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Cardiovascular Disease

Cardiovascular disease (CVD) is a term that encompasses a variety of diseases and conditions affecting the heart and blood vessels, many of which are related to a process called atherosclerosis. Atherosclerosis is a condition that develops when a substance called plaque builds up in the arteries. This buildup narrows the arteries and makes it harder for blood to flow through them. When an artery becomes blocked by a clot, it can cause a heart attack or stroke.

The most common forms of cardiovascular disease are coronary heart disease, heart attack and stroke.
  • Coronary heart disease or coronary artery disease is caused by atherosclerosis. When the blockage in the artery reaches the point where it causes chest pain or discomfort, it is called angina. Angina is chest pain or discomfort that occurs when the heart doesn't get as much blood and oxygen as it needs to function. Angina symptoms arise when the need for increased blood flow isn't met and they go away when the demand for blood flow goes away. Angina and heart attack are both caused by atherosclerosis, and they have the same symptoms, but angina symptoms usually only last for a few minutes.
  • A heart attack occurs when the blood flow to a part of the heart is blocked by a clot. If the blood flow is cut off completely, then the part of the heart muscle supplied by that artery begins to die. Symptoms include: uncomfortable pressure, squeezing fullness or pain in the chest; pain or discomfort in one or both arms, the back, neck, jaw or stomach; shortness of breath; and other signs like breaking out in a cold sweat, nausea or lightheadedness.
  • The most common type of stroke is an ischemic stroke. Ischemic strokes occur when a blood vessel leading to the brain is blocked by a clot. A hemorrhagic stroke, the second most common, occurs when a blood vessel within the brain bursts. Hemorrhagic stroke is most often caused by uncontrolled hypertension (high blood pressure). Stroke symptoms come on suddenly and include: numbness or weakness of the face, arm or leg, especially on one side of the body; confusion, trouble speaking or understanding; trouble seeing in one or both eyes; trouble walking, dizziness, loss of balance or coordination, and severe headache with no known cause.

Cardiovascular disease is the leading cause of death for both men and women in the United States and in Hawai'i. About 630,000 Americans die from heart disease each year - or 1 in every 4 deaths. Coronary heart disease is the most common type of heart disease, killing about 366,000 people in 2015. When considered separately, stroke is the fifth leading cause of death and the leading cause of disability in the United States.

In Hawai'i heart disease and stroke are responsible for almost 4,000 deaths each year and over 18,000 hospitalizations, which account for about 22% of all hospital costs in the state.

Roughly 33,000 Hawai'i adults (2.6%) have been diagnosed with coronary heart disease. Men are more likely to be diagnosed than women (3.5% vs 1.8%), and coronary heart disease prevalence increases significantly by age, from 0.6% among 25-34 year olds, to 9.5% among those 75 years and older. Other Pacific Islanders (5.1%) are significantly more likely to have been diagnosed with coronary heart disease than Chinese (1.6%), Japanese (2.1%) or Caucasian (2.5%) adults.

Similarly, 34,800 Hawai'i adults (2.8%) report having a doctor-diagnosed heart attack. Men are twice as likely as women to experience a heart attack (3.8% vs 1.9%) and Hawai'i County residents (4.1%) are significantly more likely to have had a heart attack than residents of Kauai (2.3%) or Honolulu (2.4%). Heart attack prevalence ranges by age from 0.6% among those 25-34 years old to 8.9% among those 75 years or older. By race/ethnicity, 6.1% of Other Pacific Islanders and 4.8% of Native Hawaiians have experienced a heart attack compared to 1.7% of Japanese and 1.9% of Filipinos.

About 31,800 Hawai'i adults (2.6%) report having a doctor-diagnosed stroke. Men and women are equally likely to have experienced a stroke, but Hawai'i County residents (3.0%) have significantly higher stroke prevalence than Maui County residents (1.4%). Stroke prevalence ranges from 1.1% among those 35-44 years to 9.3% among those 75 years or older. Other Pacific Islanders (5.3%) and Native Hawaiians (4.0%) have the highest stroke prevalence by race/ethnicity.

Note: Statistics based on 2015-2017 BRFSS age-adjusted data for state, county, sex and race-ethnicity and crude data for age.

Major risk factors that can't be changed

  • Age: About 80% of people who die of coronary heart disease are 65 or older.
  • Sex: While heart disease is the number one killer of both men and women, men have a greater risk of heart attack earlier in life.
  • Heredity: Children of parents with heart disease are more likely to develop it themselves.

Major risk factors that can be changed or controlled

  • Tobacco smoke: Smoking dramatically increases CVD risk among smokers and secondhand smoke increases CVD risk among non-smokers.
  • High blood pressure: Blood pressure is the force the blood exerts on the walls of the arteries when pumping through the body. High blood pressure can cause the arteries to thicken and stiffen, increasing the heart's workload.
  • High blood cholesterol: Cholesterol is a waxy, fat-like substance that can build up in the arteries and lead to heart disease and stroke. Some cholesterol is "good" and some is "bad." High cholesterol is the term used for high levels of low-density lipoprotein (LDL) which can lead to heart disease. People with high cholesterol have about twice the risk of heart disease as people with lower levels. Conversely, a higher level of high-density lipoprotein cholesterol (HDL) is considered "good" because it provides some protection against heart disease.
  • Obesity: Obesity has been linked to high cholesterol levels, high blood pressure and diabetes. Additionally, people with a larger waist circumference (greater than 35 inches for women and greater than 40 inches for men) have a higher risk of heart disease.
  • Diabetes: Diabetes causes sugars to build up in the blood. People with diabetes are about twice as likely to have heart disease as those without diabetes.
  • Physical inactivity: Not getting enough physical activity increases CVD risk along with other risk factors such as obesity, high blood pressure, high cholesterol and diabetes.

Other risk factors to consider

  • Unhealthy diet: Diets that are high in saturated fats, trans fats and cholesterol have been linked to CVD and too much salt (sodium) can raise blood pressure levels.
  • Alcohol consumption: Drinking too much alcohol can raise blood pressure and triglycerides (form of cholesterol) which can harden your arteries.

High blood pressure, high LDL cholesterol and smoking are key risk factors for heart disease and about half of Americans (49%) have at least one of these three risk factors.

There are steps that each person can take to reduce their risk of CVD.
  • Tobacco smoke: If you smoke, quit. Even long-time smokers can see rapid health improvements when they quit. Heart attack risk drops dramatically within a year and stroke risk is nearly that of a non-smoker within five years. If you do not smoke, avoid exposure to secondhand smoke.
  • High blood pressure: Control your blood pressure through diet, exercise and medication. Managing high blood pressure decreases CVD risk.
  • High blood cholesterol: Lowering your cholesterol can reduce your risk of having a heart attack, needing heart bypass surgery or angioplasty or dying of heart disease.
  • Physical inactivity: Increasing physical activity reduces CVD risk along with other risk factors such as obesity, high blood pressure, high cholesterol and diabetes.
  • Obesity: Obesity has been linked to high cholesterol levels, high blood pressure and diabetes. Talk to your health care team about a plan to reduce your weight to a healthy level.
  • Diabetes: Talk to your doctor about ways to manage your diabetes and control other risk factors.
  • Physical inactivity: Increasing physical activity to at least 30 minutes of moderate physical activity per day on five days a week reduces CVD risk along with other risk factors such as obesity, high blood pressure, high cholesterol and diabetes.
  • Unhealthy diet: Strive to eat a healthy diet of minimally processed food that includes a variety of fruits and vegetables, whole grains, lean meat and dairy, fish, nuts and legumes.
  • Alcohol consumption: Those who drink should limit their alcohol consumption to no more than 2 drinks per day among men and 1 drink per day among women.

Cardiovascular disease data come from several sources:
  • Screening and Prevalence: The Behavioral Risk Factor Surveillance System (BRFSS) monitors preventive screening for a variety of cardiovascular disease risk and protective factors including high blood pressure, high cholesterol, diabetes, cigarette smoking and exercise. The BRFSS also tracks the prevalence of coronary artery disease, heart attack and stroke.
  • Morbidity: Hospital discharge data monitors inpatient and emergency room visits for cardiovascular disease and related conditions.
  • Mortality: Death certificates are a fundamental source of demographic, geographic, and cause-of-death information. They make it possible to track every death in the nation due to cardiovascular disease. Deaths are reported as being due to cardiovascular disease when cardiovascular disease was the underlying cause of death.

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