 percent of Americans 65 years of age or older.Affects 12 to 20 percent of Americans 65 years of age or older. People with PAD have impaired function and quality of life.People with PAD have impaired function and quality of life.

40. Cost of Cardiovascular Disease The estimated direct and indirect cost of CVD for 2006 is $403.1 billion.The estimated direct and indirect cost of CVD for 2006 is $403.1 billion. In 2001, $11.6 billion was paid to Medicare beneficiaries for CHDIn 2001, $11.6 billion was paid to Medicare beneficiaries for CHD –$11,201 per discharge for acute MI –$11,308 per discharge for coronary atherosclerosis –$3,513 per discharge for other ischemic heart disease).

41. Cost of Cardiovascular Disease The 15 most costly medical conditions and the estimated percent increase in total healthcare spending for each condition from 1987–2000, by order of rank, and their percentage impact on health care spending (Health Affairs. Aug. 25, 2004):The 15 most costly medical conditions and the estimated percent increase in total healthcare spending for each condition from 1987–2000, by order of rank, and their percentage impact on health care spending (Health Affairs. Aug. 25, 2004): –heart disease (1) +8.06 percent –hypertension (5) +4.24 percent –cerebrovascular disease (7) +3.52 percent –diabetes (9) +2.37 percent –kidney disease (15) +1.03 percent

42. Estimated Direct and Indirect Costs of Major Cardiovascular Diseases and Stroke United States: 2006 Source: Heart Disease and Stroke Statistics – 2006 Update. 142.5 57.9 63.5 29.6 0 20 40 60 80 100 120 140 160 Coronary Heart Disease Stroke Hypertensive Disease Heart Failure Billions of Dollars

43. Hospital Discharges for Cardiovascular Diseases as First Listed Diagnosis United States: 1970-2003 Note: Hospital discharges include people discharged both alive and dead. Source: CDC/NCHS and NHLBI.

44. Trends in Cardiovascular Operations and Procedures United States: 1979-2003 Source: CDC/NCHS and NHLBI. Note: Inpatient procedures only.

45. Additional Information Jill Birnbaum State Advocacy Consultant jill.birnbaum@heart.org 952-278-3643

46. Questions? Q A