Managed Care Outlook

The taming of cardiovascular disease: Less deadly but could be even more so

Cardiovascular disease (CVD) is primarily a disease of old age. But it’s certainly capable of cutting down people in the prime of life, something that worries the World Health Organization (WHO) and U.S. health officials.

The WHO wants to see a 25% reduction in premature mortality (death between ages 30 and 70) caused by CVD by 2025. The U.S. government’s Healthy People 2020 goals don’t target premature deaths per se but call for a 20% decrease in all deaths from coronary heart disease and stroke. According to calculations by University of Washington (UW) researchers published in the September 29 issue of Circulation, the number of premature deaths worldwise related to CVD would increase to 7.8 million in 2025 from 5.9 million in 2013 if current trends in tobacco use, diabetes, obesity, and blood pressure were to continue. But by their figuring, if WHO goals for reducing those risk factors were reached (see the list below), the number of premature deaths would decline slightly, to 5.7 million, in 2025.

WHO risk factor control targets
  1. 30% decrease in tobacco smoking
  2. 25% reduction in prevalence of hypertension (systolic blood pressure >140 mm Hg)
  3. No increase in the number of people with diabetes
  4. No increase in number of people who are obese

The UW disease-burden boffins also did some region-by-region numbers. For “high-income North America,” which includes Canada and the United States, they projected there would be 197,831 premature CVD deaths in 2025 if current risk factor trends were to continue, compared with 187,391 if the WHO goals for risk factors were met. That’s a fairly modest 5.2% difference that can be explained partly by the fact that risk factor control (particularly the control of blood pressure) and the resulting CVD rate are already headed in the right direction in Canada and the U.S. Some evidence for that is that the Healthy People 2010 targets for deaths from coronary heart disease and stroke were reached ahead of schedule, in 2004.

Still, there’s a ways to go. CDC researchers reported last year that roughly a third of the deaths from heart disease and stroke among Americans younger than 80 were preventable. Their calculations show that cancer causes more deaths in this age group but that a smaller proportion (a little more than 20%) were preventable.

Potentially preventable deaths from the five leading causes of death — United States, 2008–2010

Sources: Roth GA et al., Circulation, Sept. 29, 2015; Yoon PW et al., Morbidity and Mortality Weekly Report, May 2, 2014.