DALLAS - Heart attack, stroke and other cardiovascular diseases could cost the nation about $15 billion more in economic costs in 1998 than they did in 1997, according to figures released Dec. 31 by the American Heart Association in its 1998 Heart and Stroke Statistical Update.
The annual toll in lives also continues to rise, with final stroke and heart disease deaths up nearly 11,000 from 1994 to 1995, the most recent year for which such totals are available, the AHA reported.
The total cost of cardiovascular disease in 1998 is expected to reach $274.2 billion, up from $259.1 billion in 1997. Included in the estimate is the cost of care provided by physicians and other professionals, hospital and nursing home services, medications, and home health and other medical durables. Also included is lost productivity resulting from the number of people who are ill or have died as a result of heart disease and stroke. "Costs are rising for several reasons," says Martha N. Hill, R.N., Ph.D., president of the American Heart Association. "First of all, as the population increases and ages, more people will be having heart attacks and strokes. And while we're developing new and better ways to treat these diseases, the treatments do cost money."
Hospital and nursing home costs - estimated at $119.9 billion - is the largest category of direct costs. Physician and other professional services account for another $25.9 billion. Among indirect costs, the American Heart Association estimates that lost productivity resulting from deaths from cardiovascular disease will cost the United States $77.9 billion in future earnings.
The number and cost of major heart-related procedures also continues to climb. In 1995 a total of 573,000 coronary artery bypass procedures were performed at an average cost of $44,820 per surgery. In 1994 a total of 501,000 bypass procedures were performed.
Percutaneous Transluminal Coronary Angioplasty procedures to open clogged blood vessels were performed about 419,000 times in 1995 at an estimated individual cost of $20,370. A total of 404,000 such procedures were done in 1994. Perhaps because of a shortage of donated organs, surgeons performed 16 fewer heart transplants - a total of 2,345 - in 1996 than in 1995. Most recent cost estimates for heart transplants are for 1993 when the first-year cost averaged $209,100. The estimated annual follow-up cost was $15,000 per patient. "While the overall costs for cardiovascular disease are staggering and adversely affect the nation's economy, the real tragedy is the number of people who die or are disabled, primarily from heart attacks and strokes," says Hill, who is professor and director of the Center for Nursing Research at The Johns Hopkins University, Baltimore.
Cardiovascular disease claimed 960,592 lives in 1995. That's 41.5 percent of all deaths for 1995, or 1 of every 2.4 deaths. According to the National Heart, Lung, and Blood Institute's Atherosclerotic Risk in Communities study and the Cardiovascular Health Study, in 1995 a total of 1.1 million Americans suffered a first-time or recurrent coronary heart attack and 600,000 had a first-time or recurrent stroke. (Note to editors: These numbers cannot be compared with 1994 because two different studies were used.)
Congestive heart failure (CHF) and strokes are taking an increasing toll of death and disability in the United States. CHF deaths increased 115.7 percent from 1979 to 1995, and hospitalizations rose 131.3 percent. Stroke-related deaths are up 10 percent since 1991, and hospitalizations from stroke have increased 24 percent from 1979 to 1995.
"If we have any hope of reducing the high cost of cardiovascular disease in both human and economic terms," says Hill, "we have to look at causes, or risk factors, and we must act to prevent disease. We need to understand, for example, that there are several major, but controllable risk factors. These include smoking and being overweight or obese."
The good news about tobacco use is that, compared with 1965 when 42.3 percent of the U.S. population over 18 were smokers, in 1994 only 25.5 percent smoked. The number of smokers increased only 0.4 percent from 1990 to 1994.
Based on 1988-94 studies reported in the 1998 Heart and Stroke Statistical Update, 65.7 million Americans exceed the healthy weight range defined by U.S. dietary guidelines, a 43 percent increase over figures compiled for 1960-62. One reason may be that 33 percent of overweight men and 41 percent of overweight women reportedly are not physically active during their leisure time.
Overweight is defined by the U.S. Dietary Guidelines for Americans as having a body mass index of 25.0 to 29.9. Body mass index is measured by the ratio of weight to height. Obesity, defined by the World Health Organization, is a body mass index of 30 or greater.
In the United States in 1988-94 among ethnic groups ages 20-74, these were the percentages of men who were overweight: Mexican-Americans, 44 percent; non-Hispanic whites, 39.6 percent; and non-Hispanic blacks, 36.2 percent. These were the percentages of overweight women: Mexican-Americans, 33.4 percent; non-Hispanic blacks, 29.2 percent; and non-Hispanic whites, 23 percent.
Among the same ethnic groups, these were the percentages of women classified as obese: non-Hispanic blacks, 37.4 percent; Mexican-Americans, 34.2 percent; and non-Hispanic whites, 22.4 percent. For men the statistics for obesity were: Mexican-Americans, 23.1 percent; non-Hispanic blacks, 21.3 percent; and non-Hispanic whites, 20 percent.
"Being overweight is serious," Hill says. "Overweight or obese people are more likely to develop heart disease and stroke even if they have no other risk factors. Excess weight is also linked to coronary heart disease mainly because it influences blood pressure and blood cholesterol and can lead to diabetes."
High blood cholesterol is another major risk factor for cardiovascular disease, the American Heart Association reports.
About 96.8 million American adults, or 51 percent of the population, have blood cholesterol levels of 200 milligrams per deciliter (mg/dL) and higher. A reading of 200-239 mg/dL is considered borderline high. Of this group, 37.7 million American adults (about 20 percent) have levels of 240 mg/dL. Readings of 240 and above are considered high.
"The important point is that for adults, cholesterol levels over 200 are potentially dangerous," Hill says. "The good news is that people can take lifestyle-related actions to lower their levels of cholesterol - actions such as becoming physically active and eating a diet low in saturated fat and cholesterol. Medical treatments, primarily cholesterol-lowering drugs, are also available."
The 1998 Heart and Stroke Statistical Update includes a section to tie in with the AHA's effort to alert women of the dangers of heart disease and stroke. It reports that in the United States since 1984 more women have died each year of cardiovascular disease than men. Final mortality data for 1995 shows that the death rate per 100,000 persons for breast cancer - the disease women fear most - was 27.5 for black females and 20.5 percent for white females. The death rate per 100,000 persons for coronary heart disease was 81.6 for black females and 60.3 for white females.
The above post is reprinted from materials provided by American Heart Association. Note: Content may be edited for style and length.
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