Cardiovascular diseases (CVD) (ICD 390-398, 402, 404-429)
remain
the leading cause of death in the United States, despite a
persistent
decline in the mortality rate of about 2% per year since 1968 (see
Table V). CVD ranks third in years of potential life lost (YPLL)
prior to age 65, a measure that generally highlights death in the
early years. This ranking reflects the large number of people who
die
prematurely from ischemic heart disease (IHD) (ICD 410-414). Other
categories of CVD accounting for YPLL are acute rheumatic fever
(ICD
390-392), chronic rheumatic heart disease (ICD 393-398),
hypertensive
disease (ICD 401-405), diseases of pulmonary circulation (ICD
415-417), and other forms of heart disease (ICD 420-429).
Total YPLL, as well as YPLL for men and women, has continued to
decline since 1968 (Figure 1). In 1983, the most recent year for
which complete age-, sex-, race-, and cause-specific mortality data
are available, CVD accounted for 1,620,219 YPLL before age 65; this
represents 16% of YPLL for all causes of death in 1983 (1). IHD
accounted for 1,001,875 YPLL (62% of all CVD). Thus, IHD alone
would
rank as the fourth highest cause of YPLL behind unintentional
injuries, malignant neoplasms, and suicide.
In 1983, white males continued to account for a majority (67%)
of
YPLL from IHD, followed by white females (18%), black males (9%),
black females (5%), and all others (1%). However, the crude rates
of
YPLL indicate similar risks for IHD mortality among white and black
males (691 and 651 YPLL/100,000, respectively). The rate for black
females was 1.75 times higher than that for white females (315 vs.
180
YPLL/100,000). Rates for males and females of other races were
substantially lower than those for their white counterparts.
Reported by Behavioral Epidemiology and Evaluation Br, Div of
Health
Education, Center for Health Promotion and Education, Div of
Chronic
Disease Control, Div of Environmental Health Laboratory Sciences,
Center for Environmental Health, CDC.
Editorial Note
Editorial Note: Because data on trends for specific risk factors
for
IHD are not available, risk factor prevalences cannot be correlated
with YPLL rates for IHD. However, changes in lifestyle factors
have
been related to the decline in total mortality from IHD (2). At
present, prevention programs place considerable emphasis on smoking
and hypertension. Two other risk factors--elevated cholesterol
levels
and low levels of physical activity--have received increasing
attention in recent years, and are emerging as important targets
for
further control efforts.
Accurate laboratory measurement of serum cholesterol will be
important in monitoring the effect of intervention programs.
Substantial variation currently exists in the precision of routine
cholesterol measurements. The National Committee on Clinical
Laboratory Standards is collaborating with the National Heart, Lung
and Blood Institute and with the Centers for Disease Control to
conduct the National Cholesterol Standardization Program. This
effort
is a vital component of the National Cholesterol Education Program
(3), which has as its overall goals the effective identification
of,
monitoring for, and treatment of persons with cholesterol
abnormalities as cardiovascular risk factors.
In many studies, a sedentary lifestyle has been reported as an
independent risk factor for IHD. Moreover, habitual physical
activity
is considered to be associated with a reduced risk of IHD (4). The
effect of vigorous physical activity on IHD appears to be
independent
of the effects of other risk factors for IHD such as smoking and
hypertension. There is also evidence for some important
interactive
effects between physical activity and other risk factors,
especially
hypertension and obesity. Animal models appear to confirm these
findings and have demonstrated that physical activity may reduce
IHD
by delaying the development of atherosclerosis.
Current evidence supports policies that promote physical
activity
for the general population. However, important questions still
remain
concerning the intensity, duration, and frequency of physical
activity
required to confer protection. The 1990 Objectives for the Nation
recommend that by 1990, at least 60% of adults ages 18-65 years
should
participate in regular physical activity sufficient to produce
moderate to high cardiorespiratory fitness (6). As of 1985, only
10%-20% of U.S. adults had attained that level of activity (5).
References
National Center for Health Statistics: Underlying cause of
death. Public Use Tapes, 1979-1983.
Goldman L, Cook EF. The decline in ischemic heart disease
mortality rates. Ann Intern Med 1984; 101:825-36.
National Cholesterol Education Program, National Heart, Lung
and
Blood Institute, NIH, PHS, DHHS, Bethesda, MD 20892.
Siscovick DS, Laporte RE, Newman JM. The disease-specific
benefits and risks of physical activity. Public Health Rep
1985;100:180-9.
Powell KE, Spain KG, Christenson GM, Mollenkamp MP. The status
of
the 1990 objectives for physical fitness and exercise. Public
Health Rep 1986;101:15-21.
US Public Health Service. Promoting health/preventing disease.
Objectives for the nation. Washington, DC: Department of
Health
and Human Services, Public Health Service, 1980.
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