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June, 2007


Highlights in Minority Health
February, 2005

American Heart Month 2005

 

FEBRUARY IS AMERICAN HEART MONTH
Heart disease is the nation's leading killer for both men and women and among most racial and ethnic groups, killing 696,947 Americans in 2002.  Though heart disease death rates are half of what they were in 1950 (586.8 per 100,000 in 1950 vs. 240.8 per 100,000 in 2002), it accounted for 29 percent of all deaths in 2002.  Cancer, the second leading cause of death that year, accounted for 23 percent of all deaths.
The major risk factors for heart disease include smoking, having high blood pressure, having high blood cholesterol, having diabetes, being overweight, being physically inactive, and having a family history of heart disease. Studies among people with and without heart disease have shown that lowering high blood cholesterol and high blood pressure can reduce the risk of developing heart disease, dying of heart disease, having a nonfatal heart attack, and needing heart bypass surgery or angioplasty.
 
EXAMPLES OF HEALTH DISPARITIES RELATED TO HEART DISEASE
Racial and Ethnic Minorities
  red arrow Heart disease is the leading cause of death for American Indians and Alaska Natives (AI/ANs) (157.4 per 100,000), African Americans (308.4 per 100,000), Hispanics/Latinos (180.5 per 100,000), and whites (236.7 per 100,000). Although cancer is the leading cause of death for Asian Americans and Pacific Islanders (AAPIs) (accounting for 26.4 percent of all deaths), heart disease is a close second (25.4 percent).
  red arrow In 2002, African Americans had the highest heart disease death rate of all races/ethnicities (308.4 per 100,000), followed by white non-Hispanics (239.2 per 100,000).
  red arrow In 2000, among U.S. adults aged 20 years and older, the age-adjusted prevalence of heart attacks was 5.2 percent for non-Hispanic white males and 2.0 percent for females; 4.3 percent for non-Hispanic black males and 3.3 percent for females; 4.1 percent for Mexican American males and 1.9 percent for females.
  red arrow Around 40 percent of African American men and women have some form of heart disease, compared to 30 percent of white men and 24 percent of white women.
  red arrow AI/AN women 20 years of age and older have higher blood pressure levels (36.4 and 36.0, respectively) than white non-Hispanic women (19.7 percent).

Gender

  red arrow Heart disease is the leading cause of death for both women and men in the United States (men: 297.4 per 100,000; women: 197.2 per 100,000). About 6.7 million American women have heart disease.
  red arrow In 2001, women under age 45 experienced higher rates of heart disease than men of the same age (49.7 vs. 27.9 per 1,000 population, respectively). However, with increased age, the rates reversed; climbing to 248.0 for men and 179.5 for women aged 75 and older.
  red arrow Females, in general, have poorer outcomes following a heart attack than do males: 44 percent of females who have a heart attack die within a year, compared with 27 percent of males.
  red arrow 42 percent of women who have heart attacks die within 1 year compared with 24 percent of men.
  red arrow At older ages, females who have a heart attack are twice as likely as males to die within a few weeks. These differences are explained, in part, by the presence of coexisting conditions such as high blood pressure, diabetes, and congestive heart failure. Complications are more frequent in females than in males after coronary intervention procedures, such as angioplasty or bypass surgery, are performed.
  red arrow About 24 million women aged 60 and older have high blood pressure. Among all women, American Indian/Alaska Native women are the least likely to have had a blood pressure screening in the past 12 months (73 percent).  Of Hispanic and Asian American women, 26 percent and 27 percent, respectively, had not had a blood pressure screening in the past 12 months. In contrast, 20 percent of white women and 18 percent of African American women reported that they had not had a blood pressure screening.

Age

  red arrow The death rate for heart disease increases with age for all races and both genders, from 93.7 per 100,000 for the 45-54 year old age group to 1677.2 per 100,000 for the 75-84 year old age group.
  red arrow According to the 2003 Behavioral Risk Factor Surveillance System (BRFSS), participation in physical activities decreased with age, from 78.5 percent of those in the 35-44 year age group reporting physical activity to 67.6 percent for those in the 65+ age group reporting physical activity.

Income & Education

  red arrow Higher prevalences of multiple CVD risk factors among AI/AN participants who were either unemployed or had completed less than a high school education corroborate the well-documented influence of low socioeconomic status on CVD risk factors.
  red arrow 32 percent of people with poor family income have high blood pressure, compared with 27 percent of those with middle/high family income.
  red arrow 84 percent of those who did not graduate high school had their blood pressure measured in the past 2 years and knew if it was normal or high, compared with 90 percent of high school graduates and 93 percent of those with at least some college.
  red arrow 58 percent of those who did not graduate high school had their blood cholesterol measured in the past 5 years, compared with 69 percent of high school graduates and 78 percent of those with at least some college.
  red arrow According to the 2003 BRFSS, participation in physical activity increased with education, from 55.4 percent of those who did not graduate high school to 87.7 percent of college graduates. Physical activity also increased with income, from 62.2 percent of those earning less that 15,000 to 86.5 percent of those earning 50,000 or more.
 
PROMISING INTERVENTION STRATEGIES
Diet is one of the things that can affect your heart health, and your risk for getting heart disease.
Physical activity reduces the risk of premature mortality in general, and of coronary heart disease, hypertension, and other diseases. Significant health benefits can be obtained by including a moderate amount of physical activity (e.g., 30 minutes of brisk walking or raking leaves, 15 minutes of running, or 45 minutes of playing volleyball) on most, if not all, days of the week. Additional health benefits can be gained through greater amounts of physical activity. People who can maintain a regular regimen of activity that is of longer duration or of more vigorous intensity are likely to derive greater benefit.
A key strategy for addressing these risk factors is to educate the public and health care practitioners about the importance of prevention. Current guidelines recommend that all adults have their blood pressure checked regularly and their blood cholesterol levels checked every 5 years. Systems changes are also needed to help practitioners adhere to guidelines for treating patients with or at risk for heart disease and stroke, such as prescribing beta-blockers and aspirin. Preventive actions can help people at any level of blood pressure or cholesterol to reduce their risk.
People also need to be educated about the signs and symptoms of heart attacks and stroke and the importance of calling 911 quickly. Forty-seven percent of heart attack victims and about the same percentage of stroke victims die before emergency medical personnel arrive. Other important risk factors for heart disease and stroke—such as diabetes, tobacco use, physical inactivity, poor nutrition, and overweight and obesity—need to be addressed through lifestyle changes and appropriate use of medications.
 
PROGRAMS
REACH 2010
REACH 2010 is part of the national initiative to eliminate disparities in health status experienced by racial and ethnic minority populations in six priority areas, including cardiovascular diseases.  REACH 2010 supports community coalitions in designing, implementing, and evaluating community-driven strategies to eliminate health disparities. Each coalition comprises a community-based organization and three other organizations, of which at least one is either a local or state health department or a university or research organization.
The Heart Truth
The campaign is especially aimed at women ages 40 to 60, the time when a woman's risk of heart disease starts to rise. But its messages are also important for younger women, since heart disease develops gradually and can start at a young age—even in the teenage years. Older women have an interest too—it's never too late to take action to prevent and control the risk factors for heart disease. Even those who have heart disease can improve their heart health and quality of life.
Generations
In 2001, the Department of Health and Human Services' (HHS) Office on Women's Health (OWH) funded a pilot program, called Generations, to prevent cardiovascular disease in African American women. The program was conducted in six African-American churches in Atlanta, Minneapolis, Los Angeles, Mississippi, and Chicago by the Association of Black Cardiologists. Generations was designed to encourage African American women to reduce their risk for cardiovascular disease. The program included personal risk assessment, cooperative support groups, and regularly scheduled educational sessions on risk factors for cardiovascular disease and risk modification.
For Your Heart Pilot Project
In 2003, OWH funded the National Black Nurses Foundation to develop and coordinate a project aimed at reducing cardiovascular disease among African-American women. The goal of this project was to promote and pilot the "For Your Heart" web based health education tool and notebook among African American Women, to create awareness around the seriousness of heart disease, and to encourage women to change behavior to lower their risk factors. The National Black Nurses Foundation trained 1-20 members of the New York Black Nurses Association (NYBNA) to provide health education services using the For Your Heart notebook. These nurses used the notebook in their professional settings, and in the community, and found the web site to be well received. Recommendations to improve the For Your Heart web site were made.
 
FOR MORE INFORMATION
  National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP)
    Preventing Heart Disease and Stroke
  Agency for Healthcare Research and Quality
    Research on Cardiovascular Disease in Women
  Healthy People 2010
    Chapter 12: Heart Disease and Stroke
  National Heart, Lung, and Blood Institute
    Heart and Vascular Diseases
    Minority Populations Gateway
  American Heart Association


 

 

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