Some good news in the fight against heart disease with new figures released this week, showing deaths from coronary heart disease (CHD) in the US on the decline, albeit that they were somewhat uneven amongst different states and ethnic groups.

The Centre for Disease Control (CDC) figures show the rates have been in steady decline since the 1960s and researchers believe this is due to multiple factors including :

  • Greater Control of Risk Factors
  • Declining incidence of CHD
  • Improved Treatment

It stands to reason that mortality rates from CHD will decline if treatment is improved and those suffering from the disease are able to live out their lives. Greater control of risk factors such as smoking and poor diet are also improved in the last few decades through better public awareness and public health campaigns. Other factors that have contributed include medications and awareness of high blood pressure and high cholesterol

However, it must be noted that Heart Disease still remains the nation’s leading killer with as many falling to CHD as cancer, lower respiratory diseases (including pneumonia), and accidents combined. These kinds of facts makes the Million Hearts National Initiative one of the most important public health campaigns and CDC Director Thomas R. Frieden, M.D., M.P.H . said :

“Where you live and how you live matters to your heart ….. The Million Hearts national initiative, which can prevent 1 million heart attacks and strokes over the next five years, focuses on actions people can take themselves and actions that businesses, communities and health providers can take to prevent heart attacks and strokes today.”

The CDC also set out to analyze state specific prevalence and trends by age, sex, race/ethnicity and education using data from Behavioral Risk Factor Surveillance System (BRFSS) surveys for the period 2006–2010. This report compiles the results of that analysis, which determined that, although self-reported CHD prevalence declined overall, substantial differences in prevalence existed by age, sex, race/ethnicity, education, and state of residence.

The aim of the report is to allow individual states and national health agencies to monitor CHD and measure their progress towards meeting the Healthy People 2020 objective to reduce the U.S. rate of CHD deaths 20% from the 2007 baseline.

BRFSS is a state-based, random-digit–dialed telephone survey of the U.S. civilian, non-institutionalized population aged ≥18 years. The survey is administered in all 50 states, the District of Columbia (DC), and the U.S. territories of Guam, Puerto Rico, and the U.S. Virgin Islands. Since 2005, BRFSS has included two questions related to coronary heart disease: “Has a doctor, nurse, or other health professional ever told you that you had angina or coronary heart disease?” and “Has a doctor, nurse, or other health professional ever told you that you had a heart attack, also called a myocardial infarction?” Participants who answered “yes” to either of the questions were defined as having self-reported CHD. Those who answered “no” to both questions were defined as not having CHD. Those who answered “don’t know,” refused to answer the questions, or for whom responses were missing were excluded.

The number of BRFSS respondents ranged from 347,790 in 2006 to 444,927 in 2010 for all states. Sample sizes for states (including DC) ranged from 1,964 in Alaska in 2010 to 39,549 in Florida in 2007. Median BRFSS response rate during 2006–2010 was 52.3%. From 2006 to 2010, age-adjusted CHD prevalence in the United States declined overall from 6.7% to 6.0%. Similar declines were observed across age group, sex, and education categories. Among racial/ethnic populations, declines from 2006 to 2010 were observed among whites (6.4% to 5.8%) and Hispanics (6.9% to 6.1%)

Table 1

Mortality Rates in Summary for 2010 :


19.8% CHD in persons over 65

7.1% persons aged 45 to 65

1.2% persons aged 18 to 44


7.8% in males

4.6% in females


9.2% those that failed to finish high school

6.7% high school graduates

6.2% those who attended some college

4.6% those with a college degree


11.6% – American Indians/Alaska Natives

6.5% – Black

6.1% – Hispanics

5.8% – Whites

3.9% – Asians or Native Hawaiians/Other Pacific Islanders

RACE AND SEX (highest prevalence)

14.3% – Male & American Indian/Alaska Natives

7.7% – Male & White

8.4% – Female & American Indian/Alaska Natives

5.9% – Female & Black

By state, from 2006 to 2010, the greatest statistically significant linear declines in age-adjusted CHD prevalence were 23.1% in West Virginia (from 10.4% to 8.0%) and 22.1% in Missouri (from 7.7% to 6.0%)

Table 2

Unfortunately Five states showed an increase in CHD prevalence from 2006 to 2010 but none of the five showed a statistically significant linear increase. In 2010, CHD prevalence ranged from 3.7% in Hawaii and 3.8% in DC to 8.0% in West Virginia and 8.2% in Kentucky, with the greatest regional prevalence generally observed in the South.

Mortality Rates by State Diagram

Written by Rupert Shepherd B.Sc