The American Heart Association (AHA), in collaboration with the United States National Institutes of Health (NIH) and other federal agencies, publishes a statistical update describing the latest statistics on cardiovascular disease and its contributing factors in the United States. In the 2023 report, the AHA discusses some of the ways in which the coronavirus disease 2019 (COVID-19) affected cardiovascular health, particularly among black, Hispanic, and Asian Americans, many of whom were already at increased risk for adverse health outcomes.
Examination: Heart disease and stroke statistics – 2023 update: A report from the American Heart Association. Image credit: Yurchanka Siarhhei / Shutterstock.com
An update on cardiovascular risk factors
The AHA’s Life’s Essential 8 characterizes health behaviors such as smoking, physical activity, diet and weight, as well as personal factors such as cholesterol levels, blood pressure and glucose control, that contribute to cardiovascular health.
In the 2023 report, the AHA states that despite the consistent decline in cigarette use over the past several years, various marginalized populations across the United States continue to use tobacco at much higher rates compared to the general population. Over 27% of American Indian/Alaska Native adults and youth, and over 16% of lesbian, gay, and bisexual adults report cigarette use, compared to 13% of whites and 12.3% of straight/heterosexual adults, respectively. In addition, electronic cigarette use has also increased in the United States, particularly among middle and high school students, with rates of 2.8% and 11.3%, respectively.
Around 21% of children between the ages of six and 17 were reported to have over 60 minutes of daily physical activity between 2019 and 2020. This was comparable to around 54% of adults in 2018 who self-reported meeting recommended aerobic guidelines.
Between 2017 and March 2020, almost 37% of children and young people between the ages of 2 and 19 were considered obese or overweight. Importantly, the highest rates of obesity in this patient population were reported among Hispanic men and black women.
The impact of COVID-19
By July 2022, over 1,000,000 COVID-19 deaths had been reported in the United States, which equated to over 300 deaths for every 100,000 people. This death rate was estimated to be 292 deaths for every 100,000 people in urban areas compared to those living in non-metropolitan areas where COVID-19 caused death in 392 people for every 100,000.
Although life expectancy in the United States declined for the general population, these communities experienced a more significant reduction in their life expectancy. For example, life expectancy among black individuals decreased from 74.7 to 71.8, whereas Hispanic individuals experienced a reduction in their life expectancy from 81.8 years to 78.8 years. In comparison, life expectancy for white individuals decreased by 1.2 years from 78.8 to 77.6 years.
In addition to their observations on cardiovascular risk factors alone, the AHA report also discussed the impact of the COVID-19 pandemic on these risk factors. For example, physical activity declined significantly throughout the COVID-19 pandemic, with sedentary individuals at significantly greater risk of being hospitalized or dying from COVID-19.
In an effort to reduce the spread of SARS-CoV-2, particularly among vulnerable patient populations, many patients chose to stay at home instead of attending their normal healthcare visits. In fact, the current AHA report indicates that weekly cholesterol testing rates dropped over 39% in 2020, with the largest reduction observed between March and May 2020.
This reluctance and/or inability to seek medical care led to a greater demand for both urgent and acute health care treatments for what might otherwise have been manageable chronic conditions. In fact, missing these important visits with clinicians likely led to unnecessary deaths in patients, especially those living with certain comorbidities.
Between 2019 and 2020, cardiovascular disease-related deaths rose from over 870,000 to over 928,000, which was the largest single-year increase since 2015. The current AHA report finds that COVID-19 had a significant impact on people of all ages and races in the United States ; however, Hispanic, Asian, and black communities were often affected to a greater extent.
The burden of cardiovascular risk factors, such as hypertension and obesity, is correspondingly high among these populations. As a result, Asian, black, and Hispanic communities also experienced the largest increases in cardiovascular-related deaths, further reducing the life expectancy of these individuals and widening the gap between them and white communities.
Since many of the risk factors for cardiovascular disease are also associated with an increased risk of dying from COVID-19, it is not surprising that those living in poverty, as well as black and Hispanic individuals, were particularly vulnerable to the effects of COVID-19.
We know that to address discrimination and inequities that affect health, we must better recognize and understand the unique experiences of individuals and populations.”
- Tsao, CW, Aday, AW, Almarzooq, ZI, et al. (2023). Heart disease and stroke statistics – 2023 update: A report from the American Heart Association. American Heart Association. doi:10.1161/CIR.0000000000001123.