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Cardiovascular disease burden traced to race and geography

heart-665091_1920Cardiovascular disease is increasingly common in the southern United States, a trend that is related to economic conditions, access to health care and race, according to an editorial published yesterday in Circulation.

Overall the rates of cardiovascular disease (a broad term that includes conditions such as coronary heart disease and heart failure) is declining, with the death rate dropping nearly 29 percent between 2003 and 2013. But the general statistics hide some worrying trends, writes Donald Barr, MD, PhD, a professor of pediatrics and a health policy associate.

For example, in 2012, the prevalence of heart failure in black men was 27 percent higher than in white men; in black women it was 45 percent higher than in white women. Heart failure is concentrated in the southern U.S., with the highest death rates in Mississippi, Oklahoma and Arkansas. Risk factors for heart failure — such as diabetes and obesity — are also disproportionately found in the south.

Broader social factors are driving these trends, Barr says. He emailed me an explanation:

The last several decades have seen a fundamental shift in the pattern of heart disease in the United States. Once principally an issue of heart attacks associated with high rates of smoking and high cholesterol levels, heart disease is increasingly becoming an issue of heart failure – a weakening of the heart's pumping capacity – associated with high rates of obesity, diabetes, and high blood pressure.

This shift has been seen geographically, with the highest concentration of heart disease shifting from states in the northeast to states in the southeast. It also reflects demographic shifts, with heart failure disproportionately impacting two groups: those with low-income, and African Americans. Perhaps not surprisingly, these demographic groups are found disproportionately in southeastern states.

These demographic shifts are here to stay, Barr says:

The predicted rise in the prevalence of heart failure will affect these groups even more in coming years, and presents a fundamental issue of population health policy that must be confronted by leaders within this field.

More information about these trends can be found in a 2015 American Heart Association Scientific Statement.

Previously: The impact of economic inequality on health care and health status in the U.S., Stanford conference highlights gender differences in heart health and Stem cell study explains how mutation common in Asians affects heart health
Image by geralt

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