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Years of Life Lost from Cardiovascular Disease

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

  1. National Center for Health Statistics: Underlying cause of death. Public Use Tapes, 1979-1983.

  2. Goldman L, Cook EF. The decline in ischemic heart disease mortality rates. Ann Intern Med 1984; 101:825-36.

  3. National Cholesterol Education Program, National Heart, Lung and Blood Institute, NIH, PHS, DHHS, Bethesda, MD 20892.

  4. Siscovick DS, Laporte RE, Newman JM. The disease-specific benefits and risks of physical activity. Public Health Rep 1985;100:180-9.

  5. 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.

  6. 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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