1. From a cross-sectional survey, four in five Americans ages 45 to 79 had exposure to at least one cardiovascular disease (CVD) risk factor.
2. From a calculated estimate, five of the major CVD risk factors were associated with about half of all preventable deaths.
Evidence Rating Level: 3 (Average)
Study Rundown: CVDs, such as heart disease and stroke, represent many of the leading causes of death in the United States. Using national survey data on over a half-million Americans, the goal of this study was to understand how such deaths were associated with leading CVD risk factors. These included elevated cholesterol, diabetes, hypertension, obesity and smoking. Nationally, four out of five people had been exposed to at least one CVD risk factor. Hypertension and elevated cholesterol were the two most prevalent risk factors, with nearly one in two people suffering from each of these conditions. It was found that about half of all deaths in the United States could be prevented if these five risk factors were completely eliminated in all states. Smoking and hypertension were the two risk factors associated with the largest percent of preventable deaths in men and women. Because complete elimination is challenging, the authors also determined how many deaths could be prevented if all states reduced risk factors to that of the best performing states. Hypertension and smoking, again, represented the largest fraction of preventable deaths by this metric, though the percent of deaths that would be avoided were about one tenth that of complete elimination. The study is strengthened by its use of another large cross-sectional study to correct for bias in self-reported data collection, though it is limited by the cross-sectional study design.
In-Depth [cross-sectional study]: This study evaluated self-reported risk factor data from 533 306 Americans ages 45 to 79 in the Behavioral Risk Factor Surveillance System (BRFSS). The prevalences for men and women, respectively, were 46.7% and 46.2% for elevated cholesterol, 17.9% and 14.5% for diabetes, 46.6% and 45.1% for hypertension, 37.1% and 38.4% for obesity, and 24.8% and 17.6% for current smoking. For men and women, respectively, the percent of preventable mortality with the complete elimination of all risk factors collectively was 54.0% and 49.6%, for elevated cholesterol 15.9% and -1.2% (negative value = increased mortality), for diabetes 7.2% and 13.0%, for hypertension 30.4% and 38.0%, for obesity 12.0% and 7.4%, and for current smoking 36.4% and 17.4%. Western states most often achieved the lowest prevalence, while the Southern and Midwestern states often had the highest prevalence for these risk factors. High cholesterol did not show a regional distribution, whereas diabetes and hypertension were highest in the South and Midwest.
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