Why prevalence in US may be halting

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A close-up of a traffic light flashing red in the shape of a heart with the blue sky in the background.Share on Pinterest
The changes in national coronary heart disease prevalence have not been significant in the U.S. in recent years. Naomi Rahim/Getty Images

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

The study, which appears as a research letter in the journal JAMA Cardiology, lays the ground for researchers to investigate the findings.

Mortality due to CHD significantly reduced during the years 2000–2011.

Medical News Today spoke with the corresponding author of the study, Cathleen Gillespie, a statistician at the Division for Heart Disease and Stroke Prevention at the Centers for Disease Control and Prevention (CDC) in Atlanta.

“CHD mortality had been decreasing in the U.S. since the 1960s,” Gillespie said.

“Those declines could be attributed to improvements in risk factors — for example, new high blood pressure medications, improvements in nutrition, reduction of smoking — and advances in treatment — for example, improvements in the emergency medical systems, coronary care units, cardiac rehabilitation,” she added.

“The decreasing prevalence of CHD from 2001 to 2012 could have resulted from a combination of prevention efforts and improvements in the management of risk factors. The use of statins and the treatment and control of high blood pressure increased during this period,” explained the researcher.

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

In the present study, the researchers wanted to gather further information about the slowing down of the reduction in heart disease prevalence.

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 the participants answered “yes” to either question, the data collectors recorded them as having self-reported CHD.

After excluding people with a history of heart disease or with incomplete responses, the researchers had a sample size 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 the prevalence of CHD is slowing.

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

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

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

– Cathleen Gillespie

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

Dr. Khandelwal said that there are various possible reasons for the observed plateauing in the prevalence of heart disease.

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

As per data from the CDC and the American Heart Association (AHA), obesity rates have increased from 30.5% to 42.4% in the last 2 decades. Dr. Khandelwal said that the same rates for children and obesity were even more alarming, “almost doubling to above 35% in the same time period,” which could signal a higher risk of heart disease in future generations.

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

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

“We know that U.S. maternal mortality — especially in certain ethnic and socioeconomic demographics — continues to be quite high. We know that, in general, the same risk factors continue to rise in our maternal population, leading to increased morbidity and mortality. This would signal a future increase in CHD in these same women,” she further explained.

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

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

“The risk of CHD can be reduced by maintaining a healthy weight, getting regular physical activity, not smoking, and keeping your blood pressure, cholesterol, and blood sugar levels normal,” said Gillespie.

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

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

Life’s Simple 7

“[These are] maintaining a healthy body weight, eating a heart-healthy diet, exercising and not being sedentary, avoiding tobacco and vaping, having blood pressure controlled, blood sugar controlled, and cholesterol controlled.”

– Dr. Abha Khandelwal

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

In addition, Dr. Khandelwal touched on the negative impact that the COVID-19 pandemic has had on heart disease.

“Our studies indicate that less than one-third of Americans have even half of these risk factors at goal. During pandemic times, we have seen many people have a further decline in heart-healthy behaviors and lifestyle [and] have also lost […] access to healthcare,” she said.

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

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