CVD and the Coloring of America
Cardiovascular disease is the leading cause of death in the U.S. and the world. Over 800,000 Americans die annually of cardiovascular disease, which equals to approximately one of every three deaths. Heart disease is the most common form of cardiovascular disease with an annual mortality rate of almost 400,000. It is estimated that by 2035, over 130 million Americans will be diagnosed with one or more cardiovascular disease conditions. This increasing prevalence of cardiovascular disease is disrupting both the health care system and economy of the nation.
Cardiovascular disease is also the costliest chronic illness in America. Reportedly, in 2014 the most expensive conditions for Medicare fee-for-service recipients were attributed to stroke and heart failure. The direct and indirect cost of cardiovascular disease and stroke in 2013 and 2014 accounted for 14 percent of the total health care expenditures at a cost of more than 300 billion dollars. The American Heart Association predicts that the cost of cardiovascular disease will rise to more than one trillion dollars by 2035. With the graying and coloring of America, the burden of cardiovascular disease will continue to increase.
Americans are living longer and U.S. demographics are changing rapidly. Over the next 35 years, Caucasians will no longer be the majority in the U.S. due to the growth of Hispanic and Asian populations. While the elderly and minorities are the fastest growing subsets of the U.S. population, these groups unfortunately account for a large burden of heart disease. With aging comes an increased risk of developing some form of heart disease.
While cardiovascular events have declined in recent years, they remain significantly high in minorities, particularly amongst African Americans. African American subgroups continue to be encumbered by myocardial infarction, stroke, heart failure and other cardiovascular events. African Americans also have the highest prevalence of hypertension in the world, which is an independent risk factor for cardiovascular disease. African American men have the highest overall death rate of cardiovascular disease and African American women have higher death rates than their white counterparts. Additionally, death occurs at a much earlier age in African Americans. When compared to non-Hispanic whites, African Americans have a 30 percent greater chance of dying from acute coronary syndrome (ACS). Interestingly, the incidence of ACS in African American women outpaces that of white males.
More than 40 percent of African American men and women have some type of cardiovascular disease that includes stroke and heart disease. However, the cardiovascular disease profile for Hispanics in the U.S. is dissimilar to African Americans and whites. Hispanics have a lower rate of cardiovascular disease but a higher rate of risk factors. For instance, when compared with whites, Hispanics have diabetes more often. In fact, Hispanics are at a 50 percent higher risk of dying from diabetes than whites. Heart disease is the second leading cause of death for Hispanics in the U.S.
As America becomes more diverse, the health of the nation is changing and becoming more vulnerable with our growing demographics. The literature is fraught with disparities in health care, particularly in cardiovascular disease as it relates to minorities. These disparities are burdensome not only to the nation's health care system but also to its socioeconomic impact. The health care system must begin to develop innovative strategies and interventions that address population health, social determinants of health, and health policies to reduce the burden and risk of cardiovascular disease in this country.
This article was authored by Karol S. Harshaw-Ellis, DNP, advanced heart failure nurse practitioner at Duke University Medical Center in Durham, NC.