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CV Mortality and Attaining Public Health Goals

JAMA Cardiol; ePub 2016 Jun 29; Sidney, et al

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The decline of mortality rates in the US due to cardiovascular disease (CVD) has decelerated since 2011, including heart disease and stroke, and this trend may lead to not meeting the strategic goals for lowering the burden of CVD set by the American Heart Association (AHA) and the Million Hearts Initiative. This according to a report that compared the annual rates of change and trend in gap between heart disease (HD) and cancer mortality rates from January 1, 2000, to December 31, 2011, and January 1, 2011, to December 31, 2014, overall, and by sex and by race/ethnicity. Details included:

• The rate of the decline in all CVD, HD, and stroke mortality decelerated substantially after 2011, while the rate of decline for cancer mortality remained relatively stable.

• The annual rates of decline for 2000 to 2011 were 3.79%, 3.69%, 4.53%, and 1.49% for all CVD, HD, stroke, and cancer mortality, respectively.

• The annual rates for 2011 to 2014 were 0.65%, 0.76%, 0.37%, and 1.55%, respectively.

• Deceleration of the decline in all CVD mortality rates occurred in males, females, and all race/ethnic groups.

• The gap between HD and cancer mortality persisted.

Citation: Sidney S, Quesenberry Jr CP, Jaffe MG, et al. Recent trends in cardiovascular mortality in the United States and public health goals. [Published online ahead of print June 29, 2016]. JAMA Cardiol. doi:10.1001/jamacardio.2016.1326.

Commentary: The decrease in age adjusted CV mortality in the first decade of this century has been impressive and has been attributed to the increased use of evidence-based preventive health measures, including aspirin in appropriate groups, statin use, treatment of hypertension and smoking cessation. The more recent dramatic deceleration of the decrease in CV mortality is likely due to both the fact that the use of preventive measures is no longer increasing at the same rate as it had been along with an increase in obesity and diabetes in the population.1 It is of concern that the increase in adverse cardiovascular outcomes as a consequence of obesity and diabetes appears to be offsetting the benefits of risk factor reduction, and if this trend continues, we are likely to see increases in cardiovascular outcomes that offset anything that medications can provide. —Neil Skolnik, MD

1. Huffman MD, Capewell S, Ning H, Shay CM, Ford ES, Lloyd-Jones DM. Cardiovascular health behavior and health factor changes (1988-2008) and projections to 2020: Results from the National Health and Nutrition Examination Surveys. Circulation. 2012;125(21):2595-2602. doi:10.1161/CIRCULATIONAHA.111.070722.

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