The Burden of Heart Disease and Stroke in South Carolina South Carolina Department of Health and Environmental Control Heart Disease and Stroke Prevention Division 2010 Edition Acknowledgements We gratefully acknowledge the assistance of those who contributed to this report: Bureau of Community Health and Chronic Disease Prevention, Heart Disease and Stroke Prevention Division Division Director ....................................................................Joy Brooks, MHA Public Information Coordinator .............................................Betsy Crick Bureau of Community Health and Chronic Disease Prevention, Office of Chronic Disease Epidemiology and Evaluation Division Director ....................................................................Khosrow Heidari, MA, MS, MS Senior Epidemiologist ............................................................Betsy Barton, MSPH Senior Epidemiologist ............................................................Patsy Myers, DrPH BRFSS Coordinator ...............................................................Ryan Lewis, MPH Funding for the Heart Disease and Stroke Prevention program is provided by the Centers for Disease Control and Prevention (CDC) and South Carolina Department of Health and Environmental Control (DHEC). Please direct requests for additional information to: Heart Disease and Stroke Prevention Division Bureau of Community Health and Chronic Disease Prevention South Carolina Department of Health and Environmental Control 1800 St. Julian Place Columbia, SC 29204 (803) 545-4490 For further information, please visit our website at http://www.scdhec.gov/hdsp. The Burden Of Heart Disease And Stroke In South Carolina Table of Contents I. Cardiovascular Disease ............................................................2 II. Heart Disease ..........................................................................3 Overview Morbidity Mortality Knowledge of Heart Attack Symptoms Heart Failure STEMI III. Stroke .....................................................................................11 Overview Morbidity Mortality Knowledge of Stroke Symptoms Success Story Pre-Transport Stroke Deaths IV. Risk Factors ............................................................................17 High Blood Pressure High Blood Cholesterol Tobacco Use Poor Nutrition Physical Inactivity Overweight and Obesity Diabetes Risk Factor Clustering Actions Taken to Reduce Risk V. Disparities ...............................................................................23 Race & Ethnicity Gender Age Socio-Economic Status Risk Factors VI. Economic Costs ......................................................................28 Heart Disease Stroke VII. Policy .......................................................................................31 Overview Success Story VIII. Glossary ..................................................................................34 IX. References ..............................................................................36 X. Notes .......................................................................................36 XI. Appendices .............................................................................37 A: County Age-Adjusted Rates B: Heart Disease Mortality Rates & Stroke Mortality Rates “On July 13, 1996, I woke up between 6:30 a.m. and 7:00 a.m. I needed to scratch my right arm, and I tried to move my left arm, but it would not cooperate. I tried to sit up in bed, I couldn’t sit up, and I fell out of bed. Life has not been the same. I have made all kinds of adjustments and learned how to accept what I cannot change.” - Cassandra, Stroke Survivor Cardiovascular Disease Cardiovascular disease (CVD) is the leading heart disease), cerebrovascular disease (stroke), cause of death and disability in the United congestive heart failure, atherosclerosis, States and South Carolina. An estimated diseases of the veins and rheumatic heart one-third of American adults have some form disease.1 The economic costs of cardiovascular of cardiovascular disease.1 In 2006, CVD disease nationwide are staggering. For 2010, caused 34 percent of all deaths in the United the American Heart Association estimated that States.2 The age-adjusted CVD death rate the cost of cardiovascular diseases nationwide in the United States was 2612 per 100,000 would be $503.2 billion in direct and indirect population.2 Cardiovascular disease is defined costs; this figure includes hospitalizations, as all diseases of the heart and blood vessels, physician services, medications, and lost including ischemic heart disease, hypertensive productivity.1 heart disease (together also called coronary In 2008, CVD remained the leading cause of death in South Carolina (Figure 1). Cardiovascular disease caused 12,223 deaths, 30 percent of all deaths in that year. Overall, cardiovascular disease mortality rates in South Carolina have dropped by 34 percent since 1999 (Figure 2). Even though South Carolina’s cardiovascular disease mortality rate has been declining, it still remains higher than the national rate. www.scdhec.gov/hdsp 2 Heart Disease OVERVIEW ST segment Elevation Myocardial Infarction (STEMI) is the most severe type of acute Heart disease is any affliction that impairs myocardial infarction that could result in high the structure or function of the heart, such as mortality without timely, active treatment. atherosclerotic and hypertensive diseases, Although STEMI mortality has been reduced congenital heart disease, rheumatic heart disease, dramatically with the development of reperfusion and other conditions. It includes coronary heart strategies over the last two decades, it still disease, heart failure, and other types of heart remains a significant public health problem. disease. Heart disease is one of a number of There are very few state-specific studies on diseases of the circulatory system, and was characteristics, management and outcome of the leading cause of death among women in patients with STEMI. Nationally, an estimated South Carolina in 2008. It is primarily a disease 500,000 STEMI cases per year represent 30 of lifestyle, and is largely preventable through percent of all Acute Myocardial Infarction (AMI) risk factor awareness and modification. Major events. Because this type of AMI has a specific modifiable risk factors include high blood pattern on the electrocardiogram (ECG) that is cholesterol, high blood pressure (hypertension), “ST elevation,” doctors use the term STEMI to type 2 diabetes, and overweight/obesity. describe this type of AMI. ST elevation in ECG is critical in diagnosing chest discomfort. Once The most common type of heart disease, coronary it is found, no time can be spared in treating artery disease, occurs when the arteries that the patient with the blocked coronary artery. supply blood to the heart become hardened and STEMI can be a life-threatening condition, that if narrowed from fatty plaque buildup on the artery recognized and treated promptly, the morbidity walls, a process called atherosclerosis. Plaque and mortality can be reduced.3 buildup can cause blood clots to form that block the arteries, can narrow the arteries so that less MORBIDITY blood can flow to the heart (experienced as chest The term morbidity rate can refer to either the pain or angina), or can completely block the incidence rate, or the prevalence of a disease arteries and the flow of blood to the heart, causing or medical condition. This refers to the number a heart attack (myocardial infarction) and possible of individuals in poor health or disability during death. Lack of blood flow to the heart is referred a given time period, the incidence rate, or to as ischemia (localized tissue anemia due to the prevalence rate, scaled to the size of the obstruction of the inflow of arterial blood). Over population. time, coronary artery disease can also weaken the heart muscle and contribute to heart failure (inability of the heart to pump blood to the rest of the body the way that it should), or to arrhythmias (changes in the normal rhythm of the heartbeats). In the literature, coronary artery disease, coronary heart disease, ischemic heart disease, and heart disease are often used interchangeably. www.scdhec.gov/hdsp 3 Heart Disease Prevalence The data source for estimating prevalence of heart disease in South Carolina is limited to the Behavioral Risk Factor Surveillance System (BRFSS). Three questions pertaining to cardiovascular disease were asked in South Carolina. These three questions asked adults if they had ever been told they had angina or coronary heart disease (CHD), or if they had ever been told they had a heart attack or myocardial infarction. • In 2009, the prevalence of CHD in the United States was 3.8 percent. That same year, it was estimated that 4.4 percent of adults in South Carolina, or approximately 150,000 adults, reported CHD. • In 2009, the prevalence of heart attack in the United States was 4 percent, and in South Carolina it was 4.6 percent. Incidence • Heart disease results in substantial morbidity and disability among South Carolinians and Americans in general. • The incidence rates of heart disease hospital discharge have declined in SC since 2001 (Figure 3). • More than 57,000 heart disease hospitalizations occur in SC each year. www.scdhec.gov/hdsp 4 Heart Disease MORTALITY The mortality rate is a measure of the number of deaths (in general, or due to a specific cause) in some population, scaled to the size of that population, per unit