Download Cardiovascular Disease * HS 404 Writing Assignment

Cardiovascular Disease – HS 404 Writing Assignment
Joseph Graves
Joseph Graves
HS 404
Writing Project Assignment – Parts 1, 2, and 3
10/16/11
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Cardiovascular Disease – HS 404 Writing Assignment
Joseph Graves
Introduction
The leading killer for males and females, regardless of age in the United Sates, is heart
disease (Centers for Disease Control and Prevention, 2010). Most frequently, media portrays the
deadliest disease as cancer; or many believe that automobile accidents are the leading cause of
death in the U.S. However, this is not the case. Also known in the medical field as cardiac
disease, it encompasses the multitude of diseases that impact the heart; these include coronary
heart disease, cardiomyopathy, cardiovascular, ischaemic heart disease, heart failure,
hypertensive heart disease, inflammatory heart disease, and valvular heart disease. Heart disease
remains America’s leading cause of death, killing one American every 34 seconds; more than
2,500 people each day. Fortunately, cardiac disease also remains a highly preventable disease
(Hitti, 2011). Heart disease is a non-infectious disease, meaning that it has no bacterial or viral
origin and it is not contagious or communicable. Many factors can lead one to be susceptible to
cardiac disease. Most commonly age, gender, genetics, and lifestyle can all influence the risk of
an individual in regards to heart disease. Heart attacks, and the symptoms leading up to them,
can be pre-symptomatic indicators of an underlying potential of cardiac disease. Treatment and
recovery vary between patients, but advances in medical technology have assisted in making this
a highly preventable and treatable disease; though death is a result that cannot be ignored. As one
of the leading fatal diseases afflicting humankind, heart disease is an issue that cannot be
ignored. It is important that medical knowledge be disseminated to learn more about preventative
measures in order to reduce the deaths caused by heart disease across the globe.
Stage of Susceptibility, Age
Age plays a significant role in heart disease. Heart disease kills more than 150,000
Americans under the age of 65 each year (Hitti, 2011). Those affected by heart disease increases
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Joseph Graves
proportionately with age, in both men and women. Heart disease becomes more prevalent in
middle-aged and elderly individuals. This is primarily a result of the physical deterioration of the
body, especially blood vessels. Blood vessels become less flexible, which makes it more difficult
for blood to move through them easily. Also, fatty deposits, called plaques, collect in the artery
walls, causing the blood flow from the heart to slow.
Stage of Susceptibility, Gender
Gender has also been scientifically shown to increase risk of cardiac disease.
Traditionally, this was considered a disease impacting only men. Research has now shown that
heart disease is the leading cause of death for women as well. Usually, men tend to develop heart
disease early in life. But after age 65, the risk of heart disease in both men and women is equal
(Abbott, 2009). This is in part due to women after 65 increasing their risk factors such as
smoking, high blood pressure, high cholesterol, and/or obesity. Heart disease does not
discriminate between gender; further it can be more impactful to females than historically
thought. “After menopause, the rates of cardiovascular disease converge, and once affected by
ischemic heart disease, females may fare worse than their male counterparts (Sugden, 2001).”
Further, women are more likely to die from heart attacks than men, regardless of age (Abbott,
2009). Women tend to develop plaque in the smaller arteries near the heart, whereas men are
more likely to develop plaque in the major arteries. Another contributing factor in women is
chronic stress, which doubles the risk of heart disease among women. Women experience greater
levels of acute and chronic stress than men, due to lifestyle and culture demands and pressures.
Stage of Susceptibility, Genetics
Scientific data has shown that one of the key risk factors associated with heart disease is
the genetic link between generations. Even if no genetic abnormalities are identified or other risk
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Joseph Graves
factors attributable to an individual, there may be an increased risk for cardiac disease if the
mother and/or father developed heart disease before the age of 55. This is also true if the
grandmother developed it before the age of 65. About 1 in 100 people have high cholesterol, due
to a genetic basis called familial hyperlipidemia. This disease results from defects in the way the
body metabolizes lipoproteins, resulting in high cholesterol. As there is a link between high
cholesterol and heart disease, this is yet another genetic risk affecting generations.
Stage of Susceptibility, Lifestyle
Although age, gender, and genetics all add to one’s risk of heart disease, the most
significant impact and controllable risk factor is lifestyle. High cholesterol, obesity, diabetes,
smoking, and inactivity are becoming more common in society, and just not among adults.
Almost 28 percent of American adults have at least two or more of these heart disease factors.
The rise of obesity and diabetes among our youth allows the disease that once typically affected
the older generations to now affect even teenagers. Most of the risk factors that affect children
can be controlled early, by altering lifestyle decisions and thereby lowering the risk of heart
disease later in life. The major two risk factors, out of the five that contribute to possible heart
problems, are due to the spike in obesity and physical inactivity among youth. These unhealthy
bad habits leave young adults susceptible in developing heart disease by the time they are an
adult.
The most significant lifestyle risk factor for developing heart disease comes from
smoking or using tobacco (Mayo Clinic Staff, 2011). Chemicals in tobacco can damage heart and
blood vessels, leading to blocked arteries; blocked arteries can then lead to a heart attack. No
amount of smoking is considered safe. All forms of tobacco are a health risk, and even exposure
to second hand smoking can cause a heart attack.
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Joseph Graves
Maintaining a healthy weight is vital in fighting against heart disease. “The childhoodonset of obesity, hypertension, and hyperlipidemia increased risk of cardiovascular morbidity
and mortality in adulthood (Ichord, 2011)”. The average person gains more fat, than muscle, with
age. The excess weight can lead to conditions that increase risk of heart disease. Obesity can lead
to high blood pressure, high cholesterol, and diabetes. Reducing your weight by just 10% can
have positive impacts on your health. A very useful tool is to measure how much fat you have is
a waist circumference test. Men are considered overweight if their waist is greater than 40
inches, and women if greater than 35 inches (Mayo Clinic Staff, 2011). Maintaining a healthy
weight decreases blood pressure, lowers blood cholesterol level, and reduces risk of diabetes.
Regular exercise for a minimum of 30 minutes for several days each week can help prevent heart
disease. Physical activity helps to maintain a healthy weight and adds other health benefits,
among them heart disease prevention. Exercise helps control weight and can reduce chances of
developing other conditions that may put a strain on the heart. These include, but are not limited
to high blood pressure, high cholesterol, and diabetes. Exercise also has been shown to aid in
stress reduction, a leading contributor of heart disease.
Poor nutrition and dietary habits contribute to the risk of cardiac disease. Eating a hearthealthy diet can help protect your heart. Foods that are low in fat, cholesterol, and salt help
reduce chances of acquiring heart disease. A diet of fruits and vegetables, whole grains, and low
fat dairy are essential for heart protection. “Most people need to add more fruits and vegetables
to their diet, and a good goal is five to ten servings a day (Alpert, 2011).” Another great way to
reduce your risk of heart disease is to incorporate fish as a regular part of the diet. It is also
important to moderate consumption of alcohol, to two drinks a day.
Stage of Susceptibility, Age
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Joseph Graves
Stage of Pre-Symptomatic Disease
In addition to lifestyle changes, regular health screenings can help catch a possible
cardiac problem early. High blood pressure and high cholesterol can damage heart and blood
vessels which can be detected during routine doctor visits. Regular blood pressure screening
should start in childhood and adults should have their blood pressure checked every two years.
Adults should have cholesterol measured once every five years, starting at age 20. Diabetes is a
high risk factor for developing heart disease, and testing for during your regular yearly checkups
is important. The most important tool in treating heart disease is prevention.
Stage of Recovery, Disability, or Death
It is vital to be aware of the symptoms and stages of heart disease. Men are more likely to
experience the classic stabbing chest pains. Other symptoms include pressure, crushing pain,
tingling in the left arm, and shortness of breath. Females are more likely to have atypical
symptoms such as nausea, weakness, lethargy, upper back/neck/jaw pain, clamminess, dizziness
and shortness of breath, in addition to the classic symptoms. Unfortunately, most individuals do
not even realize they are having a heart attack. “The most frequently cited factors for delay (in
treatment) included patients’ initial belief that their symptoms were not serious and/or did not
require treatment (Hsia, 2011).”
Conclusion
It is essential to receive treatment immediate with cardiac problems, to begin the recovery
process. Recovering from a heart attack can be a long process, requiring many lifestyle changes.
These changes are similar to the preventative measures one can take, but they are necessary
changes once cardiac trauma has occurred. Diet, exercise, medications, and doctor visits are all
routine changes, as well as participating in a structured cardiac rehabilitation program to help
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improve the heart’s ability to function and possibly prevent a second heart attack. The three parts
to cardiac rehabilitation include exercise; reduce risk factors that contribute to the risk of heart
disease, and deal with stress, anxiety, and depression properly. Although heart disease is the top
killer in the United States, the many preventative measures and treatment options can help
reduce deaths due to cardiac disease in the future.
Introduction to Data Measurement
Approximately 60 percent of deaths worldwide are from non-communicable diseases, the
majority of which are from cardiovascular disease (Centers for Disease Control and Prevention,
2010). In 2010, the total costs of cardiovascular diseases in the United States were estimated to
be $444 billion. Treatment of these diseases accounts for about $1 of every $6 spent on health
care in this country (Bleumin, Knetsc, Sturkenboom, Straus & Hofman, 2004). However,
measures can be taken to prevent heart disease and the financial impact on individuals and
insurance companies. Studies show that most individuals can become more heart healthy by
following a few key steps, such as eating a healthy diet, exercising, quitting smoking, and
maintaining a healthy body weight.
Data & Measuring Tools
Researchers are currently unable to accurately estimate the annual incidence for heart
disease. A national system that provides timely local data is desperately needed. Such a system
would improve capacity to monitor trends, identify populations at greatest risk, and evaluate the
effect of efforts to control factors for cardiovascular disease. “Final mortality data shows that
cardiovascular disease as the underlying cause of death (including congenital cardiovascular
defects) accounted for 34.3 percent (831,272) of all 2,426,264 deaths in 2006,or one of every 2.9
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deaths in the United States. CVD any mention deaths (1,347,000 deaths in 2006) accounted for
about 56 percent of all deaths in 2006 (Bleumin et al., 2004)”.
Studies
Hospitalization rates do not necessarily reflect the true incidence and prevalence of heart
disease in the general population. This is due to the fact that only very serious stages of this
syndrome require an in-hospital evaluation and treatment. The data regarding heart failure
incidence, prevalence and prognosis in the community are vital for understanding this deadly
disease. Large population-based studies have been published that help provide estimates of the
severity and the increase of heart disease amongst the population. “A large population-based
study with more than 10 years of follow-up research allowed for the incident of heart disease
rates to be documented (Adams & Apple, 2004)”. These statistics provide a valuable
understanding of the direction of where and how this disease is progressing. Studies have
predicted a global epidemic of cardiovascular disease on the basis of current trends (Ebrahim,
2001).
Incidence Rate
Cardiovascular disease constitutes a major public health burden across the world.
Incidence rates appear to be increasing over the years, especially in men. Prevalence estimates of
heart failure are also increasing as the average population ages. Hospitalization rates for heart
diseases have increased considerably. The proportion of patients having multiple hospital
admissions is rising. According to the Center for Disease Control, the biggest risk factor for heart
disease is inactivity; increasing likelihood of cardiac problems by 39.5% (Centers for Disease
Control and Prevention, 2010). The other contributing factors that increase the probability of
cardiovascular disease or related problems include obesity, high blood pressure, cigarette
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Joseph Graves
smoking, high cholesterol, and diabetes. However, inactivity stands at the top of this list year
after year, generation after generation. When there are so many negative implications and side
effects of poor healthy lifestyle decisions, it is difficult to believe that there are still so many
individuals being impacted with heart disease due to inactivity. For example, taking the initiative
to park in further parking spots can increase the amount of walking while running errands,
helping to alleviate this problem. Other ideas are to wear a pedometer and set goals and
challenges that are attainable and rewarding oneself with a healthy treat. Although changing
one’s lifestyle habits that they have grown accustom to is difficult, the alternative is much more
daunting; this includes changing activity levels as well as healthy dietary habits. Society needs to
understand the severity of their choices when favoring fast food sandwiches over healthy organic
salads. It is vital to exchange laziness for a desire to live a longer, healthier life. If something
does not change, clearly there will continue to be a rise in deaths linked to obesity and inactivity;
especially cardiovascular disease.
Prevalence Rate
The burden of heart disease is considerable; it represents 30% of all deaths worldwide
(Ebrahim, 2001). This is an average of 15 million deaths each year, and 11 million of these are in
developing countries. Some forms of heart disease appear to be declining, as clinical research
shows. New screening tools provide cardiologists with the ability to recognize cardiac problems
earlier; early detection, like with many diseases, is key in with cardiovascular disease to help
determine a treatment path. Additionally, new treatments have been shown to slow the
progression of cardiac disease, and as a result have improved the quality of life for millions of
people as well as extended it. Further, to aid in the understanding and health education efforts
related to cardiac disease, aspirin has become an active tool in spreading the information. Using
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aspirin to prevent heart attacks is one major factor that is improving the overall public health and
helping to curb the prevalence rates. Additionally, medical technology has jump vast leaps and
bounds over the past several years; “this has led to the recent implantation of the world’s first
artificial heart (Adams & Apple, 2004)”. Clearly, medicine is transforming to meet the needs of
patients, and hopefully a cure for cardiac disease is not far away.
Mortality Rate
There are certain uncontrollable factors that may increase one’s risk for cardiovascular
disease; male gender, older age, family history, post-menopausal females, and race. Every race is
susceptible to heart disease, but historically, African Americans, American Indians, and Mexican
Americans are at a higher risk of getting the disease than Caucasians. Reducing cardiovascular
disease related deaths will require young and middle aged people to take preventable measures
early, while they have a chance to reduce their controllable health risks. The mortality rate is not
adjusted to the age distribution of a standard population. Instead, it counts the number of deaths
that have occurred and is divided by the number of persons in the population. The goal is to
decrease the mortality rate to less than 166 deaths per 100,000 individuals, according to the
Healthy People 2010 initiative (Centers for Disease Control and Prevention, 2010). This
initiative will require an increase in health education and publicity of heart disease, but
ultimately the responsibility lies with each individual to improve their overall health and reduce
the likelihood of death from cardiac disease.
Conclusion
There is a national policy framework with an effort to creating an environment more
conducive to healthy lifestyles. These programs for prevention and control of diseases, like
cardiovascular disease, are promoting effective prevention and support the development of
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Joseph Graves
change in the treatment of heart disease. However, detrimental habits such as smoking, excessive
drinking and the influences related to social class will continue to keep the prevalence of heart
disease alive. We have become much better at treating patients who have had a heart attack, and
in some cases stopping a heart attack in its tracks. However, this seems to take the place of
preventable measures that seem so obvious to most. Many people can have a better quality of
life, and many more wonderful years if they would take control of their health in a positive way,
before it becomes the ultimate risk.
Introduction to Prevalence in the US
Cardiovascular disease has been the leading cause of death in the United States for almost
80 years, and is the major cause of disability among Americans. National data takes into
consideration racial/ethnic, geographic, gender, and age in death rates for heart disease regarding
the prevalence of persons living with heart disease. Prevalence of heart disease means the
number of existing cases of cardiovascular disease in a given population of the United States.
The most appropriate methodology to estimate prevalence includes geographic as well as personlevel demographic variables (Congdon, P., 2009). To estimate the prevalence of heart disease,
the Center for Disease Control (CDC) monitors several types of data to assess trends in statistics.
One specific survey is primarily used to determine the prevalence of cardiac disease within the
United States. Self-reported data from the Behavioral Risk Factor Surveillance System (BRFSS)
is provided from each state that is accumulated to provide prevalence estimates of heart disease
amongst people in the US. The results from this data includes geographic, racial/ethnic, gender,
and age in comparison to identify a correlation or relationship between any of these
characteristics (or combinations thereof) and heart disease prevalence.
Basis of the Survey and Limitations of Data
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The survey was administered by the state health depart, in cooperation with the CDC. It
was a random-dialed telephone survey and the median response rate among the states was
51.1%, which is appropriate for accumulating and compiling such health data (Center for
Disease Control and Prevention, 2011). The study took into consideration the efficiency of the
telephone sampling method used and participation rates among eligible respondents who were
contacted. A total of 356,112 responded from all 50 states and the results are effective in
assisting health professionals identify ongoing trends and patterns between certain characteristics
and heart disease.
Survey Questions
The survey respondents answered questions indicating whether a doctor ever told them
they had ever experienced a heart attack. Other questions included age, race/ethnicity, gender,
education, and, geographic location to determine demographic information to help identify
trends and patterns. Data reflected each state’s population at the age of 18 years and older, and
results were adjusted to the US adult standard population for each year, 2000 and 2009 for the
most recent data available for analysis.
Prevalence Data – Overall United States
The CDC documents that the prevalence of coronary heart disease among US adults
above 18 years of age was 3.6% of the population in 2000, but drastically increased to 4.5% of
the population in 2009 (Center for Disease Control and Prevention, 2011). There had been a
general increase in cases of cardiovascular disease since 2000, with a decrease from 2002 to
2003 and again from 2006 to 2007 but increased substantially after each of those periods.
However, statistics show that overall incidences of heart disease have increased over the nine
year period from 2000 to 2009 across the US population.
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Prevalence Data – Gender
Results of the BRFSS surveys accumulated to show that during the year 2000, US males
had a prevalence rate of 4.8% whereas US females had a prevalence rate of only 2.5% (Center
for Disease Control and Prevention, 2011). Both genders had increase in existing cases of
coronary heart disease and during 2009, US males had a prevalence rate of 6.3% and females a
rate of 2.9%. Over the course of a nine year period, the cases of cardiovascular disease for men
increased 31% and increased 16% for women.
Prevalence Data – Ethnicity
The BRFSS survey compiled statistical information from four different ethnic
populations in the United States; White, Black, Hispanic, and other. In 2000, the prevalence rates
for each of these populations was 3.7%, 3.2%, 2.8%, and 2.9% respectively (Center for Disease
Control and Prevention, 2011). In 2009, each of the ethnic groups noticed a jump in coronary
heart disease prevalence; White 4.6% (an increase of 24%), Black 4.3% (an increase of 34%),
Hispanic 3.8% (the largest increase at 36%) and other 3.2 (the lowest, at an increase of 10%). In
addition to ethnic populations, certain socioeconomic factors also can become a factor resulting
in heart disease. “There is considerable activity in population-wide prevention, primary
prevention for higher risk people, and secondary prevention, but wide disparities exist among
groups on the basis of socioeconomic status and geography, pointing to major gaps in efforts to
use available, proven approaches to control cardiovascular diseases (Cooper, R., Cutler, J.,
Desvigne-Nickens, P., Fortmann, S., Friedman, L., Havlik, R., Hogelin, G., & Marler, J., 2000).”
Prevalence Data – Age
Although the CDC survey data included Americans above the age of 18, there were no
significant reported prevalence data from age 18 to age 24. For the 25 to 44 year age group, the
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Joseph Graves
data showed an increase of 60% in cases (from 0.5% prevalence in 2000 to 0.8% in 2009). The
45 to 64 year age group, there was an increase of 19% (from 4.7% in 2000 to 5.6% in 2009).
Finally, for the data provided for anyone older than 65 years, there was a 20% increase in
cardiovascular disease, from 12.4% 2000 to 14.9% in 2009 meaning that nearly one out of every
seven people older than 65 will likely have heart disease (Center for Disease Control and
Prevention, 2011). This statistic is not a surprise, as age is a significant factor in estimating an
individual’s risk of cardiac disease. “To achieve the goal of improving cardiovascular health by
20% by 2020, we (medical professionals) will need to redouble our primordial prevention efforts
at the population and individual levels. Such efforts must be targeted at youths and young adults
because, by middle age, most Americans already have poor cardiovascular health (Folsom, A.,
Yatsuya, H., Nettleton, J., Lutsey, P., Cushman, M., & Rosamond, W., 2011).”
Prevalence Data – Location
The BRFSS survey data was segregated into one of four geographic areas in the United
States; Northeast, Midwest, South, and West. For 2000, the prevalence rates for each of these
locations was 3.1%, 3.6%, 4.0%, and 3.3% respectively. Each region saw an increase in coronary
heart disease prevalence over the next eight years, jumping to 4.2% in the Northeast, 4.7% in the
Midwest, 5.0% in the South, and 3.5% in the West (Center for Disease Control and Prevention,
2011). The overall data for the respondents in the West region were least impacted with only a
6% increase in eight years, but those in the Northeast noticed a jump of 35% in prevalence rates
over the same time frame.
Patterns and Trends Identified
In order to lower the incidence of heart disease and eliminate such health disparities,
health programs should target excessively affected populations. Using data accumulated by
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agencies like the CDC can help identify trends and patterns for more susceptible portions of the
American population. For example, it has been shown that males over the age of 65 are at
extreme risk of heart disease. In addition, those living in the Northeast and are of Caucasian
backgrounds can be further at risk which are new indentifying characteristics. Another emerging
trend shows dramatic increases in the Hispanic population as well as the younger age group of
those between 25 and 44 years old. Clearly, this indicates that there is a greater impact on
younger generations as poor lifestyle and eating habits are resulting in poor cardiovascular health
at a young age. This is a very concerning trend, and one that should be distributed to the
American population in hopes of reversing the road we are headed down.
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References
Abbott, T. (2009). How age and gender affect your heart. Well Beyond Medicine , Retrieved
from
http://www.ghc.org/healthAndWellness/index.jhtml?item=/common/healthAndWellness/
conditions/heartDisease/ageAndGender.html
Adams, J., & Apple, F. (2004). New blood tests for detecting heart disease. Circulation, 109, 1214. DOI: 10.1161/01.CIR.0000114134.03187.7B
Alpert, J. (2011). Nutritional advice for the patient with heart disease: what diet should we
recommend for our patient?. Circulation Research, 124, 258-260. Retrieved from
http://circ.ahajournals.org/content/124/10/e258
Bleumin, G. S., Knetsc, A. M., Sturkenboom, M. C., Straus, S. M., & Hofman, A. (2004).
Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and
prognosis of heart failure. European Heart Journal, 25, 1614-1619. DOI:
10.1016/j.ehj.2004.06.038
Center for Disease Control and Prevention. (2011, September 22). Division for heart disease and
stroke prevention: data trends & maps. Retrieved from
http://apps.nccd.cdc.gov/NCVDSS_DTM/IndicatorSummary.aspx?param1=5m2=34
Center for Disease Control and Prevention. (2010, July 21). Heart disease and stroke prevention.
Retrieved from
http://www.cdc.gov/chronicdisease/resources/publications/AAG/dhdsp.htm
Congdon, P. (2009). A multilevel model for cardiovascular disease prevalence in the US.
International Journal of Health Geographics, 8(6), 1-15. doi: 10.1186/1476-072X-8-6
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Cooper, R., Cutler, J., Desvigne-Nickens, P., Fortmann, S., Friedman, L., Havlik, R., Hogelin,
G., & Marler, J. (2000). Trends and disparities in coronary heart disease, stroke, and
other cardiovascular diseases in the United States. Circulation, 102(25), 3137-3147. doi:
10.1161/01.CIR.102.25.3137
Ebrahim, S. (2001). Exporting failure? coronary heart disease and stroke in developing countries.
International Journal of Epidemiology, 30(2), 201-205. DOI: 10.1093/ije/30.2.201
Folsom, A., Yatsuya, H., Nettleton, J., Lutsey, P., Cushman, M., & Rosamond, W. (2011).
Community prevalence of ideal cardiovascular health. Journal of the American College
of Cardiology, 57(16), 1690-1696. doi: 10.1016/j.jacc.2010.11.041
Hitti , M. (n.d.). Heart disease kills every 34 seconds in U.S. Retrieved from
http://www.webmd.com/
Hsia, A. (2011). Understanding reasons for delay in seeking acute stroke care in an underserved
urban population. Journal of the American Heart Association, 42, 1697-1701. Retrieved
from http://stroke.ahajournals.org/content/42/6/1697
Ichord, R. (2011). Hypertension and cerebral vascular reactivity in childhood: challenge and
opportunity. Journal of the American Heart Association, 42, 1805-1806. Retrieved from
http://stroke.ahajournals.org/content/42/7/1805
Lambert, E. (2011). Ghrelin modulates sympathetic nervous system activity and stress response
in lean and overweight men. Journal of the American Heart Association, 48, 43-50.
Retrieved from http://hyper.ahajournals.org/content/58/1/43
Mayo Clinic Staff, (2011, January 12). Heart disease prevention. Retrieved from
http://www.mayoclinic.com/health/heart-disease-prevention/WO00041
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Sugden, P. (2001). Gender differences in susceptibility to cardiovascular disease. Circulation
Research, 88, 975-977. Retrieved from http://circres.ahajournals.org/content/88/10/975
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