Why prevalence in the US may be stalling

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Changes in the national prevalence of CHD have not been significant in the United States in recent years. Naomi Rahim/Getty Images

In a new study, researchers have found evidence that indicates that the recent reported reductions in the prevalence of CHD are beginning to wane.

The study, which appears as a research letter in the journal JAMA Cardiologysets the stage for researchers to investigate the findings.

CHD mortality significantly reduced during the years 2000-2011.

medical news today spoke with the study’s corresponding author, Cathleen Gillespie, a statistician with the Division of Heart Disease and Stroke Prevention at the Centers for Disease Control and Prevention (CDC) in Atlanta.

“Coronary disease mortality had been decreasing in the United States since the 1960s,” said Gillespie.

“These declines can be attributed to improvements in risk factors – for example, new drugs for high blood pressure, improvements in nutrition, reduced smoking – and advances in treatment – ​​for example, improvements in emergency medical systems, coronary care units, cardiac rehabilitation,” she added.

“The decreasing prevalence of CHD from 2001 to 2012 may have resulted from a combination of prevention efforts and improvements in risk factor management. The use of statins and the treatment and control of hypertension increased during this period”, explains the researcher.

However, since then, there are signs that this reduction has started to slow down.

In the current study, the researchers wanted to gather more information about the slowdown in the reduction in the prevalence of heart disease.

To do this, they analyzed 2011–2018 data from the Behavioral Risk Factor Surveillance System (BRFSS) telephone survey.

During the survey, participants answered the following questions:

  • Has a doctor, nurse or other health professional ever told you that you had angina or coronary heart disease?
  • Has a doctor, nurse or other health professional ever told you that you had a heart attack, also called a myocardial infarction?

If participants answered “yes” to any of the questions, data collectors recorded them as having self-reported CHD.

After excluding people with a history of heart disease or with incomplete answers, the researchers had a sample of 3,572,977 people.

After analyzing the data, the researchers found that there was no significant change in CHD prevalence between 2011 and 2018. They concluded that this could suggest that the reduction in CHD prevalence is decreasing.

However, they also pointed out that the BRFSS survey was not necessarily comparable with other datasets.

According to Gillespie, “[d]acceleration in decline [of CHD] may be influenced by the changing trends of CHD risk factors during this time period and earlier.”

“Improvements were seen in blood cholesterol profiles and in the prevalence of smoking and physical inactivity. However, increases were reported for obesity and type 2 diabetes, and no changes occurred for high sodium intake or hypertension prevalence.”

-Cathleen Gillespie

MNT also spoke with Dr. Abha Khandelwal, who is an associate clinical professor of cardiovascular medicine at Stanford University and was not involved in the study.

Dr. Khandelwal said there are several possible reasons for the observed plateau in the prevalence of heart disease.

“There is a known increase in cardiometabolic risk factors in the US population. This includes increased rates of obesity, hypertension, diabetes and a sedentary lifestyle, to name a few,” she said.

According to CDC and American Heart Association (AHA) data, obesity rates have increased from 30.5% to 42.4% in the last 2 decades. The Doctor. Khandelwal said the same rates for children and obesity were even more alarming, “nearly doubling to over 35% over the same period”, which could signal an increased risk of heart disease in future generations.

She also pointed out that because the study did not include high-risk individuals, such as those living in nursing homes or other institutions, the data were limited. The study was also based on self-report rather than actual prevalence.

“Furthermore, there are well-known limitations in identifying CHD in women, and therefore this study would possibly grossly underestimate that as well,” she added.

“We know that maternal mortality in the United States — especially in certain ethnic and socioeconomic demographics — remains very high. We know that, in general, the same risk factors continue to increase in our maternal population, leading to increased morbidity and mortality. This would signal a future increase in CHD in these same women,” she explained.

Dr. Khandelwal said the increase in identifying heart disease in younger populations or changes monitored over time could be due to better diagnostic tools and imaging technologies.

Both Gillespie and Dr. Khandelwal said people could take steps to reduce their risk of developing heart disease.

“The risk of coronary heart disease can be reduced by maintaining a healthy weight, engaging in regular physical activity, not smoking, and maintaining normal blood pressure, cholesterol and blood sugar levels,” Gillespie said.

“Strong scientific evidence shows that self-measured blood pressure monitoring – also known as home blood pressure monitoring – plus clinical support help people with hypertension to lower their blood pressure,” she added.

For Dr. Khandelwal,[f]following the AHA Simple 7 would be a great place to start.”

life is simple 7

🇧🇷[These are] maintain a healthy body weight, eat a heart-healthy diet, exercise and not be sedentary, avoid tobacco and vaping, manage blood pressure, blood sugar and cholesterol.”

– Dr. Abha Khandelwal

She also highlighted the importance of “knowing your numbers” and getting regular checkups with a primary care physician.

Additionally, Dr. Khandelwal addressed the negative impact the COVID-19 pandemic has had on heart disease.

“Our studies indicate that less than a third of Americans have half of these risk factors as a target. During times of pandemic, we have seen many people have an even greater decline in heart-healthy behaviors and lifestyle. [and] also lost […] access to health,” he said.

She noted that this change resulted in patients’ worsening cardiometabolic profiles, the effects of which may become more apparent over time.

Why prevalence in the US may be stalling

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