Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association

Emelia J Benjamin, Michael J Blaha, Stephanie E Chiuve, Mary Cushman, Sandeep R Das, Rajat Deo, Sarah D de Ferranti, James Floyd, Myriam Fornage, Cathleen Gillespie, Carmen R Isasi, Monik C Jiménez, Lori Chaffin Jordan, Suzanne E Judd, Daniel Lackland, Judith H Lichtman, Lynda Lisabeth, Simin Liu, Chris T Longenecker, Rachel H Mackey, Kunihiro Matsushita, Dariush Mozaffarian, Michael E Mussolino, Khurram Nasir, Robert W Neumar, Latha Palaniappan, Dilip K Pandey, Ravi R Thiagarajan, Mathew J Reeves, Matthew Ritchey, Carlos J Rodriguez, Gregory A Roth, Wayne D Rosamond, Comilla Sasson, Amytis Towfighi, Connie W Tsao, Melanie B Turner, Salim S Virani, Jenifer H Voeks, Joshua Z Willey, John T Wilkins, Jason Hy Wu, Heather M Alger, Sally S Wong, Paul Muntner, American Heart Association Statistics Committee and Stroke Statistics Subcommittee, Emelia J Benjamin, Michael J Blaha, Stephanie E Chiuve, Mary Cushman, Sandeep R Das, Rajat Deo, Sarah D de Ferranti, James Floyd, Myriam Fornage, Cathleen Gillespie, Carmen R Isasi, Monik C Jiménez, Lori Chaffin Jordan, Suzanne E Judd, Daniel Lackland, Judith H Lichtman, Lynda Lisabeth, Simin Liu, Chris T Longenecker, Rachel H Mackey, Kunihiro Matsushita, Dariush Mozaffarian, Michael E Mussolino, Khurram Nasir, Robert W Neumar, Latha Palaniappan, Dilip K Pandey, Ravi R Thiagarajan, Mathew J Reeves, Matthew Ritchey, Carlos J Rodriguez, Gregory A Roth, Wayne D Rosamond, Comilla Sasson, Amytis Towfighi, Connie W Tsao, Melanie B Turner, Salim S Virani, Jenifer H Voeks, Joshua Z Willey, John T Wilkins, Jason Hy Wu, Heather M Alger, Sally S Wong, Paul Muntner, American Heart Association Statistics Committee and Stroke Statistics Subcommittee

No abstract available

Keywords: AHA Scientific Statements; cardiovascular diseases; epidemiology; risk factors; statistics; stroke.

Figures

Figure. Life’s Simple 7

Seven approaches to staying heart healthy: be active, keep a healthy weight, learn about cholesterol, don’t smoke or use smokeless tobacco, eat a heart-healthy diet, keep blood pressure healthy, and learn about blood sugar and diabetes.

Chart 2-1. Incidence of cardiovascular disease according to the number of ideal health behaviors and health factors

Reprinted from Folsom et al with permission from Elsevier. Copyright © 2011, American College of Cardiology Foundation.

Chart 2-2. Prevalence (unadjusted) estimates of poor, intermediate, and ideal cardiovascular health for each of the 7 metrics of cardiovascular health in the American Heart Association 2020 goals, among US children aged 12 to 19 years

*Healthy Diet Score reflects 2011 to 2012 NHANES. Source: National Center for Health Statistics, National Health and Nutrition Examination Survey (NHANES) 2013 to 2014.

Chart 2-3. Prevalence (unadjusted) estimates of poor, intermediate, and ideal cardiovascular health for each of the 7 metrics of cardiovascular health in the American Heart Association 2020 goals, among US adults aged 20 to 49 and ≥50 years

*Healthy Diet Score reflects 2011 to 2012 NHANES. Source: National Center for Health Statistics, National Health and Nutrition Examination Survey (NHANES) 2013 to 2014.

Chart 2-4. Proportion (unadjusted) of US children aged 12 to 19 years meeting different numbers of criteria for ideal cardiovascular health, overall and by sex

Source: National Center for Health Statistics, National Health and Nutrition Examination Survey (NHANES) 2011 to 2012.

Chart 2-5. Age-standardized prevalence estimates of US adults aged ≥20 years meeting different numbers of criteria for ideal cardiovascular health, overall and by age and sex subgroups

Source: National Center for Health Statistics, National Health and Nutrition Examination Survey (NHANES) 2011 to 2012.

Chart 2-6. Age-standardized prevalence estimates of US adults aged ≥20 years meeting different numbers of criteria for ideal cardiovascular health, overall and in selected race subgroups

Source: National Center for Health Statistics, National Health and Nutrition Examination Survey (NHANES) 2011 to 2012.

Chart 2-7. Prevalence of meeting ≥5 criteria for ideal cardiovascular health among US adults aged ≥20 years (age-standardized) and US children aged 12 to 19 years, overall and by sex

Source: National Center for Health Statistics, National Health and Nutrition Examination Survey (NHANES) 2007 to 2008 and 2011 to 2012.

Chart 2-8. Prevalence of meeting ≥5 criteria for ideal cardiovascular health among US adults aged ≥20 years (age standardized) and US children aged 12 to 19 years, by race/ethnicity

NH indicates non-Hispanic. Source: National Center for Health Statistics, National Health and Nutrition Examination Survey (NHANES) 2011 to 2012.

Chart 2-9. Age-standardized prevalence estimates of US adults meeting different numbers of criteria for ideal and poor cardiovascular health, for each of the 7 metrics of cardiovascular health in the American Heart Association 2020 goals, among US adults aged ≥20 years

Source: National Center for Health Statistics, National Health and Nutrition Examination Survey (NHANES) 2011 to 2012.

Chart 2-10. Age-standardized cardiovascular health status by US states, BRFSS, 2009

A, Age-standardized prevalence of population with ideal cardiovascular health by states. B, Age-standardized percentage of population with 0 to 2 cardiovascular health metrics by states. C, Age-standardized mean score of cardiovascular health metrics by states. BRFSS indicates Behavioral Risk Factor Surveillance System. Reprinted from Fang et al with permission. Copyright © 2013, American Heart Association, Inc.

Chart 2-11. Trends in prevalence (unadjusted) of meeting criteria for ideal cardiovascular health for each of the 7 metrics among US children aged 12 to 19 years

*Because of changes in the physical activity questionnaire between different cycles of the National Health and Nutrition Examination Survey (NHANES), trends over time for this indicator should be interpreted with caution, and statistical comparisons should not be attempted. Data for the Healthy Diet Score, based on a 2-day average intake, was only available for the 2003 to 2004, 2005 to 2006, 2007 to 2008, 2009 to 2010 and 2011 to 2012 NHANES cycles at the time of this analysis. Source: National Center for Health Statistics, NHANES 1999 to 2000 through 2013 to 2014.

Chart 2-12. Age-standardized trends in prevalence of meeting criteria for ideal cardiovascular health for each of the 7 metrics among US adults aged ≥20 years

*Because of changes in the physical activity questionnaire between different cycles of the National Health and Nutrition Examination Survey (NHANES), trends over time for this indicator should be interpreted with caution, and statis-tical comparisons should not be attempted. Data for the Healthy Diet Score, based on a 2-day average intake, was only available for the 2003 to 2004, 2005 to 2006, 2007 to 2008, 2009 to 2010 and 2011 to 2012 NHANES cycles at the time of this analysis. Source: National Center for Health Statistics, NHANES 1999 to 2000 through 2013 to 2014.

Chart 2-13. Prevalence of ideal, intermediate, and poor cardiovascular health metrics in 2006 (American Heart Association 2020 Impact Goals baseline year) and 2020 projections assuming current trends continue

The 2020 targets for each cardiovascular health metric assume a 20% relative increase in ideal cardiovascular health prevalence metrics and a 20% relative decrease in poor cardiovascular health prevalence metrics for males and females. Reprinted from Huffman et al with permission. Copyright © 2012, American Heart Association, Inc.

Chart 2-14. US age-standardized death rates* from cardiovascular diseases, 2000 to 2014

CHD indicates coronary heart disease; and CVD, cardiovascular disease. *Directly standardized to the age distribution of the 2000 US standard population. †Total CVD: International Classification of Diseases, 10th Revision (ICD-10) I00 to I99, Q20 to Q28. §Stroke (all cerebrovascular disease): ICD-10I60 to I69. ¶CHD: ICD-10 I20 to I25. **Other CVD: ICD-10 I00 to I15, I26 to I51, I70 to I78, I80 to I89, I95 to I99. Source: Centers for Disease Control and Prevention, National Vital Health Statistics System.

Chart 2-15. US age-standardized death rates* from cardiovascular disease by race/ethnicity, 2000 to 2014

NH indicates non-Hispanic. *Directly standardized to the age distribution of the 2000 US standard population. Total CVD: International Classification of Diseases, 10th Revision (ICD-10) I00 to I99, Q20 to Q28. Source: Centers for Disease Control and Prevention, National Vital Statistics System.

Chart 2-16. US age-standardized death rates* from stroke by race/ethnicity, 2000 to 2014

NH indicates non-Hispanic. *Directly standardized to the age distribution of the 2000 US standard population. Stroke (all cerebrovascular disease): International Classification of Diseases, 10th Revision (ICD-10) I60 to I69. Source: Centers for Disease Control and Prevention, National Vital Statistics System.

Chart 3-1. Prevalence (%) of cigarette use in the past month for adolescents aged 12 to 17 years by sex and race/ethnicity (NSDUH, 2014)

Because of methodological differences among the NSDUH, the Youth Risk Behavior Survey, the National Youth Tobacco Survey, and other surveys, percentages of cigarette smoking measured by these surveys are not directly comparable. Notably, schoolbased surveys may include students who are 18 years old, who are legally permitted to smoke and have higher rates of smoking. AIAN indicates American Indian or Alaska Native; NH, non-Hispanic; and NSDUH, National Survey on Drug Use and Health. Data derived from Substance Abuse and Mental Health Services Administration, NSDUH.

Chart 3-2. Prevalence (%) of cigarette smoking for adolescents (past month) and adults (current) by sex and age (NHIS, 2003–2015; NSDUH, 2003–2014)

NSDUH indicates National Survey on Drug Use and Health; and NHIS, National Health Interview Survey. Data derived from the Centers for Disease Control and Prevention/National Center for Health Statistics and the Substance Abuse and Mental Health Services Administration (NSDUH).,

Chart 3-3. Long-term trend in current cigarette smoking prevalence (%) for adults ≥18 years of age by sex (NHIS, 1965–2015, selected years)

NHIS indicates National Health Interview Survey. Data derived from the Centers for Disease Control and Prevention/National Center for Health Statistics, Health, United States, 2015(NHIS).

Chart 3-4. Prevalence (%) of current cigarette smoking for adults ≥18 years of age by sex and race/ethnicity (NHIS, 2013–2015)

All percentages are age adjusted. AIAN indicates American Indian/Alaska Native; NH, non-Hispanic; and NHIS, National Health Interview Survey. Data derived from Centers for Disease Control and Prevention/National Center for Health Statistics, NHIS.

Chart 3-5. Prevalence (%) of current cigarette smoking for adults, by state: United States (BRFSS, 2014)

BRFSS indicates Behavior Risk Factor Surveillance System. Data derived from the Centers for Disease Control and Prevention.

Chart 3-6. Percentage (%) of students who have ever tried electronic cigarettes by school level (National Youth Tobacco Survey, 2011–2013)

Data derived from the Centers for Disease Control, National Youth Tobacco Survey.

Chart 4-1. Prevalence of students in grades 9 to 12 who did not participate in ≥60 minutes of physical activity on any day in the past 7 days by race/ethnicity and sex

NH indicates non-Hispanic. Source: Youth Risk Behavior Surveillance Survey 2015.

Chart 4-2. Prevalence of students in grades 9 to 12 who met currently recommended levels of physical activity during the past 7 days by race/ethnicity and sex

“Currently recommended levels” was defined as activity that increased their heart rate and made them breathe hard some of the time for a total of ≥60 min/d on 5 of the 7 days preceding the survey. NH indicates non-Hispanic. Source: Youth Risk Behavior Surveillance Survey 2015.

Chart 4-3. Percentage of students in grades 9 to 12 who used a computer for ≥3 hours on an average school day by race/ethnicity and sex

NH indicates non-Hispanic. Source: Youth Risk Behavior Surveillance Survey 2015.

Chart 4-4. Prevalence of meeting the aerobic guidelines of the 2008 Federal Physical Activity Guidelines for Americans among adults ≥18 years of age by sex and age (NHIS: 2015)

The aerobic guidelines of the 2008 Federal Physical Activity Guidelines for Americans recommend engaging in moderate leisuretime physical activity for ≥150 min/wk or vigorous activity ≥75 min/wk or an equivalent combination. NHIS indicates National Health Interview Survey. Source: NHIS 2015 (National Center for Health Statistics).

Chart 4-5. Prevalence of meeting the aerobic guidelines of the 2008 Federal Physical Activity Guidelines for Americans among adults ≥18 years of age by race/ethnicity and sex (NHIS: 2015)

Percentages are age adjusted. The aerobic guidelines of the 2008 Federal Physical Activity Guidelines for Americans recommend engaging in moderate leisure-time physical activity for ≥150 min/wk or vigorous activity ≥75 min/wk or an equivalent combination. NH indicates non-Hispanic; and NHIS, National Health Interview Survey. Source: NHIS 2015 (National Center for Health Statistics).

Chart 4-6. Prevalence of meeting the aerobic guidelines of the 2008 Federal Physical Activity Guidelines for Americans among adults ≥25 years of age by educational attainment (NHIS: 2015)

Percentages are age adjusted. The aerobic guidelines of the 2008 Federal Physical Activity Guidelines for Americans recommend engaging in moderate leisure-time physical activity for ≥150 min/wk or vigorous activity ≥75 min/wk or an equivalent combination. GED indicates General Educational Development; and NHIS, National Health Interview Survey. Source: NHIS 2015 (National Center for Health Statistics).

Chart 4-7. Prevalence of meeting the aerobic guidelines of the 2008 Federal Physical Activity Guidelines for Americans among adults ≥18 years of age by location of residence (NHIS: 2015)

Percentages are age adjusted. The aerobic guidelines of the 2008 Federal Physical Activity Guidelines for Americans recommend engaging in moderate leisure-time physical activity for ≥150 min/wk or vigorous activity ≥75 min/wk or an equivalent combination. MSA indicates metropolitan statistical area; and NHIS, National Health Interview Survey. Source: NHIS 2015 (National Center for Health Statistics).

Chart 4-8. Prevalence of meeting the aerobic guidelines of the 2008 Federal Physical Activity Guidelines for Americans among adults ≥18 years of age by disability status (NHIS: 2015)

Percentages are age adjusted. The aerobic guidelines of the 2008 Federal Physical Activity Guidelines for Americans recommend engaging in moderate leisure-time physical activity for ≥150 min/wk or vigorous activity ≥75 min/wk or an equivalent combination. NHIS indicates National Health Interview Survey. Source: NHIS 2015 (National Center for Health Statistics).

Chart 4-9. Percent distribution of meeting the 2008 Federal Physical Activity Guidelines for Americans among adults ≥18 years of age by poverty level and type of activity (NHIS: 2015)

Percentages are age adjusted. The aerobic guidelines of the 2008 Federal Physical Activity Guidelines for Americans recommend engaging in moderate leisure-time physical activity for ≥150 min/wk or vigorous activity ≥75 min/wk or an equivalent combination and perform muscle-strengthening activities at least 2 d/wk. NHIS indicates National Health Interview Survey. Source: NHIS 2015 (National Center for Health Statistics).

Chart 4-10. Prevalence of children 12 to 15 years of age who had adequate levels of cardiorespiratory fitness, by sex and age (NHANES, National Youth Fitness Survey: 2012)

NHANES indicates National Health and Nutrition Examination Survey. Source: NHANES, National Youth Fitness Survey 2012.

Chart 4-11. Trends in meeting the physical activity guidelines of the 2008 Federal Physical Activity Guidelines for Americans among adults ≥18 years of age by type of activity (NHIS: 1998–2015)

Percentages are age adjusted. The aerobic guidelines of the 2008 Federal Physical Activity Guidelines for Americans recommend engaging in moderate leisure-time physical activity for ≥150 min/wk or vigorous activity ≥75 min/wk or an equivalent combination. NH indicates non-Hispanic; and NHIS, National Health Interview Survey. Source: NHIS 1998 to 2015 (National Center for Health Statistics).

Chart 5-1. Trends in mean healthy diet scores for children and adults, NHANES 2003 to 2004 through 2011 to 2012

Primary metrics include fruits/vegetables, whole grains, fish, sugar-sweetened beverages, and sodium. Secondary metrics include nuts, seeds, and legumes; processed meats; and saturated fats. Components of poor, intermediate, and ideal diet are defined in Table 5-1. Mean healthy diet scores based on the alternative scoring ranges described in Table 5-1. NHANES indicates National Health and Nutrition Examination Survey. Sources: My Life Check: Life’s Simple 7; Lloyd-Jones et al; Rehm et al.

Chart 5-2. Healthy diet targets in children (5–19 years old) by survey year: NHANES 2003 to 2004, 2005 to 2006, 2007 to 2008, 2009 to 2010, and 2011 to 2012

Components of poor, intermediate, and ideal diet are defined in Table 5-1. Percentages based on the alternative scoring ranges described in Table 5-1. NHANES indicates National Health and Nutrition Examination Survey. Sources: My Life Check: Life’s Simple 7; Lloyd-Jones et al; Rehm et al.

Chart 5-3. Healthy diet targets in adults (≥20 years of age) by survey year: NHANES 2003 to 2004, 2005 to 2006, 2007 to 2008, 2009 to 2010, and 2011 to 2012

Components of poor, intermediate, and ideal diet are defined in Table 5-1. Percentages based on the alternative scoring ranges described in Table 5-1. NHANES indicates National Health and Nutrition Examination Survey. Sources: My Life Check: Life’s Simple 7; Lloyd-Jones et al; Rehm et al.

Chart 5-4. Trends in AHA-defined healthy diet score components for children (5–19 years old) by survey year: NHANES 2003 to 2004, 2005 to 2006, 2007 to 2008, 2009 to 2010, and 2011 to 2012

Unscaled dietary score (maximum=50). Mean healthy diet score components based on the alternative scoring ranges described in Table 5-1. AHA indicates American Heart Association; max., maximum; and NHANES, National Health and Nutrition Examination Survey. Sources: My Life Check: Life’s Simple 7; Lloyd-Jones et al; Rehm et al.

Chart 5-5. Trends in AHA healthy diet score components for adults (≥20 years of age) by survey year: NHANES 2003 to 2004, 2005 to 2006, 2007 to 2008, 2009 to 2010, and 2011 to 2012

Unscaled dietary score (maximum=50). Mean healthy diet score components based on the scoring ranges described in Table 5-1. AHA indicates American Heart Association; and NHANES, National Health and Nutrition Examination Survey. Sources: My Life Check: Life’s Simple 7; Lloyd-Jones et al; Rehm et al.

Chart 5-6. Percentage of sodium from dietary sources in the United States, 2005 to 2006

Source: Applied Research Program, National Cancer Institute.

Chart 5-7. Total US food expenditures away from home and at home, 1977 and 2007

Data derived from Davis et al.

Chart 6-1. US children and adolescents with obesity by race/ethnicity, 2011 to 2014

Obesity is body mass index (BMI) at or above the sex-and age-specific 95th percentile BMI cutoff points from the 2000 CDC growth charts. CDC indicates Centers for Disease Control and Prevention. Source: CDC/National Center for Health Statistics, Health, United States, 2015, Figure 22. Data from the National Health and Nutrition Examination Survey (NHANES), Table 59.

Chart 6-2. Age-adjusted prevalence of obesity in adults ≥20 years of age by sex and age group (NHANES 2011–2014)

Totals were age-adjusted by the direct method to the 2000 US census population using the age groups 20 to 39, 40 to 59, and ≥60 years old. Crude estimates are 36.5% for all, 34.5% for males, and 38.5% for females. NHANES indicates National Health and Nutrition Examination Survey. 1Significantly different from those aged 20 to 39 years. 2Significantly different from females of the same age group. Source: Centers for Disease Control and Prevention/National Center for Health Statistics, NHANES, 2011 to 2014.

Chart 6-3. Age-adjusted prevalence of obesity in adults ≥20 years of age by sex and race-ethnicity (NHANES 2011–2014)

NHANES indicates National Health and Nutrition Examination Survey. 1Significantly different from non-Hispanic Asian people. 2Significantly different from non-Hispanic white people. 3Significantly different from females of the same race and Hispanic origin. 4Significantly different from non-Hispanic black people. Source: Centers for Disease Control and Prevention/National Center for Health Statistics, NHANES, 2011 to 2014.

Chart 6-4. Trends in overweight and obesity between 1999 to 2002 and 2011 to 2014 among US adults aged ≥20 years, by sex

Overweight but not obese (25≤ body mass index (BMI) 2); grade 1 obesity (30≤ BMI <35 kg/m2); grade 2 obesity (35≤ BMI <40 kg/m2); grade 3 obesity (BMI ≥40 kg/m2). Source: Centers for Disease Control and Prevention/National Center for Health Statistics, Health, United States, 2015, Figure 9 and Table 58. Data from National Health and Nutrition Examination Survey (NHANES).

Chart 6-5. Prevalence† of self-reported obesity among US adults aged ≥20 years by state and territory, BRFSS, 2014

RFSS indicates Behavioral Risk Factor Surveillance System. * Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥30%. †Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011. Source: Centers for Disease Control and Prevention, Obesity Prevalence Map, 2012–2014.

Chart 6-6. Prevalence of self-reported obesity among non-Hispanic white adults aged ≥20 years, by state and territory, BRFSS, 2012 to 2014

BRFSS indicates Behavioral Risk Factor Surveillance System. * Sample size

Chart 6-7. Prevalence of self-reported obesity among Hispanic adults aged ≥20 years, by state and territory, BRFSS, 2012 to 2014

BRFSS indicates Behavioral Risk Factor Surveillance System. *Sample size

Chart 6-8. Prevalence of self-reported obesity among non-Hispanic black adults aged ≥20 years, by state and territory, BRFSS, 2012 to 2014

BRFSS indicates Behavioral Risk Factor Surveillance System. *Sample size

Chart 6-9. Relative risks for diseases associated with body mass index by age group

APCSC indicates Asia-Pacific Cohort Studies Collaboration; ERFC, Emerging Risk Factor Collaboration; IHD, ischemic heart disease; and PSC, Prospective Studies Collaboration. Reprinted from Singh et al. Copyright © 2013, The Authors. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Chart 6-10. US children and adolescents with obesity, 1963 to 2014

Obesity is body mass index (BMI) at or above the sex- and age-specific 95th percentile BMI cutoff points from the 2000 CDC growth charts. CDC indicates Centers for Disease Control and Prevention. Source: CDC/National Center for Health Statistics, Health, United States, 2015, Figure 8 and Table 59. Data from the National Health and Nutrition Examination Survey (NHANES).

Chart 6-11. Trends in obesity prevalence among adults aged ≥20 years (age adjusted) and youth aged 2 to 19 years, United States, 1999 to 2000 through 2013 to 2014

Data from the National Center for Health Statistics 2015 Data Brief.

Chart 8-1. Trends in mean serum total cholesterol among adolescents 12 to 19 years of age by race, sex, and survey year (NHANES 1988–1994, 1999–2006, and 2007–2014)

Values are in mg/dL. Mex. Am. indicates Mexican American; NH, non-Hispanic; and NHANES, National Health and Nutrition Examination Survey. *The category of Mexican Americans was consistently collected in all NHANES years, but the combined category of Hispanics was only used starting in 2007. Consequently, for long-term trend data, the category Mexican American is used. Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 8-2. Age-adjusted trends in mean serum total cholesterol among adults ≥20 years old by race and survey year (NHANES 1988–1994, 1999–2006, and 2007–2014)

Values are in mg/dL. NH indicates non-Hispanic; and NHANES, National Health and Nutrition Examination Survey. *The category of Mexican Americans was consistently collected in all NHANES years, but the combined category of Hispanics was only used starting in 2007. Consequently, for long-term trend data, the category Mexican American is used. Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 8-3. Age-adjusted trends in the prevalence of serum total cholesterol ≥200 mg/dL in adults ≥20 years of age by race/ethnicity, sex, and survey year (NHANES 2011–2012 and 2013–2014)

NH indicates non-Hispanic; and NHANES, National Health and Nutrition Examination Survey.

Chart 8-4. Age-adjusted trends in the prevalence of serum total cholesterol ≥240 mg/dL in adults ≥20 years of age by race/ethnicity, sex, and survey year (NHANES 2011–2012 and 2013–2014)

NH indicates non-Hispanic; and NHANES, National Health and Nutrition Examination Survey.

Chart 9-1. Prevalence of high blood pressure in adults ≥20 years of age by sex and age (NHANES 2011–2014)

Hypertension is defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, if the subject said “yes” to taking antihypertensive medication, or if the subject was told on 2 occasions that he or she had hypertension. NHANES indicates National Health and Nutrition Examination Survey. Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 9-2. Age-adjusted prevalence trends for high blood pressure in adults ≥20 years of age by race/ethnicity, sex, and survey year (NHANES 1988–1994, 1999–2006, and 2007–2014)

Hypertension is defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, if the subject said “yes” to taking antihypertensive medication, or if the subject was told on 2 occasions that he or she had hypertension. NH indicates non-Hispanic; and NHANES, National Health and Nutrition Examination Survey. *The category of Mexican Americans was consistently collected in all NHANES years, but the combined category of Hispanics was only used starting in 2007. Consequently, for long-term trend data, the category Mexican American is used. Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 9-3. Extent of awareness, treatment, and control of high blood pressure by age (NHANES 2007–2012)

Hypertension is defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, or if the subject said “yes” to taking antihypertensive medication. NHANES indicates National Health and Nutrition Examination Survey. Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 9-4. Extent of awareness, treatment, and control of high blood pressure by race/ethnicity (NHANES 2011–2014)

Hypertension is defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, or if the subject said “yes” to taking antihypertensive medication. NH indicates non-Hispanic; and NHANES, National Health and Nutrition Examination Survey. Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 9-5. Extent of awareness, treatment, and control of high blood pressure by race/ethnicity and sex (NHANES 2011–2014)

Hypertension is defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, or if the subject said “yes” to taking antihypertensive medication. NH indicates non-Hispanic; and NHANES, National Health and Nutrition Examination Survey. Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 10-1. Age-adjusted prevalence of physician-diagnosed diabetes mellitus in adults ≥20 years of age by race/ethnicity and sex (NHANES 2011–2014)

NH indicates non-Hispanic; and NHANES, National Health and Nutrition Examination Survey. Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 10-2. Age-adjusted prevalence of physician-diagnosed diabetes mellitus in adults ≥20 years of age by race/ethnicity and years of education (NHANES 2011–2014)

NH indicates non-Hispanic; and NHANES, National Health and Nutrition Examination Survey. Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 10-3. Trends in diabetes mellitus prevalence in adults ≥20 years of age by sex (NHANES 1988–1994 and 2011–2014)

NHANES indicates National Health and Nutrition Examination Survey. *The definition of diabetes changed in 1997 (from glucose ≥140 mg/dL to ≥126 mg/dL). Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 10-4. Trends in the prevalence of diagnosed and undiagnosed diabetes mellitus (calibrated hemoglobin A1c levels >6.5%), by race/ethnic group

Data from US adults aged 20 years in NHANES 1988 to 1994, 1999 to 2004, and 2005 to 2010. NHANES indicates National Health and Nutrition Examination Survey. Reprinted from Selvin et al with the permission of American College of Physicians, Inc. Copyright © 2014, American College of Physicians. All Rights Reserved.

Chart 10-5. Diabetes mellitus awareness, treatment, and control in adults ≥20 years of age (NHANES 2011–2014)

NHANES indicates National Health and Nutrition Examination Survey. Source: National Heart, Lung, and Blood Institute.

Chart 10-6. Trends in age-standardized rates of diabetes mellitus–related complications among US adults with and without diagnosed diabetes

ESRD indicates end-stage renal disease. Reprinted From Gregg et al with permission from Massachusetts Medical Society. Copyright © 2014, Massachusetts Medical Society.

Chart 11-1. Secular trend of metabolic syndrome components in youth in the NHANES and KNHANES cohorts

BP indicates blood pressure; HDL, high-density lipoprotein cholesterol; KNHANES, Korean National Health and Nutrition Examination Survey; NHANES, National Health and Nutrition Examination Survey; TG, triglycerides; and WC, waist circumference. *Significant difference between NHANES 2003 to 2006 and NHANES III. †Significant difference between NHANES 2003 to 2006 and NHANES 1999 to 2002. ‡Significant difference between KNHANES 2007 and KNHANES 1998. §Significant difference between KNHANES 2007 and KNHANES 2001. Reproduced with permission from from Lim et al. Copyright © 2013, by the American Academy of Pediatrics.

Chart 11-2. Prevalence of metabolic syndrome in youth

The prevalence of metabolic syndrome in youth has decreased in the most recent NHANES follow-up (2009–2010 and 2011–2012). This is most evident when considering a metabolic syndrome severity score. Despite increasing obesity, decreased metabolic syndrome has been driven by increased HDL and decreased triglycerides. There has been concomitant decrease in calorie intake and carbohydrate intake as well as an increase in unsaturated fat. ATP indicates Adult Treatment Panel; BMI, body mass index; HDL, high-density lipoprotein; MetS, metabolic syndrome; and NHANES, National Health and Nutrition Examination Survey.

Chart 11-3. Age-adjusted prevalence of metabolic syndrome in the United States, NHANES 1999 to 2010

NHANES indicates National Health and Nutrition Examination Survey. Data derived from Beltrán-Sánchez et al.

Chart 11-4. Age-adjusted prevalence of metabolic syndrome among adult males by race, NHANES 1999 to 2010

NHANES indicates National Health and Nutrition Examination Survey. Data derived from Beltrán-Sánchez et al.

Chart 11-5. Age-adjusted prevalence of metabolic syndrome among adult females by race, NHANES 1999 to 2010

NHANES indicates National Health and Nutrition Examination Survey. Data derived from Beltrán-Sánchez et al.

Chart 11-6. Prevalence and trends of the 5 components of metabolic syndrome in the adult US population (≥20 years old), 1999 to 2010, by sex (first column), race/ethnicity (second column), and race/ethnicity and sex (third and fourth columns)

Shaded areas represent 95% confidence intervals. HDL-C indicates high-density lipoprotein cholesterol; Mex-Am, Mexican American; and Waist circumf., waist circumference. Reprinted from Beltrán-Sánchez et al with permission from the American College of Cardiology Foundation. Copyright © 2013, by the American College of Cardiology Foundation.

Chart 11-7. Age-standardized prevalence of metabolic syndrome by sex and Hispanic/Latino background, 2008 to 2011

Values were weighted for survey design and nonresponse and were age standardized to the population described by the 2010 US census. Source: Hispanic Community Health Study/Study of Latinos.

Chart 11-8. Age-standardized prevalence of metabolic syndrome by age and sex in Hispanics/Latinos, 2008 to 2011

Values were weighted for survey design and nonresponse and were age standardized to the population described by the 2010 US census. Source: Hispanic Community Health Study/Study of Latinos.

Chart 11-9. Age-standardized prevalence of metabolic syndrome (MetS) and metabolically healthy obesity (MHO) among obese (body mass index ≥30 kg/m2) males (A) and females (B) in different cohorts

CHRIS indicates Collaborative Health Research in South Tyrol Study; DILGOM, Dietary, Lifestyle, and Genetics Determinants of Obesity and Metabolic Syndrome; EGCUT, Estonian Genome Center of the University of Tartu; HUNT2, Nord-Trøndelag Health Study; KORA, Cooperative Health Research in the Region of Augsburg; MICROS, Microisolates in South Tyrol Study; NCDS, National Child Development Study; NL, the Netherlands; and PREVEND, Prevention of Renal and Vascular End-Stage Disease. Reprinted from van Vliet-Ostaptchouketet al. Copyright © 2014, van Vliet-Ostaptchouk et al.; licensee BioMed Central Ltd.

Chart 11-10. Ten-year progression of metabolic syndrome in the ARIC study, stratified by age, sex, and race/ethnicity

ARIC indicates Atherosclerosis Risk in Communities. Reprinted from Vishnu et al with permission from Elsevier. Copyright © 2015, Elsevier Ireland Ltd.

Chart 12-1. Trends in adjusted* end-stage renal disease incidence rate by age group in the United States (2015 USRDS Annual Data Report, volume 2, Figure 1.4b)

USRDS indicates US Renal Data System. *Adjusted for sex and race. The standard population was the US population in 2011. Source: Special analyses, USRDS end-stage renal disease database.

Chart 12-2. Map of the adjusted* incidence rate (per million/year) of end-stage renal disease by health service area in the US population, 2013 (2015 USRDS Annual Data Report, volume 2, Figure 1.3)

USRDS indicates US Renal Data System. *Adjusted for age, sex, and race. The standard population was the US population in 2011. Source: Special analyses, USRDS end-stage renal disease database.

Chart 12-3. Estimated cumulative incidence of ESRD across categories of time-updated SBP among participants in the CRIC Study

CRIC indicates Chronic Renal Insufficiency Cohort; ESRD, end-stage renal disease; and SBP, systolic blood pressure. Reprinted from Anderson et al. Copyright © 2015, American College of Physicians. All Rights Reserved. Reprinted with the permission of American College of Physicians, Inc.

Chart 12-4. Percentage of NHANES participants within the KDIGO 2012 prognosis of chronic kidney disease by GFR and albuminuria categories, 1998 to 2012 (2014 USRDS Annual Report, volume 1, Table 1.2)

GFR indicates glomerular filtration rate; KDIGO, Kidney Disease: Improving Global Outcomes; NHANES, National Health and Nutrition Examination Survey; and USRDS, US Renal Data System.

Chart 12-5. Adjusted odds ratios of chronic kidney disease (CKD) in NHANES by risk factor, 1998 to 2012 (2015 USRDS Annual Data Report, volume 1, Figure 1.9)

CKD defined as presence of estimated glomerular filtration rate (eGFR) −1·1.73 m−2, urine albumin-to-creatinine ratio (ACR) ≥30 mg/g, and either eGFR <60 mL·min−1·1.73 m−2 or ACR ≥30 mg/g for each of the comorbid conditions. Adjusted for age, sex, and race; single-sample estimates of eGFR and ACR; eGFR calculated with the Chronic Kidney Disease Epidemiology Collaboration equation. Whisker lines indicate 95% confidence intervals. BMI indicates body mass index; CVD, cardiovascular disease; DM, diabetes mellitus; HTN, hypertension; NHANES, National Health and Nutrition Examination Survey; SR, self-report; and USRDS, US Renal Data System. Source: NHANES 1988 to 1994, 1999 to 2004, and 2007 to 2012 participants aged ≥20 years.

Chart 12-6. Adjusted relative risk of (A) all-cause mortality and (B) cardiovascular mortality in the general population categorized by KDIGO 2012 categories of chronic kidney disease

Data are derived from categorical meta-analysis of population cohorts. Pooled relative risks are expressed relative to the reference (Ref) cell. Colors represent the ranking of the adjusted relative risks (green=low risk; yellow=moderate risk; orange=high risk; red=very high risk). ACR indicates urine albumin-to-creatinine ratio; eGFR, estimated glomerular filtration rate; and KDIGO, Kidney Disease: Improving Global Outcomes. Modified from Levey et al with permission from International Society of Nephrology. Copyright © 2011, International Society of Nephrology.

Chart 12-7. CVD in patients with or without CKD, 2013 (2015 USRDS Annual Data Report, volume 1, Figure 4.1)

Patients aged ≥66, alive, without end-stage renal disease, and residing in the United States on December 31, 2013 with fee-for-service coverage for the entire calendar year. Totals of patients for the study cohort: N=1 238 888; with CKD=132 840; without CKD=1 106 048. AFIB indicates atrial fibrillation; AMI, acute myocardial infarction; ASHD, atherosclerotic heart disease; CHF, congestive heart failure; CKD, chronic kidney disease; CVA/TIA, cerebrovascular accident/transient ischemic attack; CVD, cardiovascular disease; PAD, peripheral artery disease; SCA/VA, sudden cardiac arrest and ventricular arrhythmias; USRDS, US Renal Data System; and VHD, valvular heart disease. Source: Special analyses, Medicare 5% sample.

Chart 12-8. Prevalence of CVD in patients with end-stage renal disease (ESRD) by treatment modality, 2013 (2015 USRDS Annual Data Report, volume 2, Figure 9.2)

Point prevalent hemodialysis, peritoneal dialysis, and transplant patients at all ages, with Medicare as primary payer on January 1, 2011, who were continuously enrolled in Medicare Parts A and B from July, 1, 2010 to December 31, 2010; ESRD service date was at least 90 days before January 1, 2011; and survived past 2012. AFIB indicates atrial fibrillation; AMI, acute myocardial infarction; ASHD, atherosclerotic heart disease; CHF, congestive heart failure; CVA/TIA, cerebrovascular accident/transient ischemic attack; CVD, cardiovascular disease; PAD, peripheral arterial disease; SCA/VA, sudden cardiac arrest and ventricular arrhythmias; and USRDS, US Renal Data System. Source: Special analyses, USRDS ESRD database.

Chart 13-1. Prevalence of cardiovascular disease in adults ≥20 years of age by age and sex (NHANES 2011–2014)

These data include coronary heart disease, heart failure, stroke, and hypertension. NHANES indicates National Health and Nutrition Examination Survey. Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 13-2. Age-adjusted percentage of selected circulatory diseases among American adults by education level using data from Summary Health Statistics: NHIS, 2014

GED indicates Tests of General Educational Development; and NHIS, National Health Interview Survey. Source: Summary Health Statistics: NHIS, 2014, Centers for Disease Control and Prevention National Center for Health Statistics.

Chart 13-3. Age-adjusted percentages of selected circulatory diseases among American adults by employment status using data from Summary Health Statistics: NHIS, 2014

NHIS indicates National Health Interview Survey. Source: Summary Health Statistics: NHIS, 2014, Centers for Disease Control and Prevention National Center for Health Statistics.

Chart 13-4. Age-adjusted percentages of selected circulatory diseases among American adults by race and ethnicity using data from Summary Health Statistics: NHIS, 2014

NH indicates non-Hispanic; and NHIS, National Health Interview Survey. *Data may not be reliable. †Data are not available. Source: Summary Health Statistics: NHIS, 2014, Centers for Disease Control and Prevention National Center for Health Statistics.

Chart 13-5. Deaths attributable to diseases of the heart (United States: 1900–2014)

See Glossary (Chapter 29) for an explanation of “diseases of the heart.” In the years 1900 to 1920, the International Classification of Diseases codes were 77 to 80; for 1925, 87 to 90; for 1930 to 1945, 90 to 95; for 1950 to 1960, 402 to 404 and 410 to 443; for 1965, 402 to 404 and 410 to 443; for 1970 to 1975, 390 to 398 and 404 to 429; for 1980 to 1995, 390 to 398, 402, and 404 to 429; for 2000 to 2014, I00 to I09, I11, I13, and I20 to I51. Before 1933, data are for a death registration area and not the entire United States. In 1900, only 10 states were included in the death registration area, and this increased over the years, so part of the increase in numbers of deaths is attributable to an increase in the number of states. Source: National Center for Health Statistics.

Chart 13-6. Deaths attributable to cardiovascular disease (United States: 1900–2014)

Cardiovascular disease (International Classification of Diseases, 10th Revision codes I00–I99) does not include congenital heart disease. Before 1933, data are for a death registration area and not the entire United States. Source: National Center for Health Statistics.

Chart 13-7. Percentage breakdown of deaths attributable to cardiovascular disease (United States: 2014)

Total may not add to 100 because of rounding. Coronary heart disease includesInternational Classification of Diseases, 10th Revision (ICD-10) codes I20 to I25; stroke, I60 to I69; heart failure, I50; high blood pressure, I10 to I15; diseases of the arteries, I70 to I78; and other, all remaining ICD-I0 I categories. *Not a true underlying cause. With any-mention deaths, heart failure accounts for 36% of cardiovascular disease deaths. Source: National Heart, Lung, and Blood Institute from National Center for Health Statistics reports and data sets.

Chart 13-8. Cardiovascular disease (CVD) deaths versus cancer deaths by age (United States: 2014)

CVD includes International Classification of Diseases, 10th Revision codes I00 to I99; cancer, C00 to C97. Source: National Center for Health Statistics.

Chart 13-9. Cardiovascular disease (CVD) and other major causes of death: total,

Deaths among both sexes, United States, 2014. Heart disease includesInternational Classification of Diseases, 10th Revisioncodes I00 to I09, I11, I13, and I20 to I51; stroke, I60 to I69; all other CVD, I10, I12, I15, and I70 to I99; cancer, C00 to C97; chronic lower respiratory disease (CLRD), J40 to J47; Alzheimer disease, G30; and accidents, V01 to X59 and Y85 and Y86. Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 13-10. Cardiovascular disease (CVD) and other major causes of death in males: total,

Deaths among males, United States, 2014. Heart disease includesInternational Classification of Diseases, 10th Revisioncodes I00 to I09, I11, I13, and I20 to I51; stroke, I60 to I69; all other CVD, I10, I12, I15, and I70 to I99; cancer, C00 to C97; chronic lower respiratory disease (CLRD), J40 to J47; and accidents, V01 to X59 and Y85 and Y86. Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 13-11. Cardiovascular disease (CVD) and other major causes of death in females: total,

Deaths among females, United States, 2014. Heart disease includesInternational Classification of Diseases, 10th Revisioncodes I00 to I09, I11, I13, and I20 to I51; stroke, I60 to I69; all other CVD, I10, I12, I15, and I70 to I99; cancer, C00 to C97; chronic lower respiratory disease (CLRD), J40 to J47; and Alzheimer disease, G30. Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 13-12. Cardiovascular disease and other major causes of death for all males and females (United States: 2014)

A indicates cardiovascular disease (International Classification of Diseases, 10th Revision codes I00–I99); B, cancer (C00–C97); C, accidents (V01–X59 and Y85–Y86); D, chronic lower respiratory disease (J40–J47); E, diabetes mellitus (E10–E14); and F, Alzheimer disease (G30). Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 13-13. Cardiovascular disease and other major causes of death for non-Hispanic (NH) white males and females (United States: 2014)

A indicates cardiovascular disease (International Classification of Diseases, 10th Revision codes I00–I99); B, cancer (C00–C97); C, accidents (V01–X59 andY85–Y86); D, chronic lower respiratory disease (J40–J47); E, diabetes mellitus (E10–E14); and F, Alzheimer disease (G30). Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 13-14. Cardiovascular disease and other major causes of death for non-Hispanic (NH) black males and females (United States: 2014)

A indicates cardiovascular disease (International Classification of Diseases, 10th Revision codes I00–I99); B, cancer (C00–C97); C, accidents (V01–X59 and Y85–Y86); D, diabetes mellitus (E10–E14); E, chronic lower respiratory disease (J40–J47); and F, nephritis (N00–N07, N17–N19, and N25–N27). Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 13-15. Cardiovascular disease and other major causes of death for Hispanic or Latino males and females (United States: 2014)

Number of deaths shown may be lower than actual because of underreporting in this population. A indicates cardiovascular disease (International Classification of Diseases, 10th Revision codes I00–I99); B, cancer (C00–C97); C, accidents (V01–X59 and Y85–Y86); D, diabetes mellitus (E10–E14); E, chronic lower respiratory disease (J40–J47); and F, Alzheimer disease (G30). Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 13-16. Cardiovascular disease and other major causes of death for non-Hispanic (NH) Asian or Pacific Islander males and females (United States: 2014)

“Asian or Pacific Islander” is a heterogeneous category that includes people at high cardiovascular disease risk (eg, South Asian) and people at low cardiovascular disease risk (eg, Japanese). More specific data on these groups are not available. Number of deaths shown may be lower than actual because of underreporting in this population. A indicates cardiovascular disease (International Classification of Diseases, 10th Revision codes I00–I99); B, cancer (C00–C97); C, accidents (V01–X59 and Y85–Y86); D, diabetes mellitus (E10–E14); E, chronic lower respiratory disease (J40–J47); and F, influenza and pneumonia (J09–J18). Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 13-17. Cardiovascular disease and other major causes of death for non-Hispanic (NH) American Indian or Alaska Native males and females (United States: 2014)

Number of deaths shown may be lower than actual because of underreporting in this population. A indicates cardiovascular disease (International Classification of Diseases, 10th Revision codes I00–I99); B, cancer (C00–C97); C, accidents (V01–X59 and Y85–Y86); D, diabetes mellitus (E10–E14); E, chronic liver disease (K70 and K73–K74); and F, chronic lower respiratory disease (J40–J47). Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 13-18. Age-adjusted death rates for coronary heart disease (CHD), stroke, and lung and breast cancer for white and black females (United States: 2014)

CHD includes International Classification of Diseases, 10th Revision codes I20 to I25; stroke, I60 to I69; lung cancer, C33 to C34; and breast cancer, C50. NH indicates non-Hispanic. Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute. NH indicates non-Hispanic.

Chart 13-19. Cardiovascular disease (CVD) mortality trends for males and females (United States: 1979–2014)

CVD excludes congenital cardiovascular defects (International Classification of Diseases, 10th Revision[ICD-10] codes I00–I99). The overall comparability for cardiovascular disease between theInternational Classification of Diseases, 9th Revision(1979–1998) and ICD-10 (1999–2013) is 0.9962. No comparability ratios were applied. Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 13-20

US maps corresponding to state death rates (including the District of Columbia), 2014.

Chart 13-21. Hospital discharges for cardiovascular disease (United States: 1970–2010)

Hospital discharges include people discharged alive, dead, and “status unknown.” Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 13-22. Hospital discharges (International Classification of Diseases, 9th Revision) for the 10 leading diagnostic groups (United States: 2010)

Source: National Hospital Discharge Survey/National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 13-23. Estimated average 10-year cardiovascular disease risk in adults 50 to 54 years of age according to levels of various risk factors (FHS)

BP indicates blood pressure; FHS, Framingham Heart Study; and HDL, high-density lipoprotein. Data derived from D’Agostino et al.

Chart 14-1. Prevalence of stroke by age and sex (NHANES 2011–2014)

NHANES indicates National Health and Nutrition Examination Survey. Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 14-2. Annual age-adjusted incidence of first-ever stroke by race

Hospital plus out-of-hospital ascertainment, 1993 to 1994, 1999, and 2005. ICH indicates intracerebral hemorrhage; and SAH, subarachnoid hemorrhage. Data derived from Kleindorfer et al.

Chart 14-3. Annual rate of first cerebral infarction by age, sex, and race (GCNKSS 1999)

Rates for black men and women 45 to 54 years of age and for black men ≥75 years of age are considered unreliable. GCNKSS indicates Greater Cincinnati/Northern Kentucky Stroke Study. Source: Unpublished data from the GCNKSS.

Chart 14-4. Annual rate of all first-ever strokes by age, sex, and race (GCNKSS 1999)

Rates for black men and women 45 to 54 years of age and for black men ≥75 years of age are considered unreliable. GCNKSS indicates Greater Cincinnati/Northern Kentucky Stroke Study. Source: Unpublished data from the GCNKSS.

Chart 14-5. Age-adjusted incidence of stroke/transient ischemic attack by race and sex, ages 45 to 74 years, ARIC study cohort, 1987 to 2001

ARIC indicates Atherosclerosis Risk in Communities. Data derived from the National Heart, Lung, and Blood Institute’s2006 Chart Book on Cardiovascular and Lung Diseases.

Chart 14-6. Age-adjusted death rates for stroke by sex and race/ethnicity, 2014

Death rates for the American Indian or Alaska Native and Asian or Pacific Islander populations are known to be underestimated. Stroke includesInternational Classification of Diseases, 10th Revisioncodes I60 through I69 (cerebrovascular disease). Mortality for non-Hispanic (NH) Asians includes Pacific Islanders. Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 14-7. Stroke death rates, 2011 through 2013

All ages, by county. Rates are spatially smoothed to enhance the stability of rates in counties with small populations. International Classification of Diseases, 10th Revision codes for stroke: I60 through I69. Data source: National Vital Statistics System and the US Census Bureau.

Chart 14-8. Estimated 10-year stroke risk in adults 55 years of age according to levels of various risk factors (FHS)

AF indicates atrial fibrillation; CVD, cardiovascular disease; and FHS, Framingham Risk Study. Data derived from Wolf et al.

Chart 14-9. Probability of death within 1 year after first stroke

Source: Pooled data from the Framingham Heart Study, Atherosclerosis Risk in Communities Study, Cardiovascular Health Study, Multi-Ethnic Study of Atherosclerosis, Coronary Artery Risk Development in Young Adults, and Jackson Heart Study of the National Heart, Lung, and Blood Institute.

Chart 14-10. Probability of death within 5 years after first stroke

Source: Pooled data from the Framingham Heart Study, Atherosclerosis Risk in Communities Study, Cardiovascular Health Study, Multi-Ethnic Study of Atherosclerosis, Coronary Artery Risk Development in Young Adults, and Jackson Heart Study of the National Heart, Lung, and Blood Institute.

Chart 14-11. Probability of death with recurrent stroke in 5 years after first stroke

Source: Pooled data from the Framingham Heart Study, Atherosclerosis Risk in Communities Study, Cardiovascular Health Study, Multi-Ethnic Study of Atherosclerosis, Coronary Artery Risk Development in Young Adults, and Jackson Heart Study of the National Heart, Lung, and Blood Institute.

Chart 14-12. Trends in carotid endarterectomy and carotid stenting procedures (United States: 1993–2013)

Source: Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality.

Chart 15-1. Incidence of ischemic and hemorrhagic or other stroke type by age and sex

Reprinted from Barker-Collo et al with permission of the publisher. Copyright © 2015, S. Karger AG, Basel.

Chart 15-2. Age-standardized global death rates for CVD stratified by sex, 1990 to 2013

CVD indicates cardiovascular disease; and UI, uncertainty interval. Reprinted from Roth et al. Copyright © 2015, American Heart Association, Inc.

Chart 15-3. Number of ischemic heart disease deaths by age, 2013

Source: Institute for Health Metrics and Evaluation.

Chart 15-4. Proportion of YLLs because of CVD stratified by global region, 2013

YLL is a measure of premature mortality calculated by using a normative goal for survival computed from the lowest observed death rate across countries. CVD indicates cardiovascular disease; and YLL, years of life lost. Reprinted from Roth et al. Copyright © 2015, American Heart Association, Inc.

Chart 15-5. Map of age-standardized ischemic heart disease mortality rate per 100 000 people in 2013

Source: Institute for Health Metrics and Evaluation.

Chart 15-6. Age-standardized annual mortality rates (per 100 000) of ischemic stroke in 2013

Reprinted from Feigin et al with permission of the publisher. Copyright © 2015, S. Karger AG, Basel.

Chart 15-7. Cardiovascular disease event rates in selected high-, middle-, and low-income countries

Reprinted from Yusuf et al. Copyright © 2014, Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.

Chart 15-8. Risk factor burden, by rural and urban regions, in selected high-, middle-and low-income countries

Reprinted from Yusuf et al. Copyright © 2014, Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.

Chart 15-9. Proportion of survey respondents who experienced catastrophic health spending (out-of-pocket health spending >40% nonfood expenditures) and distress financing after cardiovascular disease–related hospitalization, divided by income strata

Differences across income strata were considered statistically significant (P<0.05) for China (catastrophic health spending and distress financing), India (catastrophic health spending), and Tanzania (catastrophic health spending and distress financing). Reprinted from Huffman et al. Copyright © 2011, Huffman et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Chart 15-10. Change in age-standardized CVD death rate and total number of CVD deaths, 1990 to 2013

CVD indicates cardiovascular disease; and UI, uncertainty interval. Reprinted from Roth et al. Copyright © 2015, American Heart Association, Inc.

Chart 15-11. Contribution of changes in population growth, population aging, and rates of age-specific cardiovascular death to changes in cardiovascular mortality, 1990 to 2013

Reprinted from Roth et al. Copyright © 2015, Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.

Chart 16-1. Trends in age-adjusted death rates attributable to congenital heart defects, 1999 to 2014

Source: National Center for Health Statistics, National Vital Statistics System.

Chart 16-2. Trends in age-adjusted death rates attributable to congenital cardiovascular defects by race/ethnicity, 1999 to 2014

NH indicates non-Hispanic. Source: National Center for Health Statistics, National Vital Statistics System.

Chart 16-3. Trends in age-adjusted death rates attributable to congenital cardiovascular defects by sex, 1999 to 2014

Source: National Center for Health Statistics, National Vital Statistics System.

Chart 16-4. Trends in age-adjusted death rates attributable to congenital cardiovascular defects by age at death, 1999 to 2014

Source: National Center for Health Statistics, National Vital Statistics System.

Chart 16-5. Age-adjusted death rates attributable to congenital cardiovascular defects, by sex and race/ethnicity, 2014

NH indicates non-Hispanic. Source: National Center for Health Statistics, National Vital Statistics System.

Chart 17-1. Long-term outcomes in individuals with prolonged PR interval (>200 ms; first-degree atrioventricular block) compared with individuals with normal PR interval in the FHS

FHS indicates Framingham Heart Study. Data derived from Cheng et al.

Chart 17-2. Primary indications (in thousands) for pacemaker placement between 1990 and 2002 from the NHDS, NCHS

AV indicates atrioventricular; NCHS, National Center for Health Statistics; and NHDS, National Hospital Discharge Survey. Data derived from Birnie et al.

Chart 17-3. Incidence rate of paroxysmal supraventricular tachycardia per 100 000 person-years by age and sex

Data derived from Orejarena et al.

Chart 17-4. Current and future US prevalence projections for AF

Projections assume no increase (red dashed line) or logarithmic growth (blue dashed line) in incidence of AF from 2007. AF indicates atrial fibrillation. Data derived from Go et al and modified from Colilla et al with permission from Elsevier. Copyright © 2013, Elsevier Inc.

Chart 17-5. Atrial fibrillation incidence by race

Incidence increases with advancing age among different races and sexes in the United States. Data derived from Dewland et al.

Chart 17-6. Lifetime cumulative risk for atrial fibrillation (AF) at different ages (through age 94 years) by sex

With increasing incidence of AF with aging, lifetime risk is unchanged. Reprinted from Lloyd-Jones et al. Copyright © 2004, American Heart Association, Inc.

Chart 17-7. Cumulative incidence of events in the 5 years after diagnosis of incident AF in Medicare patients

AF indicates atrial fibrillation. Reprinted from Piccini et al by permission of the European Society of Cardiology. Copyright © 2013, The Authors.

Chart 17-8. AF cost estimates, where AF is diagnosed in inpatient and outpatient encounters

Indirect costs are incremental costs of inpatient and outpatient visits. AF indicates atrial fibrillation; and USD, US dollars. Data derived from Kim et al and Coyne et al.

Chart 17-9. Population attributable fraction of major risk factors for atrial fibrillation in the ARIC study

ARIC indicates Atherosclerosis Risk in Communities; BMI, body mass index (in kg/m2); cardiac disease, patients with history of coronary artery disease or heart failure; and smoking, current smoker. Data derived from Huxley et al.

Chart 17-10. Time-to-event analysis of incidence of atrial fibrillation by category of METs in the FIT Project between 1991 and 2009

The P value was determined by a log-rank test. FIT indicates Henry Ford Exercise Testing; and METs, metabolic equivalents. Reprinted from Qureshi et al. Copyright © 2015, American Heart Association, Inc.

Chart 17-11. Global age-adjusted atrial fibrillation prevalence rates (per 100 000 population) in the 2010 GBD

GBD indicates Global Burden of Diseases, Injuries, and Risk Factors Study. Reprinted from Chugh et al. Copyright © 2014, American Heart Association, Inc.

Chart 18-1. Detailed causes of cardiac arrest by age group in children and young adults in King County, WA (1980–2009)

CAD indicates coronary artery disease; DCM, dilated cardiomyopathy; and HCM, hypertrophic cardiomyopathy. “Other” corresponds to all other causes. Reprinted with permission from Meyer et al. Copyright © 2012, American Heart Association, Inc.

Chart 18-2. Location of out-of-hospital cardiac arrest, 2015

Data derived from 2015 Cardiac Arrest Registry to Enhance Survival (CARES) National Summary Report.

Chart 18-3. Out-of-hospital cardiac arrest witness status, 2015

EMS indicates emergency medical services. Data derived from 2015 Cardiac Arrest Registry to Enhance Survival National Summary Report.

Chart 18-4. Temporal trends in survival to hospital discharge after pulseless IHCA in GWTG-Resuscitation from 2000 to 2015

GWTG indicates Get With the Guidelines; IHCA, in-hospital cardiac arrest; PEA, pulseless electrical activity; VF, ventricular fibrillation; and VT, ventricular tachycardia. Source: GWTG-Resuscitation unpublished data.

Chart 19-1. Prevalence (%) of detectable coronary calcium in the CARDIA study: US adults 33 to 45 years of age (2000–2001)

P<0.0001 across race-sex groups. CARDIA indicates Coronary Artery Risk Development in Young Adults. Data derived from Loria et al.

Chart 19-2. Prevalence (%) of detectable coronary calcium in MESA: US adults 45 to 84 years of age

P<0.0001 across ethnic groups in both males and females. MESA indicates Multi-Ethnic Study of Atherosclerosis. Data derived from Bild et al.

Chart 19-3. Ten-year trends in coronary artery calcification in individuals without clinical cardiovascular disease in MESA

MESA indicates Multi-Ethnic Study of Atherosclerosis. Data derived from Bild et al.

Chart 19-4. HRs for CHD events associated with coronary calcium scores: US adults 45 to 84 years of age (reference group, CAC=0)

All HRs P<0.0001. Major CHD events included myocardial infarction and death attributable to CHD; any CHD events included major CHD events plus definite angina or definite or probable angina followed by revascularization. CAC indicates coronary artery calcification; CHD, coronary heart disease; and HR, hazard ratio. Data derived from Detrano et al.

Chart 19-5. HRs for coronary heart disease events associated with coronary calcium scores: US adults (reference group, CAC=0 and Framingham Risk Score

Coronary heart disease events included nonfatal myocardial infarction and death attributable to coronary heart disease. CAC indicates coronary artery calcification; and HR, hazard ratio. Data derived from Greenland et al.

Chart 19-6. Mean values of carotid IMT for different carotid artery segments in younger adults by race and sex (Bogalusa Heart Study)

IMT indicates intima-media thickness. Data derived from Urbina et al.

Chart 19-7. Association between cardiovascular risk factors and mean common carotid intima-media thickness, by ethnicity

Point estimates for betas, lines represent 95% confidence intervals. HDL indicates high-density lipoprotein. Reprinted from Gijsberts et al. Copyright © 2015, Gijsberts et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Chart 19-8. Mean values of carotid IMT for different carotid artery segments in older adults, by race

IMT indicates intima-media thickness. Data derived from Manolio et al.

Chart 20-1. Prevalence of coronary heart disease by age and sex (NHANES: 2011–2014)

NHANES indicates National Health and Nutrition Examination Survey. Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 20-2. Prevalence of myo-cardial infarction by age and sex (NHANES: 2011–2014)

Myocardial infarction includes people who answered “yes” to the question of ever having had a heart attack or myocardial infarction. NHANES indicates National Health and Nutrition Examination Survey. Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 20-3. Annual number of adults per 1000 having diagnosed heart attack or fatal CHD by age and sex (ARIC surveillance: 2005–2013 and CHS)

These data include MI and fatal CHD but not silent MI. ARIC indicates Atherosclerosis Risk in Communities; CHD, coronary heart disease; CHS, Cardiovascular Health Study; and MI, myocardial infarction. Source: National Heart, Lung, and Blood Institute.

Chart 20-4. Incidence of heart attack or fatal CHD by age, sex, and race (ARIC Surveillance: 2005–2013)

ARIC indicates Atherosclerosis Risk in Communities; CHD, coronary heart disease; and MI, myocardial infarction. Source: National Heart, Lung, and Blood Institute.

Chart 20-5. Incidence of myocardial infarction by age, sex, and race (ARIC Surveillance: 2005–2013)

ARIC indicates Atherosclerosis Risk in Communities. Source: Unpublished data from ARIC, National Heart, Lung, and Blood Institute.

Chart 20-6. Estimated 10-year coronary heart disease risk in adults 55 years of age according to levels of various risk factors (FHS)

FHS indicates Framingham Heart Study; and HDL-C, high-density lipoprotein cholesterol. Data derived from Wilson et al.

Chart 20-7. Prevalence of low coronary heart disease risk, overall and by sex (NHANES: 1971–2006)

Low risk is defined as systolic blood pressure 2; currently not smoking cigarettes; and no prior myocardial infarction or diabetes mellitus. NHANES indicates National Health and Nutrition Examination Survey. Source: Personal communication with the National Heart, Lung, and Blood Institute, June 28, 2007.

Chart 20-8. Hospital discharges for coronary heart disease by sex (United States: 1970–2010)

Hospital discharges include people discharged alive, dead, and “status unknown.” Source: National Hospital Discharge Survey/National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 20-9. Prevalence of angina pectoris by age and sex (NHANES: 2011–2014)

Angina pectoris includes people who either answered “yes” to the question of ever having angina or angina pectoris or were diagnosed with Rose angina. NHANES indicates National Health and Nutrition Examination Survey. Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 20-10. Secular trends in age- and sex-standardized prevalence rates of angina for adults aged =40 years in the United States, by race, for angina symptoms defined using the Rose questionnaire

Reprinted from Will et al. Copyright © 2014, American Heart Association, Inc.

Chart 20-11. Incidence of angina pectoris (deemed uncomplicated on the basis of physician interview of patient) by age and sex (FHS 1986–2009)

FHS indicates Framingham Heart Study. Data derived from the National Heart, Lung, and Blood Institute.

Chart 21-1. Incidence of peripartum cardiomyopathy

Reproduced from Blauwet et al. Copyright © 2011, BMJ Publishing Group Ltd and the British Cardiovascular Society, with permission from BMJ Publishing Group Ltd.

Chart 21-2. Prevalence of heart failure for adults ≥20 years by sex and age (NHANES: 2011–2014)

NHANES indicates National Health and Nutrition Examination Survey. Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 21-3. First acute decompensated heart failure annual event rates per 1000 from ARIC Community Surveillance (2005–2013)

ARIC indicates Atherosclerosis Risk in Communities Study. Source: ARIC and National Heart, Lung, and Blood Institute.

Chart 21-4. Hospital discharges for heart failure by sex (United States: 1980–2010)

Hospital discharges include people discharged alive, dead, and status unknown. Source: National Hospital Discharge Survey/National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 21-5. Number of patients receiving left ventricular assist devices in the United States, 2006 to 2014

Data derived from Kirklin et al.

Chart 22-1. Rheumatic heart disease prevalence trends per 1000 people for each WHO region

A, the Americas; B, Europe; C, Africa;D, Eastern Mediterranean; E, Western Pacific; andF, Southeast Asia. WHO indicates World Health Organization. Reprinted from Seckeler and Hoke. Copyright © 2011, Seckeler and Hoke, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

Chart 22-2. Age and sex distribution of 3343 subjects with rheumatic heart disease participating in the REMEDY study

REMEDY indicates Global Rheumatic Heart Disease Registry. Reprinted from Zühlke et al by permission of Oxford University Press. Copyright © 2014, The Authors.

Chart 24-1. Estimates of prevalence of peripheral artery disease in males by age and ethnicity

Amer. indicates American; and NH, non-Hispanic. Data derived from Allison et al.

Chart 24-2. Estimates of prevalence of peripheral artery disease in females by age and ethnicity

Amer. indicates American; and NH, non-Hispanic. Data derived from Allison et al.

Chart 24-3. Prevalence of peripheral artery disease by age in males and females in high-income countries and low-income or middle-income countries

Data derived from Fowkes et al.

Chart 24-4. Hazard ratios of cardiovascular mortality with 95% CI by ABI categories

ABI indicates ankle-brachial index; and CI, confidence interval. Data derived from Fowkes et al.

Chart 24-5. Association between the diameter and the minimum and maximum risk of AAA rupture per year

AAA indicates abdominal aortic aneurysm. Data derived from Brewster et al.

Chart 24-6. Numbers needed to screen to avoid an AAA-associated death and a ruptured AAA

AAA indicates abdominal aortic aneurysm. Data derived from Eckstein et al.

Chart 25-1. Survival rates after out-of-hospital cardiac arrest in US sites of the Resuscitation Outcomes Consortium, 2006 to 2014

AED indicates automated external defibrillator; CPR, cardiopulmonary resuscitation; and EMS, emergency medical services.

Chart 26-1. Trends in cardiovascular procedures, United States: 1979 to 2010; inpatient procedures only

PCI indicates percutaneous coronary intervention. Source: National Hospital Discharge Survey, National Center for Health Statistics, and National Heart, Lung, and Blood Institute.

Chart 26-2. Number of surgical procedures in the 10 leading diagnostic groups, United States: 2010

Source: National Hospital Discharge Survey/National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Chart 26-3. Trends in heart transplantations, 1975 to 2015

Source: Organ Procurement and Transplantation Network data as of March 31, 2016.

Chart 26-4. Heart transplantations in the United States by recipient age, 2015

Source: Organ Procurement and Transplantation Network data as of March 31, 2016.

Chart 27-1. Direct and indirect costs of CVD and stroke (in billions of dollars), United States, average annual 2012 to 2013

CVD indicates cardiovascular disease. Source: Prepared by the National Heart, Lung, and Blood Institute.–

Chart 27-2. The 23 leading diagnoses for direct health expenditures, United States, average annual 2012 to 2013 (in billions of dollars)

COPD indicates chronic obstructive pulmonary disease; and GI, gastrointestinal (tract). Source: National Heart, Lung, and Blood Institute; estimates are from the Medical Expenditure Panel Survey, Agency for Healthcare Research and Quality, and exclude nursing home costs.

Chart 27-3. Projected total costs of CVD, 2015 to 2030 (2012 dollars in billions) in the United States

Unpublished data tabulated by the American Heart Association using methods described in Heidenreich et al. CHD indicates coronary heart disease; CHF, congestive heart failure; CVD, cardiovascular disease; and HBP, high blood pressure.

Chart 27-4. Projected total (direct and indirect) costs of total cardiovascular disease by age (2012 dollars in billions)

Unpublished data tabulated by the American Heart Association using methods described in Heidenreich et al.

Chart 27-5. Projected direct costs of total cardiovascular disease by type of cost (2010 dollars in billions)

Unpublished data tabulated by the American Heart Association using methods described in Heidenreich et al.