burden of cardiovascular disease in mississippi. top ten leading causes of death in mississippi,...
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Burden of Cardiovascular Disease in Mississippi
Top Ten Leading Causes of Death in Mississippi, 2007
38%
27%
8%
7%
6%
4%
3%3% 2% 2%
Heart Disease
Cancer
Unitentional Injuries
CVD (Stroke)
COPD/Emphysema
Alzehimers Disease
Kidney Disease
Dibetes Mellitus
Influenza/Pneumonia
Septicemia
Source: Mississippi Vital Statistics, 2007
CVD Age-Adjusted Mortality Rates, MS vs. US, 1999-2006
0
50
100
150
200
250
300
350
400
450
500
Year
Ag
e-A
dju
sted
Rat
e p
er 1
00,0
00
MS 440.1 440 424.8 418.7 394.6 370.5 375.3 348.8
US 350.8 341.4 328.2 319 307.7 288 278.9 262.5
1999 2000 2001 2002 2003 2004 2005 2006
Source: CDC Wonder, 2006
MS Stroke Rates
Sources:
Mississippi Vital Statistics, 2007
CDC Wonder 2005
MS BRFSS 2008
• 2005 MS age-adjusted stroke mortality was 19% higher than US
• 2008 MS stroke rate was 54% higher than US
Risk Factors of CVD, MS vs. US, 2007
•
Source: MS BRFSS, 2007
Adults, NHANES: 2005-2006Adults, NHANES: 2005-2006
13.4
35.9
55.8
69.6
23.2
36.2
53.764.7 64.1
6.2
76.4
16.5
0102030405060708090
20-34 35-44 45-54 55-64 65-74 75+
Per
cen
t o
f P
op
ula
tio
n
Men Women
Prevalence of HypertensionPrevalence of Hypertension
JNC 7 Classification BP SBP
(mmHg) DBP
(mmHg)
Normal < 120 and < 80
Prehypertension 120 - 139 or 80 - 89
Stage 1 HTN 140 - 159 or 90 - 99
Stage 2 HTN > 160 or > 100
Chobanian et al. JAMA. 2003;289:2560-2572.
NHANES: 2005-2006NHANES: 2005-2006
53.8
33.127.9
67.2
48.8
77.279.9 82.4
45.9
0102030405060708090
Awareness Treatment Controlled
Per
cen
t o
f P
op
ula
tio
n W
ith
H
yper
ten
sio
n
20-39 40-59 60+
Hypertension – Barriers to ControlHypertension – Barriers to Control
_____________
CVD Risk Factors• Hypertension*• Obesity*• Dyslipidemia*• Diabetes mellitus*• Microalbuminuria or
est GFR <60 mL/min
• Cigarette smoking• Physical inactivity
• Age – > 55 for men– > 65 for women
• Family hx of premature CVD – < 55 for men– < 65 for women
*Components of metabolic syndrome.
Chobanian et al. JAMA. 2003;289:2560-2572.NCEP ATP III. 2002. NIH Publication No. 02-5215 – uses earlier age cutpoints.
Body Mass Index ( kg/m 2)
14 16 18 20 22 24 26 28 30 32
Sys
tolic
BP
(m
mH
g)
115
120
125
130
135
140
Jones et al. J Hypertension 12: 1433-1437,1994
Relation Between Adiposity and Systolic BP
Epidemiological studies have shown a correlation between
body weight and blood pressure
75% of hypertension in men and
65 % in women is associated with excess adiposity
Garrison RJ. Prev Med. 16:1987
1999
Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1999, 2008
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
2008
1990
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Childhood Obesity
Trends in Blood Pressure Among Children and Adolescents: JAMA;2004:291
Average weight gain of ~2 lbs/yr (~100 kcal/d surplus)
A Diet That Reduces Blood Pressure
• DASH eating– Grains– Vegetables– Fruits– Low-fat dairy foods– Poultry, fish– Nuts, dry beans– Oils– Sweets
Ambulatory Blood Pressure in High and Low Salt Diet
Less Sodium - More Potassium
Sodium: Less than 2300 mg/day (~ 1 tsp); with HTN < 1,500 mg/day
Processed Foods
80%
Added at Table10%
Cooking10%
Lifestyle Modifications Modification SBP reduction
(~ mmHg)
Weight reduction 5 - 20 / 10 kg loss
Adopt DASH* eating plan 8 - 14
Dietary sodium reduction 2 - 8
Physical activity 4 - 9
Moderation of alcohol consumption
2 - 4
*Dietary Approach to Stop Hypertension
Evolution of SBP over the Life Course
Green – Desirable BP trajectoryRed, Orange – BP trajectories in individuals with multiple RFs
Cultural forcesCultural forces
AgeAgeBody WeightBody Weight
Societal norms Societal norms Commercial interests Commercial interests
Food industry Food industry Public policyPublic policy
GeneticGeneticPredispositionPredisposition
Dietary ChoicesDietary Choices
LifestyleLifestyle PharmocologyPharmocology
Opportunity for Improving Blood Opportunity for Improving Blood Pressure ControlPressure Control
The Tide Is Rising!A Bad Situation With the Potential to Get Worse Presents Great Opportunity!
Egan. Egan. HypertensionHypertension. 2004;44:389.. 2004;44:389.
Hypertension
• “Blood pressure that increases the risk for cardiovascular events (disease)”
• “A level of BP above which treatment does more good than harm”
Hypertension AssessmentAccurate and Reliable BP
Readings
972 million people with HTN worldwide
73.6 million in US with HTN (33% of > 20 years)
53.6 million with preHTN)> 70% of pts with stroke, MI, CHF
have antecedent HTN1/5 deaths related to HTN
Heart Disease is #1 cause of death in women in MS
Stroke is #3 cause of death in women in MS
