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Heart Health Tracked by State for the First Time

Heart Health

The American Heart Association (AHA) has established a goal of improving U.S. heart health by 20% by 2020. Now, a team of CDC researchers has determined how all 50 states and the District of Columbia measure up to these metrics, findings that can help state policymakers as they seek to improve the health of Americans across the country.

Cardiovascular disease (CVD) is the leading cause of death in the United States, contributing to one in every three deaths each year. The direct medical costs of CVD in the United States and indirect costs due to lost productivity total an estimated $444 billion per year. Despite these statistics, CVD deaths have declined over the past 40 years. Much of this momentum comes from reducing risk factors, such as high blood pressure and high cholesterol, and improving health behaviors, such as not smoking, getting regular exercise, and eating a healthful diet.

Healthy People 2020, the nation’s roadmap for better health, includes a goal to “Improve cardiovascular health and quality of life through prevention, detection, and treatment of risk factors for heart attack and stroke...” Similarly, the American Heart Association (AHA) set a 2020 Impact Goal to address CVD: “By 2020, to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%.”

These goals for heart health take a step away from the “treatment-only” approach and instead emphasize prevention and the positive steps people can take to reduce their risk for CVD. The approach also raises new questions, which CDC researchers set out to answer:

  • “How good is our current heart health, according to these measures?”
  • “How does our current heart health vary by state and region?”

First Study to Measure Heart Health at State Level

To dig deeper into state-level heart health, a CDC team gathered data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS), a telephone health behavior survey, in partnership with health departments in all 50 states and the District of Columbia.

The team began by excluding BRFSS respondents who already had heart disease or had a past stroke. The remaining data included complete demographic information for 356,441 U.S. adults, with answers to questions about seven heart-health factors.

The researchers defined “ideal heart health” as having ideal values for each heart-health risk factor. Poor heart health meant having ideal values for only two or fewer of the seven metrics.

7 Heart-health Risk Factors

  • High blood pressure
  • High cholesterol
  • Smoking
  • Overweight
  • Diabetes
  • Lack of Physical Activity
  • Less than 5 servings of fruit and vegetable a day

The Findings

Overall, about 3% of respondents had ideal cardiovascular health, and nearly 10% had poor cardiovascular health. However, results across states varied widely. The percentage of adults with ideal cardiovascular health ranged from a low of slightly more than 1% percent in Oklahoma to a high of nearly 7% in Washington, DC. Other states with low ideal cardiovascular health included West Virginia and Mississippi. In addition to the District of Columbia, states with higher ideal cardiovascular health included Vermont and Virginia.

Those 65 years or older had the lowest percentage of ideal heart health and the highest percentage of poor heart health. Adults aged 18 to 34 years had the lowest percentage of poor health, and the group in the middle—those aged 35 to 54 years—had the highest percentage of ideal heart health.

Women had better heart health than men across all categories. Non-Hispanic whites and Asian/Pacific Islanders had consistently better heart health than Hispanics. Non-Hispanic blacks and American Indian/Alaska Natives had poorer heart health than their counterparts in the other three groups. Adults who had received college or postgraduate degrees had consistently higher levels of ideal heart health.

The research team noted that these results can be used to direct local, state, and national programs aimed at improving heart health, help focus limited resources, and tailor communication efforts.

More Information

To learn more about better heart health in your state and across the country, visit