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Update Healthy New Jersey 2000
Second Update and Review

Priority Area 5
Prevent, Detect And Control Cardiovascular
And Other Vascular Diseases

Introduction

Cardiovascular disease is the leading cause of death in New Jersey and the United States. The main forms of cardiovascular disease (CVD) are coronary heart disease, which can lead to heart attack, and cerebrovascular disease (stroke). The cost of cardiovascular diseases and stroke for 1998 is estimated at $274.2 billion nationally, according to the American Heart Association. Key modifiable risk factors include cigarette smoking, high blood pressure, high blood cholesterol, excessive body weight and physical inactivity. Diabetes is also a major risk factor that may be modified to a certain degree.

New Jersey will likely meet most of its year 2000 objectives for reduction of coronary heart and cerebrovascular diseases. The likelihood of achieving other year 2000 objectives, including reduction in renal disease, increasing physical activity, and the evaluation of blood pressure and cholesterol remains uncertain.

Outlook For Reaching Specific Objectives:

Achieve target: Likely Unlikely Uncertain
5Ai. Reduction in coronary heart disease death rates for:




total population
X




minorities
X


5Aii. Reduction in coronary heart disease death rates for persons 45-64:




total population
X




minorities
X


5B. Reduction in cerebrovascular disease death rates for:




total population

X


minorities
X




persons 45-64

X


minorities 45-64

X


persons 65 and over
X

5C. Reduction in end stage-renal disease rates for:




total population
X




blacks

X
5D. Increase in physical activity

X
5E. Increase in adults with blood pressure checks
X

5F. Increase in adults with cholesterol checks
X

Data Update

5Ai. Reduce deaths due to coronary heart disease per 100,000 population to:

107.2 for the total population (age-adjusted)
99.8 for minorities (age-adjusted)

Achieve target:LikelyUnlikelyUncertain
total population
X
minorities
X

Death Rates From Coronary Heart Disease
Year Total Age-Adjusted Minority Age-Adjusted
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
162.4
153.6
147.5
144.6
129.2
121.6
118.4
117.3
108.8
110.1
107.1
102.5
161.0
152.9
148.5
142.8
129.3
121.3
127.0
119.4
115.8
108.9
102.5
100.8

Except for a slight increase in 1994, the age-adjusted death rate from coronary heart disease among the total population has declined steadily since 1985, to the point where the 1996 rate represents a more than one-third reduction in the death rate due to this cause. The same is true for the minority population, with the exception of an increase in 1991. After age-adjustment has been done, the death rates are similar for both the total and the minority populations. For the population as a whole, New Jersey's year 2000 objective has been achieved. For minorities, the rate still remains slightly above the target, but it should be reached by the year 2000.

5Aii. Reduce deaths due to coronary heart disease per 100,000 population aged 45 through 64 years to:

154.7 for the total population
161.1 for minorities

Achieve target:LikelyUnlikelyUncertain
total population
X
minorities
X

Death Rates From Coronary Heart Disease
Year Total 45-64 Minorities 45-64
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
255.0
237.0
224.2
211.0
187.5
169.5
167.2
158.7
143.2
152.2
143.7
131.8
283.0
259.5
252.9
232.0
217.1
195.3
202.7
193.0
173.1
167.7
159.8
154.0

The patterns of the declines in death rates among the total and minority populations aged 45 through 64 are similar but even more dramatic than the respective age-adjusted declines for the total and the minority populations, with a 48.3 percent reduction in the death rate for the total population in this age bracket over the time period, and a 45.6 percent reduction for minorities in this age bracket. It appears likely that the year 2000 objective will be reached for both the total population and minorities in this age bracket. As of 1996, however, the death rate from coronary heart disease for minorities aged 45 through 64 remained higher than that for the total population this age.

5B. Reduce deaths due to cerebrovascular diseases per 100,000 population to:

20.8 for the total population (age-adjusted)
32.0 for minorities (age-adjusted)
22.8 for the population aged 45-64 years
44.9 for minorities aged 45-64 years
283.8 for the population aged 65 and over

Achieve target:LikelyUnlikelyUncertain
total population

X
minorities
X
total 45-64

X
minorities 45-64

X
total 65 and over
X

Death Rates From Cerebrovascular Disease
Year Total Age-Adjusted Minorities Age-Adjusted Total 45-64 Minorities 45-64 Total 65+
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
29.7
28.3
28.5
27.3
25.4
24.7
24.7
22.6
23.1
23.8
23.8
23.0
47.1
42.5
43.5
42.2
38.7
37.4
41.9
34.6
33.0
35.7
34.2
32.7
37.9
34.1
36.9
33.4
31.6
29.5
31.8
25.7
26.1
28.3
28.6
27.5
71.9
65.7
68.8
69.2
60.2
55.4
66.0
49.7
49.1
62.4
49.8
53.7
395.2
382.9
381.3
357.2
345.3
331.3
331.2
324.0
323.8
334.9
340.4
338.9

In all five of the populations considered, the death rates from cerebrovascular disease, or stroke, declined between 1985 and 1996, but exhibited considerable year-to-year fluctuations. The year 2000 target for minorities of all ages is likely to be achieved, but both this rate and the rate for 45-through 64-year-olds are consistently higher among minorities than among the total population. It is uncertain whether the targets for the age-adjusted total population, or those aged 45 to 64 will be reached, and it is unlikely that the target for the population 65 and over will be achieved.

5C. Reduce end-stage renal disease as a complication of diabetes per 1,000 diabetics over the age of 18 to:

1.8 for the total population
12.0 for blacks

Achieve target:LikelyUnlikelyUncertain
total population
X
blacks

X

End-Stage Renal Disease As
A Complication Of Diabetes Rates
Year Total Blacks
1991
1992
1993
1994
1995
2.8
2.9
3.2
3.4
4.7
13.2
N/A*
7.0
6.2
9.6
* Not available

Although end stage-renal disease (ESRD) has other causes, its chief causes are complications from diabetes and/or high blood pressure. These complications may be reduced through preventive interventions, such as diet or exercise. ESRD prevalence rates in the total diabetic population in New Jersey are rising, making it unlikely that the year 2000 objective will be met. Due to the small numbers of black diabetics, the New Jersey prevalence estimates presented above are not reliable to use in predicting whether the year 2000 objective will be met.

5D. Increase the number of persons aged 18 and over who participated in physical activity for at least 30 minutes three or more times per week during the past month to:

42.5 percent

Achieve target:LikelyUnlikelyUncertain



X

Percentage Of Persons Aged 18 And Over Who
Participated In Physical Activity For At Least 30 Minutes
Three Or More Times Per Week During The Past Month
Year Percentage
1991
1992
1993
1994
1995
1996
1997
38.6
34.8
N/A*
37.6
41.1
40.5
35.9
*Not available

Despite year-to-year fluctuations in the percentage of adults participating in regular physical activity, the overall trend reflects little change. The fluctuations are largely the result of small sample size in the Behavioral Risk Factor Surveillance System Survey. It is uncertain whether the year 2000 goal will be achieved.

5E. Increase the proportion of persons aged 18 and over who have had their blood pressure checked by a health professional within the past two years to:

96.0 percent

Achieve target:LikelyUnlikelyUncertain


X

Percentage Of Persons Aged 18 And Over Who
Have Had Their Blood Pressure Checked By A
Health Professional Within The Past Two Years
Year Percentage
1991
1992
1993
1994
1995
1996
1997
95.1
94.1
95.0
N/A*
95.2
N/A*
94.4
*Not available

While the percentage of New Jersey adults having their blood pressure checked has been high since data first became available through the Behavioral Risk Factor Surveillance System, it does not appear to be increasing. It appears unlikely that the year 2000 objective of 96 percent will be achieved.

5F. Increase the proportion of persons aged 18 and over who have had their blood cholesterol checked by a health professional within the past five years to:

82.0 percent

Achieve target:LikelyUnlikelyUncertain


X

Percentage Of Persons Aged 18 And Over Who Have Had Their Blood Pressure Checked By A Health
Professional Within The Past Five Years
Year Percentage
1991
1992
1993
1994
1995
1996
1997
72.9
68.4
71.5
N/A*
73.2
75.7
75.3
*Not available

Behavioral Risk Factor Surveillance System survey data indicates that the percentage of New Jersey adults who have gotten their blood cholesterol checked within the past five years has varied between 68 and 76 percent. The year-to-year fluctuations reflected in the data above are largely due to small sample size. However, with the lack of a clearly increasing trend in the proportion of respondents who report having this test, it appears unlikely that the year 2000 objective will be met.

Discussion

Over the past decade, cardiovascular disease death rates in New Jersey have declined, dramatically so in the case of coronary heart disease. Nevertheless, cardiovascular disease remains the leading cause of death in New Jersey and the United States. The main forms of cardiovascular disease (CVD) are coronary heart disease, which can lead to heart attack, and cerebrovascular disease (stroke). In 1996, these two forms of CVD accounted for 23,169 deaths of New Jersey residents.

Most CVD develops over time as the result of the narrowing of blood vessels by fatty deposits. Many factors influence not only whether a person develops CVD, but also how rapidly the disease progresses. Some of the risk factors are fixed; others are modifiable. The fixed risk factors are: age - persons aged 40 and older are at increased risk; gender - CVD is more common among men; and genetic background - persons with a family history of the disease are more susceptible than the general population.

Key modifiable risk factors include cigarette smoking, high blood pressure, high blood cholesterol, excessive body weight and physical inactivity. Diabetes is also a major risk factor that may be modified to a certain degree. Year 2000 objectives and Departmental strategies focus on modifiable risk factors, primarily smoking and diabetes, as well as on improving the quality of and access to treatment for CVD.

A smoker's risk of heart attack is more than twice that of a nonsmoker. Studies have also shown cigarette smoking to be an important risk factor for stroke. Evidence also indicates that secondhand exposure to smoke may increase the risk of heart disease. The Department's comprehensive tobacco-reduction initiatives are discussed in detail in priority areas 3 and 11.

Diabetes is a major risk factor for stroke, and is now recognized as a major risk factor for coronary heart disease as well. People with diabetes are two to four times more likely to have heart disease, stroke, or end stage renal disease (ESRD). People with diabetes may avoid or delay CVD by controlling the other risk factors. In addition, to controlling blood sugar levels, it is especially important for diabetics to control weight and blood cholesterol with a low-saturated-fat, low-cholesterol diet and regular exercise. It is also important to lower high blood pressure and avoid smoking. The prevalence of ESRD is an indicator not only of complications of diabetes, but also of high blood pressure.

The Department's Diabetes Control Program works to decrease the prevalence of complications from diabetes, through community-based outreach and education, as well as provision of preventive services to low-income, uninsured diabetics. Beginning in 1997, the Department also monitors the quality of preventive services provided to diabetics in its annual performance report on managed care health insurance plans.

Much of the progress in reducing CVD death rates may be attributable to improvements in treatment, which is a major priority for the Department. The Department convened a cardiovascular health advisory panel, consisting of a wide range of experts as well as consumer representatives, to assist in promoting improvements in cardiovascular health policy. Initiatives undertaken since this panel was convened include improved access through expansion of the number of low-risk diagnostic cardiac catheterization laboratories and cardiac surgery centers in the state. The Department has also supported use of portable defibrillators, which increase the chance that someone having a heart attack will survive. In addition, beginning in 1997 the Department has released reports comparing patient mortality rates for the hospitals and surgeons performing coronary artery bypass graft (CABG) surgery, one of the major treatments for CVD. For the first time, consumers have comparative information on hospitals and surgeons to help them make decisions about their care. The report's greatest impact, however, is on hospitals and doctors, who use it to make changes to improve the quality of services.

The Department is also committed to improving the access of minorities to cardiac services, and holds hospitals accountable for their provision of preventive health programs, diagnostic procedures and cardiac surgery to minorities.

In recent years, improvements have been made in treatment for one type of stroke, acute ischemic strokes. Persons suffering from this type of stroke can significantly benefit from thrombolytic therapy, so long as it is administered within a three-hour period following onset of stroke symptoms. Because of the need to first diagnose what type of stroke has occurred, thrombolytic therapy is available only in a hospital setting. The Department has convened an advisory committee to assess provision of stroke care in New Jersey.

Advances in treatment have accomplished a great deal, but controlling modifiable risk factors remains the most cost-effective intervention to reduce the impact of CVD. The Department will continue to explore ways to promote healthy cardiovascular behaviors.

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