State of the Heart

By Steve Barrett
Sunday, January 1, 2017
Specialty: 

An emphasis on evidence-based guidelines has yielded improvement in cardiovascular outcomes in recent years. However, with heart disease continuing to claim the lives of hundreds of thousands of Americans annually, even the most optimistic clinicians are not likely to unfurl the victory flag.

In Perspective

Though cancer is a close second, heart disease remains the biggest killer of Americans, with deaths outnumbering all those from chronic lower respiratory diseases, accidents, stroke, Alzheimer’s disease and diabetes combined, according to the CDC.

Number of deaths in 2015 for each of the leading causes of death in the United States:

  • Heart disease — 614,348
  • Cancer — 591,699
  • Chronic lower respiratory diseases — 147,101
  • Accidents — 136,053
  • Stroke (cerebrovascular diseases) — 133,103
  • Alzheimer’s disease — 93,541
  • Diabetes — 76,488

Prescription for Poor Outcomes

More than 26% of Medicare Part D beneficiaries — nearly 5 million people — fail to adhere to their prescribed antihypertensive medication regimens, according to an analysis by the Centers for Medicare & Medicaid Services and the CDC. There are significant demographic and other disparities in adherence rates.

Nonadherence by ethnic group:

  • White non-Hispanics — 24.3%
  • Asian/Pacific Islanders — 26.3%
  • Hispanics — 33.8%
  • Blacks — 35.7%
  • American Indians/Alaska natives — 38.8%

Nonadherence by medication:

  • Among users of angiotensin II receptor blockers — 16.9%
  • Among users of diuretics — 28.9%

Nonadherence by region:

  • Midwest — 22.8%
  • Northeast — 24.1%
  • West — 26.7%
  • South — 28.9%

Linking Head and Heart

Of more than 115,000 women in a 2016 study in The BMJ, approximately 17,500 were diagnosed with migraine. Over 20 years of follow-up, that group was found to be at greater risk for major cardiovascular disease, myocardial infarction, stroke and cardiovascular disease mortality than women who were not diagnosed with migraine.

The researchers recommended that clinicians evaluate the vascular risk of women with migraine and that additional research be conducted to develop strategies for reducing cardiovascular risk among migraine patients.