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Press Briefing Transcript

Vital Signs telebriefing on heart disease and stroke deaths

September 3, 2013 at 1pm E.T.

TOM SKINNER: Thank you all for joining us for the release of another CDC Vital Signs. This September Vital Signs is on preventable death from heart disease, stroke, and hypertensive disease, United States 2001 to 2010.  With us is the director of the CDC Dr. Tom Frieden who will provide some opening remarks, and then we'll get to your questions. Dr. Frieden? 

TOM FRIEDEN: Thank you very much for joining us today. Each month we release a Vital Signs on a health topic that we can do something about and that's a major cause of illness, injury, disability, or death in the U.S. Nothing is more important than reducing heart disease and stroke.  These are number one killer in the U.S., and I’m certain that everyone listening to this call has firsthand experience knowing someone who has died too soon from a heart attack or a stroke. A family member, friend, someone who died early and unexpectedly. In fact, here at CDC tragically one of our long-standing leaders passed away from a massive stroke recently, and we're all still reeling from that, but that kind of incident, that kind of tragedy happens far too often, particularly because it's so preventable. 

Every day we read about stories of high profile athletes or movie stars or other celebrities who suddenly die or have a heart attack or stroke. It seems to make the headlines everywhere, but what's behind those headlines is that every year about one out of every three deaths in our country, about 800,000 deaths, are from cardiovascular disease. For the first time ever today we're reporting on the number of preventable deaths from heart disease and stroke, and we report that an estimated 200,000 preventable deaths occurred among people under the age of 75 in the U.S. in 2010. 

Preventable death can also be called avoidable, as we describe in the MMWR that we released today.  These are defined as those from heart disease, stroke in people under the age of 75, although we know that in some ways this is an underestimate and in some ways it's an overestimate. It's an underestimate because many deaths in people over 75 could also be prevented, and some of the deaths in people under the age of 65 may not have been able to be prevented with our current technologies.

But as a doctor, I find it really heartbreaking to know that the vast majority of people who are having a heart attack or stroke under the age of 65 in particular and dying from it didn't have to have that happen. We made progress overall. In fact, the rate of preventable deaths from heart disease and stroke decreased by nearly 30 percent between 2001 and 2010, but most of this progress was among the older of that age group: 65 to 74-year-olds. While those who are age 65 to 74 still have the highest rate or greatest risk of heart attack and stroke, more than half of the preventable deaths, about six in ten, happen in people under the age of 65, and in that group improvements have been much slower, and we have a graphic that shows that the number actually hasn't decreased at all because while there's been a slower decline in the rate of deaths in 65 to 74-year-olds, the population in that age group is increasing, so the actual numbers stayed essentially the same.

Now, there are certain trends that I think are relevant here, and it's worth outlining them because to add implications for what we can do to bring heart disease and deaths down everywhere. The first, as I mentioned, is age. Preventable deaths are decreasing much faster in the 65 to 74-year-old age group than in younger age group, and this may well be because they have access to health insurance and preventive screenings and treatment through their Medicare coverage. So, one is age. 

The next key factor is location. It's unfortunate, but your longevity may be more likely to be influenced by your zip code than by your genetic code.  In fact, what we've seen is a striking convergence of risk factors in the southern states, and while risk varies by county, even within the same state, counties in southern states have much higher overall risk. The highest rates by state in 2010 were in Washington D.C., Mississippi, Oklahoma, Tennessee, Louisiana, Arkansas, Kentucky, and Alabama.

There was nearly a three-fold difference in rates among states and a ten-fold difference among counties between the highest and the lowest rates, and that difference reflects the amount that we could improve health overall. Rates are too high virtually everywhere in the country, but counties that have some of the highest rates are in Missouri, Mississippi, and elsewhere, and counties with some of the lowest rates are in places like Colorado and California, but we know that all places can reduce their rates by doing a few simple things that I'll talk about in just a minute.

The third after age and location is race and ethnicity. African-Americans were twice as likely as whites to die from preventable heart disease and stroke. Blacks experienced nearly twice the rate of avoidable deaths, and, in fact, heart disease is the single largest contributor to racial differences in life expectancy. And finally, sex. Men are at much higher risk of death across all races and ethnic groups and African-American men are at the highest risk. Now, not only are there big differences within the U.S., but if you compare us with other countries, we're not doing as well as we could. 

In fact, the overall rate of cardiovascular death in the U.S. is about 50 percent higher than many similar countries around the world.  A recently released study shows that – a different study, not the one we're releasing today – shows that heart disease accounts for about half of the gap in life expectancy between us here in the U.S. and other countries, so we know that we have a much lower life expectancy. Well, about half of that is just from heart disease itself. In fact, we rank 27th out of 34 countries that were studied in that publication in years of life lost from premature death from heart disease. 

Now, heart disease and stroke deaths have been prevented through a few simple things. First, better management of blood pressure, cholesterol, and diabetes. Second, improving health overall by reducing smoking, increasing physical activity, and improving nutrition. And, third, by community level changes so we have healthier spaces, easier places to walk, more smoke-free places. Now, in 2010 more than one out of five adults in the U.S., age 18 to 64, had no health insurance.  Having no health insurance greatly reduces the likelihood that you'll get preventive screening, that you'll get effective treatment for high blood pressure and high cholesterol, and this may well explain a significant portion of the difference that we saw in the faster decline of preventable deaths in people over 65 and under 65. 

Beginning in October the health insurance marketplace, part of the Affordable Care Act, will provide a new way that the law provides for people to get health insurance so more patients have access to quality, affordable health insurance coverage and preventive care beginning as early as January 1st, 2014.  In addition, the CDC along with the American Heart Association, United Health and many partners and the Center for Medicare and Medicaid services are co-leading the Million Hearts campaign with the goal of preventing a million heart attacks and stroke over five years.  There are a few things that the health care system really needs to do, and we've been tremendously impressed by examples in different parts of the health care system where we've seen huge progress.  Health care providers can track patient progress on the ABC'S of heart health. A for aspirin, where appropriate. B for blood pressure control. C for cholesterol management and S for smoking cessation. They can also adopt electronic health records to target patients that are at risk and provide more follow-up. They also can encourage healthy behavior at every visit including not smoking, increasing physical activity, and taking medications as directed.

For individuals one of the key lessons here is simple things make a big difference. Not smoking, controlling blood pressure, controlling cholesterol can drastically reduce your risk of having a heart attack or stroke. The federal government is doing a lot of things, including providing resources to all 50 states to address chronic disease, including heart disease and stroke, through a new funding opportunity that CDC has released recently. We're also leading national campaigns to reduce the risk factors for heart disease and stroke, such as Weight of the Nation and Tips From Former Smokers and we're measuring progress rigorously to hold all of us accountable to making more progress because even one preventable death is one too many. There's even more that communities and health departments can do to create and encourage systems that promote blood pressure control, that increase the use of health information technology, that expand healthier living spaces.

Now, before I turn it over for questions, I’d just like to comment that these findings are really striking because we're talking about hundreds of thousands of deaths that don't have to happen when they happen. We're talking about rates that are much higher in some parts of the country than others, and while you might think that it is, for example, all a reflection of race ethnicity, in fact, and our website has an interactive tool that you can work this out on. Even if you look at the Caucasian population in the U.S., the map looks virtually the same as it does for the overall map which you see in the CDC MMWR and in our fact sheet. Bottom line here is this is the number one cause of death. It's the number one preventable cause of death.  It's the number one cause of health inequalities, and it's really possible for us to make rapid and substantial progress reducing these preventable deaths. Thanks for joining us, and we'll be ready for questions next. 


TOM SKINNER: We’re ready for questions, please. 

OPERATOR: At this time if you would like to ask a question, please press star one on your touchtone phone.  You will be prompted to record your name.  Please unmute your phone and state your name when prompted.  If you would like to ask a question, please press star one.  Our first question today is from Betsy McKay from wall street journal. 

BETSY MCKAY: Thanks.  Dr. Frieden, I have two questions.  One is about the deaths in people -- the avoidable deaths in people under 65.  Could you talk about the reasons beyond the increase in the rates of uninsured?  In other words, what role do you think obesity, diabetes, and smoking are playing in this group versus the older group?  If you could just talk more about that.  Secondly, you mentioned the Affordable Care Act, and I was wondering what you expect to happen in the changes in these rates as more people -- well, as the Affordable Care Act goes into effect and people either become insured or some remain uninsured. 

TOM FRIEDEN:  Sure.  So we talk a lot about the ABC’s -- aspirin, blood pressure, cholesterol, and smoking cessation -- and we've looked at those for the over and the under 65, and there are some differences overall, but the most dramatic differences are truly in cholesterol control, which is about 64 percent in people over the age of 65 and much lower, 48 percent, in those 40 to 64 years of age.  So it's an example of when people have access to screening and treatment, and they get the treatment.  Cholesterol-lowering drugs for those at risk are very effective, but too many people who are at risk are not getting them.  By enrolling in health insurance coverage, seeing the doctor regularly, getting diagnosed and getting treatment, you can see dramatic improvements in not only the numbers, but in the impact of those numbers in heart attacks and strokes.  Of course, smoking rates are drastically lower in the elderly than in others.  Part of that is a survival effect.  Smokers die young, and so there aren't as many people over the age of 65 who smoke.  The smoking rate in those over 65 is only 9.5 percent versus much higher.  I’m sorry.  It's only 9.5 percent versus about 20-22 percent in those -- in younger adults.  Smoking and cholesterol are two of the big differences that account for some of the difference in the rates here.  In terms of the Affordable Care Act and in particular in Medicaid expansion, we do expect that if people in the -- particularly the 40 to 64-year-old age group get insured, get care, and get good care, we will see significant reductions in the rate of preventable heart attacks and strokes in that population.  Some but not all of the states that are -- that kind of stand out in this analysis have decided or are considering expanding Medicaid coverage.  The law provides for funding for people to get health care so they don't have to have preventable heart attacks and strokes, and over the coming years as coverage expands, we will track what the impact of that coverage expansion is on the risk factors and the outcomes for heart disease and death. 

TOM SKINNER: Next question. 

OPERATOR: Thank you.  As a reminder to ask the question, please press star one.  Our next question is from Evan Brown from Fox News Radio. 

EVAN BROWN: I’m going to yield my time.  My question was actually just answered.  Thank you so much. 

OPERATOR: One moment, please, for the next question.  Our next question today is from Anna Barry-Jester from Univision. 

ANNA BARRY-JESTER: Hi, Dr. Frieden.  I wondered if you can talk a little bit about the rates for Hispanics?  Some of the risk factors for cardiovascular disease like obesity and lack of insurance are even higher amongst Hispanics and they have a higher rate among cardiovascular disease and stroke.  Can you speak to why that might be? 

TOM FRIEDEN: I will make a few comments and turn it over to staff here to comment further.  One thing that we know is that there is something called the Hispanic paradox that even at higher rates of risk factors, there are lower death rates than we would expect in Hispanic populations.  One possibility there is that deaths are -- deaths are undercounted in Hispanics, either because of migration back to another country late in life or because the ethnicity is not well recorded on death certificates.  This is something that there are a lot of scientific articles written about, but the bottom line is we don't fully understand it.  What we do know is that rates of diabetes are much higher in Hispanic populations and rates of insurance are lower in  Hispanic populations, and so on the major risk factors for heart disease and stroke, we see much lower rates of blood pressure and cholesterol control, for example, among Hispanics.  We also though do see a lower smoking prevalence among Hispanics in the U.S., so there's definitely a good benefit from the lower rate of smoking. 

LINDA SCHIEB: This is Linda Schieb. That’s L-I-N-D-A S-C-H-I-E-B.  I’m a lead author on the Vital Signs, and I will just reiterate, actually, what Dr.  Frieden said.  One of our limitations on the Vital Signs data – well, the death certificate data that we use for this, but sometimes it doesn't accurately count Hispanics.  It may not be in that number on the death certificate. 

ANNA BARRY-JESTER: Great.  Thank you. 

TOM SKINNER:  Next question. 

OPERATOR: Sir, I am showing no further questions at this time. 

TOM FRIEDEN: Okay.  So just to recap, first, thank you all very much for joining us.  Heart disease and stroke or cardiovascular disease is the number one killer in the US  There's a lot we can do to reduce the number of people who have heart attacks and stroke and can die from them.  Those things that we can do are pretty simple.  Controlling blood pressure.  Controlling cholesterol.  Taking an aspirin for those at high risk, and quitting smoking, All things that are well within reach, particularly for people who have health insurance.  So there's good news in that we have seen somewhat of a decrease, and we've seen a bigger decrease among the over 65 population that has access to Medicare, and there's a challenge.  Can we really drive these rates down?  This is half of the difference in life expectancy between the U.S. and other countries, so really when it comes to what more we can do with our health care system, there's nothing more important than programs like million hearts that can literally prevent a million heart attacks and strokes over the next five years.  So thank you all very much for your interest. 

TOM SKINNER: Thank you for joining us.  If you have any follow-up questions or need additional information, please call the CDC press office at 404-639-3286.  Thank you, and this concludes our call. 

OPERATOR: Thank you.  This does conclude today's conference.  You may disconnect at this time.  


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