Nearly half of all adults in the United States in 2016 — 48% or 121.5 million — have some form of cardiovascular disease (CVD), according to the annual statistical update on heart disease and stroke from the American Heart Association (AHA).
This reported prevalence of CVD represents a significant increase over previous years. It was driven mainly by an increase in the number of people classified as having high blood pressure, after the 2017 guidelines redefined hypertension as 130/80 mm Hg, instead of the previous threshold of 140/90 mm Hg.
When adults with only a diagnosis of hypertension are excluded, the prevalence of CVD drops from 48% to 9%.
“That might seem like good news, but 9% of the US adult population represents more than 24.3 million Americans with coronary artery disease, heart failure, or stroke,” Mariell Jessup, MD, AHA chief science and medical officer, said in a statement.
“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,” Jessup commented. “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,” she added.
Progress and Challenges
CVD remains the leading cause of death in the United States and around the world. In 2016, CVD was responsible for 840,678 deaths in the United States (roughly one in every three deaths), up from 836,546 in 2015, although worldwide, the number of people dying from CVD was lower in 2016 (17.6 million) than it was in 2015 (17.9 million).
The average annual cost (direct and indirect) of CVD and stroke in the United States was an estimated $351.2 billion in 2014/15. From 2015 to 2035, these costs are projected to increase slightly for middle-aged adults and sharply for older adults.
In 2016, stroke accounted for about one of every 19 deaths in the United States. On average in 2016, someone died of stroke every 3 minutes and 42 seconds, the report notes. When considered separately from other CVD, stroke ranks fifth among all causes of death in the United States, killing approximately 142,000 people a year.
Among the many statistics in the 473-page report, some indicate progress and others suggest opportunities for improvement. Smoking and tobacco use is one bright spot; the report shows that:
- In 2015/16, 94% of youth 12 to 19 years of age were nonsmokers, up nearly 20 percentage points from the turn of the millennium (76% in 1999/2000).
- The percentage of adolescents 12 to 17 years who reported smoking in the previous month has dropped by two-thirds in 14 years (from 13% in 2002 to 3.4% in 2016).
- 79% of adults were nonsmokers in 2015/16, up from 73% in 1999/2000. In the previous 50 years, the number of adults who smoke dropped from 51.0% in 1965 to 16.7% in 2015 for men and from 34.0% to 13.6%, respectively, for women (age-adjusted rates).
More Americans are also becoming more physically active, with 53.5% of students participating in muscle-strengthening activities on 3 or more days per week in 2015, up from 47.8% in 1991. The prevalence of physical inactivity among adults has decreased by more than a third, from 40.2% in 2005 to 26.9% in 2016.
However, the AHA notes that prevalence of obesity remains high in the United States, with 39.6% adults and 18.5% of youth meeting the criteria for obesity in 2015, and 7.7% of adults and 5.6% of youth meeting the criteria for severe obesity.
“There are no quick fixes to help more Americans achieve a healthy weight,” Jessup said. “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 more bike-friendly. We also need to continue progressing toward making healthy foods and beverages more available, affordable, and prominent in corner stores, vending machines, schools, workplace cafeterias, and other public places.”
This year’s update includes a new chapter on the importance of sleep in relation to cardiovascular and overall health. The American Academy of Sleep Medicine and the Sleep Research Society recommend adults get at least 7 hours of sleep per night to promote optimal health. However, a recent report from the Centers for Disease Control and Prevention revealed that only about 65% of people in the United States achieve this goal on a regular basis.
Circulation. Published online January 31, 2019. Full text