Heart Disease and Stroke Statistics—2018 Update

Benjamin EJ, Virani SS, Callaway CW, et al.
Heart Disease and Stroke Statistics—2018 Update: A Report From the American Heart Association. Circulation 2018;Jan 31:[Epub ahead of print].

The following are key points to remember from this American Heart Association (AHA) 2018 update on heart disease and stroke statistics:

  1. This is the 2018 update of heart and stroke statistics, which is provided annually by the AHA in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies.
  2. Findings from US and international studies show a strong protective association between ideal cardiovascular (CV) health metrics and clinical and preclinical conditions, including premature all-cause mortality, CV and pulmonary diseases and mortality, and reduced healthcare expenditures.
  3. Tobacco use remains the leading cause of preventable death in the US and globally. It was estimated to account for 7.2 million deaths worldwide in 2015. Over the past 5 years, there has been a sharp increase in e-cigarette use among adolescents.
  4. Physical inactivity and poor dietary habits remain major reversible causes of US deaths. Only 21.5% of American adults achieve the guidelines for leisure-time aerobic and muscle-strengthening activities. An estimated 22.4% of all male deaths and 20.7% of all female deaths in 2015 were attributable to poor dietary factors. The prevalence of obesity in adults increased from 34.9% in 2011-2012 to 37.7% in 2013-2014, and in children 2-19 years increased from 16.9% to 17.2%.
  5. While the 2010 target for the adult population of a mean cholesterol of <200 mg/dl was reached for all subgroups, the 2020 target of 178 mg/dl has not been achieved by any. Based on the 2013 guidelines, 56.0 million (48.6%) US adults ≥40 years of age are eligible for statin therapy.
  6. Importance of hypertension as a risk factor has increased despite the availability and low cost of drug therapy. From 2005-2015, the death rate attributable to high blood pressure (BP) increased by 10.5%, and the actual number of deaths attributable to high BP rose by 37.5%.
  7. In 2012, when assessed by county, the prevalence of diagnosed diabetes was estimated to range from 5.6% to 20.4%. On the basis of National Health and Nutrition Examination Survey (NHANES) data from 2001-2012, the prevalence of metabolic syndrome was higher among females (34.4%) than males (29%) and increased with advancing age to >44% to those 60 years and older.
  8. Coronary heart disease (CHD) (43.8%) is the leading cause of deaths attributable to CV disease (CVD) in the US, followed by stroke (16.8%), high BP (9.4%), heart failure (HF) (9.0%), and other CVDs (17.9%). By 2035, >130 million adults in the US population (45.1%) are projected to have some form of CVD, and total costs of CVD are expected to reach $1.1 trillion in 2035. Stroke prevalence in adults is 2.7% in the US. The impact of hypertension management on stroke risk is evident with the greater risk reduction among those with more intense treatment.
  9. Disorders of heart rhythm are increasing worldwide with increasing awareness that atrial fibrillation (AF) is frequently unrecognized. The detection of AF, even in an asymptomatic stage, is the basis for risk stratification for stroke and appropriate decision making about the need for anticoagulant therapy. In individuals with AF, HF deaths (30%) exceeded deaths caused by stroke (8%). Observational data have suggested that overweight and obese individuals with symptomatic AF who opted for weight loss and aggressive risk factor management had fewer hospitalizations, cardioversions, and ablation procedures with a cost savings of >$12,000.
  10. Sudden cardiac death appears among the multiple causes of death on 13.5% of death certificates, which suggests that 1 of every 7.4 people in the US will die of sudden cardiac death. Because some survive sudden cardiac arrest, the lifetime risk of cardiac arrest is even higher.
  11. Coronary artery calcification (CAC) by chest computed tomography is an excellent CVD risk marker. A significant proportion of people in the US considered statin eligible based on the current cholesterol guideline had no detectable CAC, and the observed atherosclerotic CVD risk was below the threshold for statin consideration. Absence of CAC was a powerful negative marker for clinical atherosclerotic CVD in a study of African American adults with up to 10 years of follow-up. When compared to other negative risk markers, a CAC score = 0 has the lowest diagnostic likelihood ratio for CHD and CVD (0.41 and 0.54, respectively).
  12. This year, approximately 720,000 Americans will have a new coronary event (defined as first hospitalized myocardial infarction [MI] or CHD death), and approximately 335,000 will have a recurrent event. CHD mortality dropped by 34.4% from 2005 to 2015, with a predicted continued decline (27% reduction by 2030); however, race disparities are projected to persist. Median survival of those ≥45 years after first MI is 8.4 years for white males, 5.6 years for white females, 7.0 years for black males, and 5.5 years for black females. Variables associated with a higher incidence of CHD include lower education and income (2x).
  13. The prevalence of HF is rising with aging of the population and is estimated at 6.5 million adults. The major risk factors for HF are CHD, hypertension, and diabetes. Compliance with AHA’s My Life Check-Life’s Simple 7 goals (smoking, body mass index (BMI), physical activity, diet, cholesterol, glucose) is associated with a lower lifetime risk of HF and better cardiac structural and functional parameters by echocardiography. Of incident hospitalized HF events, approximately half are characterized as HF with reduced ejection fraction (HFrEF) and half as HF with preserved EF (HFpEF). Black males had the highest proportion of presentations with HFrEF (~70%); white females had the highest proportion of HF hospitalizations with HFpEF (~60%).
  14. Valvular heart disease: There has been no increase in the prevalence of infective endocarditis since the 2007 restriction of antibiotic use to prevent infective endocarditis. At the end of 2014, transcatheter aortic valve replacement (TAVR) was being performed in 348 centers in 48 states. A recent meta-analysis that enrolled >44,000 patients, with a mean follow-up of 21.4 months, compared TAVR to surgical aortic valve replacement (SAVR). Compared with SAVR, balloon-expandable TAVR in symptomatic high-risk patients had similar all-cause mortality; lower incidence of stroke, AF, major bleeding, and acute kidney injury; and higher incidence of vascular complications, aortic regurgitation, and pacemaker implantation. Percutaneous mitral valve repair techniques are becoming a treatment option for high-risk patients with mitral regurgitation who are not deemed candidates for surgical repair. Data from the Society of Thoracic Surgeons/American College of Cardiology transcatheter valve therapy registry on patients commercially treated with the MitraClip percutaneous mitral valve repair device showed a reduction in the severity of mitral regurgitation and procedural success in >90% of cases, although mitral valve dysfunction at 12 months was more common with percutaneous mitral valve repair than with surgical repair.
  15. Venous thromboembolism and pulmonary embolism as the reason for hospitalizations increased from 2005-2014; there was a 34% increase in hospitalizations for deep vein thrombosis and a 53% increase for pulmonary embolism. An estimated 676,000 cases of deep vein thrombosis occurred in 2014 with about 30% treated as an outpatient.
  16. US patients demonstrated higher rates of abdominal aortic aneurysm repair, a smaller abdominal aortic aneurysm diameter at the time of repair, and lower rates of abdominal aortic aneurysm rupture and abdominal aortic aneurysm–related death than patients in the United Kingdom.
  17. Quality of care performance on inpatient measures exceeded 90% for most, but outpatient measures were <80% for assessment of BMI, and counseling for physical activity and smoking cessation, which may have been related to documentation.
  18. In 2013-2014, the annual direct and indirect cost of CVD and stroke in the US was an estimated $329.7 billion. CVD and stroke accounted for 14% of total health expenditures in 2013-2014, more than any major diagnostic group. The mean hospital charges for CV procedures in 2014 ranged from $43,484 for carotid endarterectomy to $808,770 for heart transplantations. The total number of inpatient CV operations and procedures decreased 6%, from 8,461,000 in 2004 to 7,971,000 in 2014.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Cardiac Surgery, Diabetes and Cardiometabolic Disease, Dyslipidemia, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Valvular Heart Disease, Anticoagulation Management and Atrial Fibrillation, Anticoagulation Management and Venothromboembolism, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Lipid Metabolism, Nonstatins, Novel Agents, Statins, Acute Heart Failure, Heart Transplant, Interventions and Imaging, Interventions and Structural Heart Disease, Interventions and Vascular Medicine, Echocardiography/Ultrasound, Diet, Exercise, Hypertension, Smoking, Mitral Regurgitation

Keywords: Acute Kidney Injury, American Heart Association, Anticoagulants, Aortic Aneurysm, Abdominal, Aortic Valve Insufficiency, Atrial Fibrillation, Body Mass Index, Cholesterol, Coronary Disease, Death, Sudden, Cardiac, Diabetes Mellitus, Diet, Echocardiography, Endarterectomy, Carotid, Endocarditis, Exercise, Geriatrics, Heart Arrest, Heart Failure, Heart Transplantation, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypertension, Lung Diseases, Metabolic Syndrome X, Mitral Valve Insufficiency, Myocardial Infarction, Obesity, Overweight, Pacemaker, Artificial, Plaque, Atherosclerotic, Primary Prevention, Pulmonary Embolism, Risk Factors, Smoking, Stroke, Tobacco Use, Tomography, Transcatheter Aortic Valve Replacement, Venous Thromboembolism, Weight Loss

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