the risk of heart disease and stroke in alabama:
burden document
findinG the Path to
CardioVasCUlar health
2010
table of Contents
executive Summary................................................................................................................. 1
demographic characteristics of Alabama................................................................................. 2
Leading causes of death ......................................................................................................... 3
cardiovascular disease ........................................................................................................... 4
Heart disease ......................................................................................................................... 8
Stroke ................................................................................................................................... 11
cardiovascular risk Factors: High blood Pressure ................................................................. 14
cardiovascular risk Factors: High blood cholesterol.............................................................. 16
cardiovascular risk Factors: diabetes ................................................................................... 18
cardiovascular risk Factors: overweight and obesity............................................................. 20
cardiovascular risk Factors: Smoking ................................................................................... 22
cardiovascular risk Factors: Physical Inactivity ..................................................................... 24
cardiovascular risk Factors: Fruit and Vegetable consumption .............................................. 26
economic cost of cardiovascular disease .............................................................................. 28
Access to care ...................................................................................................................... 29
Signs and Symptoms of Heart Attack or Stroke ...................................................................... 32
Sodium consumption ............................................................................................................ 33
references ........................................................................................................................... 34
exeCUtiVe sUmmary
cardiovascular disease (cVd), which includes heart disease and stroke, is the leading cause of
death in the united States and in Alabama.
Heart disease, the most common form of cVd, is the single leading cause of death in Alabama.
In 2006, heart disease accounted for 12,583 (26.7 percent) deaths in the state. men continue
to have a higher age-adjusted heart disease mortality rate than women. coronary heart disease,
the most common type of heart disease, can result in a heart attack. Heart attacks may be
preventable by modifying risk factors.
brain attack, a cerebrovascular accident (cVA) also known as stroke, is the third leading cause of
death in Alabama, following heart disease and cancer. In 2006, strokes accounted for 2,740 (5.83
percent) deaths in the state. men are about 50 percent more likely to die from stroke than women,
and there are strong race/ethnic differences. blacks have significantly higher age-adjusted stroke
mortality rates when compared to whites. As with heart disease, cerebrovascular accidents can
be preventable by modifying risk factors.
modifiable risk factors for heart disease and stroke are as follows:
1. High blood pressure
2. High blood cholesterol
3. diabetes
4. overweight and obesity
5. Smoking
6. Physical inactivity
7. Inadequate fruit and vegetable consumption
compared to the nation, Alabama continues to have a high prevalence of these risk factors. the
following Alabama statistical data compiled in 2009 revealed that all these factors contributed to
an increase in cVd in the state.
• 27.2 percent of Alabama adults reported being affected by high blood pressure.
• 39.9 percent of Alabama adults were diagnosed with elevated blood cholesterol.
• Prevalence of diabetes in Alabamians is 12.2 percent—an increase of 74 percent
since 1998.
• currently, 68.1 percent of obese and overweight individuals in Alabama have multiple
risk factors that contribute to cVd.
• 22.5 percent of Alabama adults are smokers—doubling an individual’s risk for cVd.
• 31 percent of Alabama adults indicated they were physically inactive.
• only 20.6 percent of Alabama adults met recommended fruit and vegetable intake
requirements.
Focusing on prevention can help reduce deaths from heart disease and stroke by:
1. reducing risk factors
2. Increasing public awareness of warning signs and symptoms of heart attack and stroke
3. decreasing the time between the appearance of warning signs and symptoms and the
receipt of appropriate medical care
this report provides details about the burden of cVd by describing the mortality rates and risk
factors associated with heart disease and stroke.
findinG the Path to CardioVasCUlar health 2010
• 1
demoGraPhiCs
table 1: demoGraPhiC CharaCteristiCs of alabama, 2008
demographic Variable
AL (#)
AL (%)
u.S.
total PoPUlation
4,625,354
(x)
301,237,703
male
2,239,148
48.4
49.3%
Female
2,386,206
51.6
50.7%
37.3
(x)
36.7
under 5 years
304,772
6.6
6.9%
5-17 years
814,745
17.6
17.6%
18 years and over
3,505,837
75.8
75.5%
65 years and over
625,940
13.5
12.6%
one raCe
4,568,890
98.8
97.8%
White
3,254,119
70.4
74.3%
black or African-American
1,209,666
26.2
12.3%
American Indian or Alaska native
22,606
0.5
0.8%
Asian
44,778
1.0
4.4%
56,464
1.2
2.2%
Hispanic or Latino (of any race)
122,924
2.7
15.1%
civilian veterans (civilian population 18 years and over)
406,777
11.7
10.1%
Foreign born
132,599
2.9
12.5%
male, married, except separated (population 15 years and over)
956,012
54.1
52.2%
Female, married, except separated (population 15 years and over)
937,340
48.4
48.2%
Speak a language other than english at home (population 5 years and over)
180,916
4.2
19.6%
median aGe (years)
two or more raCes
(x) the value is not applicable or not available.
Source: united States census bureau, 2008
2
•
the risk of heart disease and stroke in alabama: bUrden doCUment
fiGUre 1: leadinG CaUses of death in alabama, 2006
heart
disease
26.7%
all other
CaUses
36.2%
stroke
5.8%
CanCer
21.1%
ChroniC lower
resPiratory disease 4.9%
aCCidents
5.3%
• cVd is the leading cause of death and disability in Alabama.
• Heart disease is the leading cause of death in Alabama and kills over
12,000 residents each year.
• Stroke is the third leading cause of death, killing nearly 3,000
Alabamians each year.
• 26.7 percent of the deaths in Alabama were due to heart disease and
5.8 percent were due to stroke in 2006.
Source: centers for disease control and Prevention (cdc) Wonder
findinG the Path to CardioVasCUlar health 2010
• 3
CardioVasCUlar disease
cVd refers to a wide variety of heart and blood vessel diseases, including ischemic heart disease, hypertension, stroke, and
rheumatic heart disease. cVd accounts for more deaths in Alabama than any other cause of death. Although cVd remains
the number one cause of death for Alabamians, many adults do not recognize the signs and symptoms of a heart attack or
stroke. most victims surviving a heart attack or stroke often require long-term, expensive medical treatment, and experience
a compromised quality of life. there are decreasing trends in mortality rates for cVd and stroke in Alabama. (Figure 2)
fiGUre 2: aGe-adjUsted mortality rates for CVd, heart disease, and stroke in alabama,
1999-2006
400
396.6
393.7
379.8
377.7
370.6
355.7
350
rate Per 100,000
300
303.0
299.5
289.7
285.7
280.9
269.3
349.3
264.5
250
330.9
254.0
200
150
100
71.5
71.5
66.1
69.5
2001
2002
year
64.9
63.1
60.9
2003
2004
2005
50
55.5
0
1999
2000
CVd
heart disease
Source: cdc Wonder
4
•
the risk of heart disease and stroke in alabama: bUrden doCUment
stroke
2006
cVd, a preventable disease, includes conditions of the heart, arteries, and veins that supply oxygen to vital life-sustaining
areas of the body like the brain, the heart, and other vital organs. If oxygen does not arrive, the tissue or organ will die. In
Alabama, as in the nation, cVd, including heart disease and stroke, is the leading cause of death. About one-third of adult
Americans have some form of cVd.
• In 2006, the age-adjusted death rate for Alabama was 330.9 per 100,000 population, a decrease from 396.6 in 1999.
• cVd age-adjusted death rates in Alabama exceeded the comparable rates for the united States over the past eight years.
(Figure 3)
fiGUre 3: aGe-adjUsted death rates for CVd in alabama and the United states, 1999-2006
400
350
396.6
350.8
393.7
341.4
379.8
328.2
377.7
319.0
370.6
355.7
349.3
330.9
307.7
300
288.0
278.9
rate Per 100,000
262.5
250
200
150
100
50
0
1999
2000
2001
alabama
2002
year
2003
2004
2005
2006
United states
Source: cdc Wonder
findinG the Path to CardioVasCUlar health 2010
• 5
fiGUre 4: CardioVasCUlar deaths by aGe GroUP in alabama, 2006
6000
5000
5,033
nUmber of deaths
4,733
4000
3000
2,749
2000
1,925
1000
1,256
682
0
<45
45-54
Source: cdc Wonder
55-64
65-74
aGe in years
75-84
85+
• Age is a non-modifiable risk factor for cVd. the number of cVd deaths increases significantly with age.
• deaths from cVd occurred often in those over the age of 75.
• nearly one out of four deaths from cVd occurred in those below the age of 65 in 2006. (Figure 4)
fiGUre 5: aGe-adjUsted death rates for CVd by Gender and raCe in alabama, 2006
600
rate Per 100,000
500
504.9
400
366.7
336.6
300
267.8
200
100
0
male
Gender
Source: cdc Wonder
female
blaCk
white
• In 2006, the age-adjusted death rate was highest among black males (504.9/100,000 population).
• males were at a higher risk of dying due to cVd than females in 2006.
• overall, blacks had a higher age-adjusted death rate compared to whites. (Figure 5)
6
•
the risk of heart disease and stroke in alabama: bUrden doCUment
fiGUre 6: CVd mortality rate in alabama by CoUnty, 2002-2006 Combined
384.0
LAUDERDALE
271.5
360.4
410.3
LIMESTONE
MADISON
COLBERT
303.2
392.1
LAWRENCE
MORGAN
FRANKLIN
415.5
344.9
388.1
398.6
MARION
WINSTON
JACKSON
DEKALB
MARSHALL
414.8
422.5
391.9
CHEROKEE
400.7
CULLMAN
323.6
ETOWAH
BLOUNT
461.0
347.8
LAMAR
352.1
WALKER
FAYETTE
354.6
TUSCALOOSA
PICKENS
377.9
BIBB
382.2
HALE
COOSA
420.2
CHILTON
426.9
419.1
PERRY
CHAMBERS
TALLAPOOSA
386.0
415.8
366.8
325.5
393.0
SUMTER
404.4
RANDOLPH
CLAY
313.7
GREENE
361.2
TALLADEGA
SHELBY
465.5
CLEBURNE
394.3
400.2
334.4
345.4
423.3
388.8
JEFFERSON
392.6
CALHOUN
ST. CLAIR
343.6
ELMORE
LEE
AUTAUGA
455.6
440.7
DALLAS
MARENGO
274.5
MACON
453.0
416.8
417.7
MONTGOMERY
311.7
LOWNDES
RUSSELL
BULLOCK
CHOCTAW
WILCOX
407.6
425.0
333.3
CLARKE
375.7
476.0
332.7
BUTLER
BARBOUR
PIKE
369.4 476.1
CRENSHAW
352.7
MONROE
HENRY
CONECUH
WASHINGTON
DALE
COFFEE
406.8
341.7
353.9
411.2
COVINGTON
ESCAMBIA
357.0
369.3
GENEVA
HOUSTON
356.7
321.0
372.4
MOBILE
BALDWIN
Age-Adjusted per 100,000
293.8
Source: cdc Wonder
cVd mortality rate
271.5 - 347.8
352.1 - 386.0
388.1 - 415.5
415.8 - 476.1
findinG the Path to CardioVasCUlar health 2010
• 7
heart disease
Heart disease is a grouping of various conditions of the heart including coronary heart disease, congestive heart failure, heart
attack, hypertension, and others. It is the leading cause of death for both men and women. more than 600,000 deaths occur
each year in the united States. It is the most common form of cVd and can cause angina (chest pain), myocardial infarction
(heart attacks), and cardiac arrest. many times, a heart attack is the first sign of heart disease.
• In 2006, the age-adjusted mortality rate for heart disease was 254.0 per 100,000 population in Alabama and 200.2 per
100,000 population in the united States.
• Heart disease death rates in Alabama have shown to be consistently higher than the united States heart disease death rates
since 1999. (Figure 7)
fiGUre 7: aGe-adjUsted death rates for heart disease in alabama and the United states, 1999-2006
300
303.0
266.4
299.5
257.6
rate Per 100,000
250
289.7
285.7
280.9
269.3
247.8
240.8
264.5
254
232.3
217.0
211.1
2004
2005
200
200.2
150
100
50
0
1999
2000
2001
2002
2003
year
Source: cdc Wonder
8
•
alabama
the risk of heart disease and stroke in alabama: bUrden doCUment
United states
2006
fiGUre 8: heart disease deaths by aGe GroUP in alabama, 2006
4000
nUmber of deaths
3,558
3000
2000
2,100
1,545
1000
998
0
558
<45
45-54
Source: cdc Wonder
•
•
•
•
3,824
55-64
65-74
75-84
85+
aGe in years
deaths from heart disease increase with age.
A total of 12,583 people died from heart disease in Alabama during 2006.
twenty-five percent of the deaths occurred in those below the age of 65.
the majority of deaths from heart disease occur in individuals 75 years of age and older. (Figure 8)
fiGUre 9: aGe-adjUsted death rates for heart disease by Gender and raCe
in alabama, 2006
400
357.3
rate Per 100,000
300
299.1
237.9
200
203.5
100
0
male
Source: cdc Wonder
Gender
female
blaCk
white
• In 2006, the age-adjusted mortality rate for heart disease was highest among black males with a rate
of 357.3 per 100,000 population.
• risk of death from heart disease was higher among males compared to females.
• risk of death from heart disease was slightly higher among blacks compared to whites. (Figure 9)
findinG the Path to CardioVasCUlar health 2010
• 9
fiGUre 10: heart disease mortality rate in alabama by CoUnty, 2002-2006 Combined
289.6
LAUDERDALE
197.9
289.1
335.4
LIMESTONE
MADISON
COLBERT
226.8
303.6
LAWRENCE
MORGAN
FRANKLIN
320.5
277.9
313.4
333.3
MARION
WINSTON
JACKSON
DEKALB
MARSHALL
345.1
340.2
310.8
CHEROKEE
317.1
CULLMAN
254.8
ETOWAH
BLOUNT
389.6
256.4
LAMAR
286.1
WALKER
FAYETTE
277.0
247.2
PICKENS
306.8
BIBB
298.2
HALE
COOSA
253.3
CHILTON
338.7
291.9
PERRY
TALLAPOOSA
297.5
CHAMBERS
273.7
261.3
301.0
SUMTER
296.1
RANDOLPH
CLAY
233.1
GREENE
276.9
TALLADEGA
SHELBY
392.5
CLEBURNE
294.1
309.4
238.4
TUSCALOOSA
337.8
303.3
JEFFERSON
302.9
CALHOUN
ST. CLAIR
306.7
254.1
ELMORE
LEE
AUTAUGA
351.1
348.0
DALLAS
MARENGO
197.3
MACON
377.2
334.1
323.1
MONTGOMERY
233.0
LOWNDES
RUSSELL
BULLOCK
CHOCTAW
WILCOX
303.3
337.4
231.7
CLARKE
281.5
388.1
258.2
BUTLER
BARBOUR
PIKE
284.7 393.4
CRENSHAW
263.1
MONROE
HENRY
CONECUH
WASHINGTON
DALE
COFFEE
316.9
272.9
281.2
252.8
COVINGTON
ESCAMBIA
261.5
283.5
GENEVA
277.3
HOUSTON
206.6
278.4
MOBILE
BALDWIN
Age-Adjusted per 100,000
224.8
Source: cdc Wonder
10
•
the risk of heart disease and stroke in alabama: bUrden doCUment
Heart disease mortality rate
197.3 - 261.3
261.5 - 291.9
294.1 - 323.1
333.3 - 393.4
stroke
A brain attack, more commonly known as a stroke, and medically called a cerebrovascular accident (cVA), is the third leading
cause of death in Alabama, following only heart disease and cancer. A brain attack is the early phase or first few hours of a
stroke. these hours are a critical time when doctors can attempt to stop and even reverse the effects that lead to disability.
A stroke occurs when a blood vessel in or near the brain is blocked or bursts, interrupting the flow of blood to the brain. this
causes a lack of oxygen which leads to brain cells dying. there are two primary types of stroke: ischemic and hemorrhagic.
Ischemic stroke, the most common cause, occurs when there is a blockage of a blood vessel that is supplying the brain. A
hemorrhagic stroke occurs when a blood vessel ruptures or leaks in or around the brain.
• the stroke mortality rate declined over the past few years in Alabama. the stroke mortality rate in the united States had
been declining over the past few years.
• Age-adjusted mortality rates were 55.5 per 100,000 population for Alabama and 43.6 per 100,000 population in the united
States. (Figure 11)
fiGUre 11: aGe-adjUsted death rates for stroke in alabama and United states, 1999-2006
80
70
60
71.5
71.5
69.5
66.1
61.6
64.9
63.1
60.9
60.9
57.9
56.2
55.5
53.5
50.0
rate Per 100,000
50
46.6
43.6
40
30
20
10
0
1999
2000
2001
alabama
2002
year
2003
2004
2005
2006
United states
Source: cdc Wonder
findinG the Path to CardioVasCUlar health 2010
• 11
fiGUre 12: stroke deaths by aGe GroUP in alabama, 2006
1000
922
879
nUmber of deaths
800
600
441
400
252
200
168
0
78
<45
45-54
Source: cdc Wonder
55-64
65-74
aGe in years
75-84
85+
• deaths from stroke occurred more often in those over age 65.
• 2,740 deaths occurred from stroke in 2006. (Figure 12)
fiGUre 13: aGe-adjUsted death rates for stroke by Gender and raCe in alabama, 2006
100
97.2
rate Per 100,000
80
68.7
60
49.0
48.7
40
20
0
male
Source: cdc Wonder
Gender
female
blaCk
white
• In 2006, black males showed the highest stroke death rate of 97.2 per 100,000 population followed
by black females with the rate of 68.7 per 100,000 population.
• the stroke death rate between white males and white females showed no significant difference.
• For stroke, race is a better predictor of death than gender, with the black race being at higher risk
than whites. (Figure 13)
12 •
12
the risk of heart disease and stroke in alabama: bUrden doCUment
fiGUre 14: stroke mortality rate in alabama by CoUnty, 2002-2006 Combined
66.4
LAUDERDALE
60.3
52.9
60.0
LIMESTONE
MADISON
COLBERT
54.9
71.5
LAWRENCE
MORGAN
FRANKLIN
79.3
51.0
58.6
46.6
MARION
WINSTON
JACKSON
DEKALB
MARSHALL
51.1
67.5
65.3
CHEROKEE
66.9
CULLMAN
59.0
ETOWAH
BLOUNT
54.2
69.1
LAMAR
48.5
WALKER
FAYETTE
63.5
TUSCALOOSA
PICKENS
RANDOLPH
CLAY
55.4
60.8
BIBB
GREENE
60.4
HALE
141.7
COOSA
CHAMBERS
92.5
59.6
47.3
67.0
SUMTER
TALLAPOOSA
60.5
CHILTON
64.9
104.2
PERRY
76.7
62.1
TALLADEGA
SHELBY
54.0
CLEBURNE
59.0
74.3
72.1
67.9
63.7
66.5
JEFFERSON
62.7
CALHOUN
ST. CLAIR
69.3
ELMORE
LEE
AUTAUGA
77.2
70.9
DALLAS
MARENGO
58.3
MACON
57.8
55.6
64.4
MONTGOMERY
56.0
LOWNDES
RUSSELL
BULLOCK
CHOCTAW
87.3
WILCOX
70.1
77.6
CLARKE
72.5
69.3
58.5
BUTLER
BARBOUR
PIKE
68.1
58.6
CRENSHAW
57.9
MONROE
HENRY
CONECUH
WASHINGTON
COFFEE
78.4
51.9
DALE
46.2
97.1
COVINGTON
ESCAMBIA
58.7
70.2
GENEVA
HOUSTON
58.5
47.0
61.2
MOBILE
BALDWIN
Age-Adjusted per 100,000
48.0
Source: cdc Wonder
Stroke mortality rate
46.2 - 57.8
57.9 - 62.1
62.7 - 70.1
70.2 - 141.7
findinG the Path to CardioVasCUlar health 2010
• 13
CardioVasCUlar risk faCtors: hiGh blood PressUre
High blood pressure or hypertension is common in the united States, with at least one in three individuals being at risk of
developing it. there are often no symptoms to signal high blood pressure. Lowering blood pressure by changes in lifestyle and/
or by medication can lower the risk of heart disease and heart attack.
fiGUre 15: PreValenCe of rePorted hiGh blood PressUre in alabama and the United
states, 1995-2009
40
37.2
31.2
30
PerCent
33.1
31.2
28.9
24.8
20
31.6
23.0
24.0
25.6
24.8
25.5
1999
2001
year
2003
2005
33.1
27.5
28.6
22.2
10
0
1995
1997
alabama
2007
2009
United states
Source: Alabama behavior risk Factor Surveillance System (brFSS)
• the prevalence of high blood pressure in Alabama has continually increased since 1995 from 24.8 percent to 37.2 percent
in 2009. the prevalence has consistently remained above the national average in Alabama.
• over 37 percent of adults in Alabama reported having high blood pressure in 2009. (Figure 15)
fiGUre 16: PreValenCe of rePorted hiGh blood PressUre in alabama by Gender, aGe, and raCe, 2009
80
64.9%
PerCent
60
52.7%
40
37.2%
37.7%
40.8%
35.3%
36.6%
43.1%
26.2%
20
13.1%
0
8.7%
oVerall male female
18-24
25-34
35-44
45-54
55-64
65+
Source: Alabama brFSS
• males had a similar prevalence of high blood pressure when compared to females in Alabama.
• there was a significant increase of reported high blood pressure with increasing age.
• blacks had a higher prevalence of high blood pressure than whites. (Figure 16)
14
•
the risk of heart disease and stroke in alabama: bUrden doCUment
white blaCk
fiGUre 17: PerCentaGe of adUlts with hiGh blood PressUre (hyPertension) in alabama by PUbliC
health area, 2009
area
2
LAUDERDALE
area
LIMESTONE
1
COLBERT
LAWRENCE
34%
MADISON
MORGAN
FRANKLIN
45%
DEKALB
MARSHALL
WINSTON
MARION
JACKSON
area
5
CHEROKEE
CULLMAN
ETOWAH
BLOUNT
WALKER
LAMAR
41%
area
FAYETTE
CALHOUN
ST. CLAIR
4
CLEBURNE
JEFFERSON
38%
TUSCALOOSA
PICKENS
37%
area
6
TALLADEGA
area
RANDOLPH
CLAY
SHELBY
3
39%
BIBB
COOSA
GREENE
TALLAPOOSA
CHILTON
CHAMBERS
HALE
PERRY
SUMTER
area
7
47%
ELMORE
AUTAUGA
MARENGO
31%
MONTGOMERY
DALLAS
LEE
MACON
8
LOWNDES
RUSSELL
area
BULLOCK
CHOCTAW
WILCOX
BARBOUR
PIKE
BUTLER
CLARKE
CRENSHAW
MONROE
area
9
WASHINGTON
CONECUH
38%
COFFEE
COVINGTON
ESCAMBIA
34%
41%
area
HENRY
DALE
10
GENEVA
HOUSTON
MOBILE
area
11
BALDWIN
Source: Alabama brFSS
findinG the Path to CardioVasCUlar health 2010
15
• 15
CardioVasCUlar risk faCtors: hiGh blood Cholesterol
cholesterol is a waxy, fat-like substance that occurs naturally in all parts of the body. the body needs some cholesterol to work
properly, but too much in your blood can stick to the walls of the arteries causing problems with the circulation of blood. this is
called plaque. Plaque can narrow the arteries or even block them. High levels of cholesterol in the blood can increase the risk
of heart disease. to travel in the bloodstream, cholesterol is carried in small packages called lipoproteins. there are two types
of cholesterol in the body, low-density lipoprotein (LdL), sometimes called bad cholesterol, and high-density lipoprotein (HdL),
sometimes called good cholesterol.
fiGUre 18: PreValenCe of rePorted hiGh blood Cholesterol in alabama and the United
states, 1995-2009
40
38.3
36.0
30
27.3
28.8
28.1
28.0
1995
1997
33.2
32.9
30.1
30.3
35.6
33.1
39.4
39.9
37.5
37.5
2007
2009
PerCent
20
10
0
1999
Source: Alabama brFSS
2001
year
alabama
2003
2005
United states
• In 2009, 39.9 percent of Alabama adults reported they were diagnosed with high blood cholesterol, while only 37.5 percent
of the united States reported they were diagnosed with high blood cholesterol.
• In the past seven years, both the united States and Alabama have shown an increase in numbers of those diagnosed with
high blood cholesterol. (Figure 18)
fiGUre 19: PreValenCe of rePorted hiGh blood Cholesterol in alabama by Gender, aGe, and raCe, 2009
80
PerCent
60
52.7%
40
39.9%
40.6%
52.8%
40.7%
40.9%
38.6%
34.5%
30.0%
20
0
oVerall male female
Source: Alabama brFSS
19.9%
8.2%
18-24
25-34
35-44
45-54
55-64
65+
white blaCk
• males had similar rates compared to females for high blood cholesterol in Alabama.
• the high blood cholesterol rate increased with increasing age up until about age 55 and then levels off.
• Among the race and ethnic groups, whites reported having the highest rate of 40.7 percent. (Figure 19)
16 •
16
the risk of heart disease and stroke in alabama: bUrden doCUment
fiGUre 20: PerCentaGe of adUlts with hiGh Cholesterol in alabama by PUbliC health area, 2007
area
2
LAUDERDALE
area
LIMESTONE
1
COLBERT
LAWRENCE
39%
MARION
JACKSON
MORGAN
FRANKLIN
45%
MADISON
DEKALB
MARSHALL
WINSTON
area
5
CHEROKEE
CULLMAN
ETOWAH
BLOUNT
WALKER
LAMAR
CALHOUN
ST. CLAIR
4
44%
CLEBURNE
JEFFERSON
37%
area
6
TALLADEGA
TUSCALOOSA
PICKENS
44%
area
FAYETTE
area
RANDOLPH
CLAY
SHELBY
3
41%
BIBB
COOSA
GREENE
TALLAPOOSA
CHILTON
CHAMBERS
HALE
PERRY
ELMORE
SUMTER
LEE
AUTAUGA
area
7
MARENGO
MACON
MONTGOMERY
DALLAS
58%
RUSSELL
area
8
LOWNDES
36%
BULLOCK
CHOCTAW
WILCOX
BARBOUR
PIKE
BUTLER
CLARKE
CRENSHAW
MONROE
area
9
WASHINGTON
HENRY
CONECUH
36%
COFFEE
COVINGTON
ESCAMBIA
36%
44%
area
DALE
10
GENEVA
HOUSTON
MOBILE
area
11
BALDWIN
Source: Alabama brFSS
findinG the Path to CardioVasCUlar health 2010
• 17
CardioVasCUlar risk faCtors: diabetes
A person with diabetes has an automatic cardiovascular risk because they are at the same risk of heart attacks as people who
have already suffered a heart attack. diabetes is a disease in which the body does not produce or properly use insulin. there
are more than 25 million children and adults in the united States, which translates into 8.3 percent of the population, who
have diabetes. the cdc estimates that as many as 200,000 or more have the condition, but are unaware of it. there are two
major types of diabetes. type 1 diabetes results from the body’s failure to produce insulin, and type 2 diabetes results from
insulin resistance, a condition in which the body fails to properly use insulin, combined with relative insulin deficiency.
fiGUre 21: PreValenCe of adUlt-diaGnosed diabetes in alabama and the United states, 1998-2009
12
10
9.6
8.5
PerCent
8
7.0
7.4
7.4
6.1
6
5.4
5.4
1998
1999
6.4
9.9
9.7
6.7
8.7
8.1
7.1
7.3
7.5
2004
2005
2006
7.2
11.2
12.2
8.1
8.3
8.3
2007
2008
2009
10.3
4
2
2000
2001
Source: Alabama brFSS
2002
2003
year
alabama
United states
• the prevalence of self-reported doctor-diagnosed diabetes among adults in Alabama in 2009 was 12.2 percent, compared
to the united States with 8.3 percent of adults diagnosed with diabetes.
• the prevalence of diabetes in Alabama was consistently higher than in the united States from 1998 - 2009. (Figure 21)
fiGUre 22: PreValenCe of adUlts diaGnosed with diabetes in alabama by Gender, aGe, and raCe, 2009
20
22.5%
22.6%
PerCent
15
10
12.2%
14.1%
13%
12.7%
11.5%
11.2%
5
0
oVerall male female
Source: Alabama brFSS
6.6%
0.5%
2.5%
18-24
25-34
35-44
45-54
55-64
• the prevalence of adults diagnosed with diabetes was similar in males and females.
• there was a significant increase in the percentage of diabetes with an increase in age.
• the prevalence of diabetes was greater among blacks than whites. (Figure 22)
18
•
the risk of heart disease and stroke in alabama: bUrden doCUment
65+
white blaCk
fiGUre 23: PerCentaGe of adUlts with diabetes in alabama by PUbliC health area, 2009
area
2
LAUDERDALE
area
LIMESTONE
1
MADISON
LAWRENCE
MORGAN
FRANKLIN
16%
DEKALB
MARSHALL
WINSTON
MARION
JACKSON
12%
COLBERT
area
5
CHEROKEE
CULLMAN
ETOWAH
BLOUNT
WALKER
LAMAR
CALHOUN
ST. CLAIR
4
11%
CLEBURNE
JEFFERSON
10%
TUSCALOOSA
PICKENS
13%
area
FAYETTE
6
RANDOLPH
CLAY
SHELBY
area
area
TALLADEGA
14%
3
BIBB
COOSA
GREENE
TALLAPOOSA
CHILTON
CHAMBERS
HALE
PERRY
ELMORE
SUMTER
LEE
AUTAUGA
area
7
MARENGO
CHOCTAW
MACON
MONTGOMERY
DALLAS
17%
RUSSELL
area
8
LOWNDES
11%
BULLOCK
WILCOX
BARBOUR
PIKE
BUTLER
CLARKE
CRENSHAW
MONROE
area
9
WASHINGTON
15%
HENRY
CONECUH
11%
COFFEE
COVINGTON
ESCAMBIA
11%
area
DALE
10
GENEVA
HOUSTON
MOBILE
area
11
BALDWIN
Source: Alabama brFSS
findinG the Path to CardioVasCUlar health 2010
• 19
CardioVasCUlar risk faCtors: oVerweiGht and obesity
overweight and obesity are two common factors contributing to the risk of heart disease and stroke. overweight is defined as a
body mass index (bmI) of 25.0 - 29.9 kg/m2 and obesity is a bmI greater than 30.0 kg/m2. overweight and obese individuals
are also more likely to have other risk factors for heart disease and stroke, including high blood pressure, high cholesterol,
high triglycerides, diabetes, and some types of cancer. Persons who are obese have medical costs that are $1,429 per year
higher than those of normal weight.
fiGUre 24: PreValenCe of oVerweiGht and obesity in alabama and the United states, 1998-2009
80
PerCent
60.8
59.6
60
64.5
65.0
66.6
67.9
68.1
64.6
60.7
61.7
62.7
63.2
59.2
59.5
60.1
61.1
61.6
63.0
63.2
62.1
2002
2003
year
2004
2005
2006
2007
2008
2009
54.6
56.6
56.8
58.3
1998
1999
2000
2001
40
20
0
United states
alabama
Source: Alabama brFSS
• the prevalence of overweight and obesity had increased significantly in Alabama from 1998 to 2009. the trend followed the
same pattern for the united States, with a slight decrease in 2009.
• In 2009, the prevalence of reported overweight and obesity was 6 percent higher in Alabama than the national average.
(Figure 24)
fiGUre 25: PreValenCe of oVerweiGht and obesity in alabama by Gender, aGe, and raCe, 2009
80
PerCent
60
68.2%
73.9%
70.4%
74.9%
74.2%
67.6%
64.5%
62.8%
40
74.7%
66.1%
45.5%
20
0
oVerall male female
Source: Alabama brFSS
18-24
25-34
35-44
45-54
55-64
65+
white blaCk
• the prevalence of overweight and obesity was higher in males than in females.
• overweight and obesity increased with age.
• blacks reported having a higher prevalence of being overweight and obese compared to whites in 2009. (Figure 25)
20
•
the risk of heart disease and stroke in alabama: bUrden doCUment
fiGUre 26: PerCentaGe of adUlts who are oVerweiGht or obese in alabama by PUbliC health area, 2009
area
LAUDERDALE
area
LIMESTONE
1
COLBERT
LAWRENCE
62%
2
MADISON
MORGAN
FRANKLIN
74%
DEKALB
MARSHALL
WINSTON
MARION
JACKSON
area
5
CHEROKEE
CULLMAN
ETOWAH
BLOUNT
WALKER
LAMAR
CALHOUN
ST. CLAIR
4
71%
CLEBURNE
JEFFERSON
66%
TUSCALOOSA
PICKENS
69%
area
FAYETTE
6
RANDOLPH
CLAY
SHELBY
area
area
TALLADEGA
72%
3
BIBB
COOSA
GREENE
TALLAPOOSA
CHILTON
CHAMBERS
HALE
PERRY
ELMORE
SUMTER
AUTAUGA
8
area
7
MARENGO
CHOCTAW
MACON
69%
MONTGOMERY
DALLAS
78%
LEE
area
LOWNDES
RUSSELL
BULLOCK
WILCOX
BARBOUR
PIKE
BUTLER
CLARKE
CRENSHAW
MONROE
area
9
WASHINGTON
CONECUH
69%
73%
COFFEE
COVINGTON
ESCAMBIA
area
HENRY
DALE
10
GENEVA
HOUSTON
66%
MOBILE
area
11
BALDWIN
Source: Alabama brFSS
findinG the Path to CardioVasCUlar health 2010
• 21
CardioVasCUlar risk faCtors: smokinG
cigarette smoking is a major cause of heart disease and stroke. It increases the clotting factors in the blood, damages the linings
of the blood vessels, and decreases HdL (the good cholesterol) in the blood. Smokers have twice the risk of heart attack or stroke
of non-smokers. Smoking is the single largest preventable cause of heart disease in the united States.
fiGUre 27: PreValenCe of CUrrent smokers in alabama and United states, 1998-2009
26
24.6
24
23.5
PerCent
22.9
25.4
25.2
24.8
24.4
24.8
23.8
23.2
23.2
23.0
22.8
22.6
22.5
22.0
22
22.1
22.5
21.2
20.5
20.0
20
19.7
18.3
18
17.9
16
1998
1999
2000
2001
alabama
Source: Alabama brFSS
2002
year
2003
2004
2005
2006
2007
2008
2009
United states
• the prevalence of current smokers had decreased in the united States since 2002, while Alabama had been fluctuating until
2008, then increased slightly.
• Alabama’s rate of current smokers was higher than the national average rates from 1998-2009.
• 22.5 percent of Alabama residents reported that they smoked in 2009. (Figure 27)
fiGUre 28: PreValenCe of CUrrent smokers by Gender, aGe, and raCe, 2009
40
PerCent
30
25.7%
20
25.0%
22.5%
26.9%
26.9%
27.0%
10
0
oVerall male female
Source: Alabama brFSS
22.6%
20.5%
19.7%
20.6%
10.5%
18-24
25-34
35-44
45-54
55-64
65+
white blaCk
• males were significantly more likely to be smokers than females.
• up to the 55-64 age group, the prevalence rate of current smokers showed little to no variance; however, after age 55, the
prevalence dropped significantly.
• the rates were similar between blacks and whites, with whites slightly higher than blacks. (Figure 28)
22
•
the risk of heart disease and stroke in alabama: bUrden doCUment
fiGUre 29: PerCentaGe of adUlts who are CUrrent smokers in alabama by PUbliC health area, 2009
area
2
LAUDERDALE
area
LIMESTONE
1
MADISON
LAWRENCE
MORGAN
FRANKLIN
24%
DEKALB
MARSHALL
WINSTON
MARION
JACKSON
24%
COLBERT
area
5
CHEROKEE
CULLMAN
ETOWAH
BLOUNT
WALKER
LAMAR
21%
area
FAYETTE
CALHOUN
ST. CLAIR
4
CLEBURNE
JEFFERSON
21%
TUSCALOOSA
PICKENS
22%
3
BIBB
COOSA
GREENE
6
RANDOLPH
CLAY
SHELBY
area
area
TALLADEGA
27%
TALLAPOOSA
CHILTON
CHAMBERS
HALE
PERRY
ELMORE
SUMTER
AUTAUGA
area
8
area
7
MARENGO
22%
MACON
MONTGOMERY
DALLAS
LEE
LOWNDES
20%
RUSSELL
BULLOCK
CHOCTAW
WILCOX
BARBOUR
PIKE
BUTLER
CLARKE
CRENSHAW
MONROE
area
9
WASHINGTON
HENRY
CONECUH
22%
COFFEE
COVINGTON
ESCAMBIA
27%
20%
area
DALE
10
GENEVA
HOUSTON
MOBILE
area
11
BALDWIN
Source: Alabama brFSS
findinG the Path to CardioVasCUlar health 2010
• 23
CardioVasCUlar risk faCtors: PhysiCal inaCtiVity
the chance of developing heart disease is 1.5 to 2.5 times higher among those who are physically inactive compared to those
who are physically active. exercise reduces the development of high blood pressure, controls diabetes, lowers weight, and
decreases high blood cholesterol.
fiGUre 30: PreValenCe of PhysiCal inaCtiVity* in alabama and the United states, 1998-2009
35
31.6
31.2
30
29.6
22.9
22.6
29.7
29.2
29.3
22.6
22.5
2006
2007
31.0
27.3
26.7
PerCent
29.9
25.2
25
24.6
23.7
23.6
20
15
1998
2001
2002
2003
2004
year
alabama
Source: Alabama brFSS
2005
2009
United states
• In Alabama, the prevalence of physical inactivity gradually declined from 1998 to 2007, with an increase of individuals
who were physically inactive in 2009 to 31.0 percent.
• Alabama consistently had higher rates of physical activity compared to the united States. (Figure 30)
* Physical inactivity is defined as those reporting no physical activity or exercise in the last thirty days.
fiGUre 31: PreValenCe of PhysiCal inaCtiVity in alabama by Gender, aGe, and raCe, 2009
40
PerCent
30
36.1%
35.2%
34.1%
31.0%
29.4%
28.6%
26.1%
26.4%
20
35.2%
34.6%
21.1%
10
0
oVerall male female
18-24
25-34
35-44
45-54
55-64
65+
white blaCk
Source: Alabama brFSS
• In Alabama, females were more likely to be physically inactive than males.
• the prevalence rate of physical inactivity increased with age.
• Among race and ethnic groups, blacks had a higher prevalence of physical inactivity compared to whites. (Figure 31)
24
•
the risk of heart disease and stroke in alabama: bUrden doCUment
fiGUre 32: PerCentaGe of adUlts who are PhysiCally inaCtiVe* in alabama by PUbliC health
area, 2009
area
2
LAUDERDALE
area
LIMESTONE
1
MADISON
LAWRENCE
MORGAN
FRANKLIN
37%
DEKALB
MARSHALL
WINSTON
MARION
JACKSON
30%
COLBERT
area
5
CHEROKEE
CULLMAN
ETOWAH
BLOUNT
WALKER
LAMAR
34%
area
FAYETTE
CALHOUN
ST. CLAIR
4
CLEBURNE
JEFFERSON
27%
TUSCALOOSA
PICKENS
32%
6
RANDOLPH
CLAY
SHELBY
area
area
TALLADEGA
31%
3
BIBB
COOSA
GREENE
TALLAPOOSA
CHILTON
CHAMBERS
HALE
PERRY
ELMORE
SUMTER
AUTAUGA
8
area
7
MARENGO
CHOCTAW
LEE
area
37%
MACON
30%
MONTGOMERY
DALLAS
LOWNDES
RUSSELL
BULLOCK
WILCOX
BARBOUR
PIKE
BUTLER
CLARKE
CRENSHAW
MONROE
area
9
WASHINGTON
MOBILE
11
33%
COFFEE
COVINGTON
ESCAMBIA
29%
area
CONECUH
BALDWIN
31%
area
HENRY
DALE
10
GENEVA
HOUSTON
* Physical inactivity is defined as those reporting no physical activity or
exercise in the last 30 days.
Source: Alabama brFSS
findinG the Path to CardioVasCUlar health 2010
• 25
CardioVasCUlar risk faCtors: frUit and VeGetable ConsUmPtion
daily consumption of five or more servings of fresh fruits and vegetables is associated with a reduced risk of heart disease
and stroke. the consumption of recommended amounts of fruits and vegetables results in the intake of antioxidants, natural
vitamins, and fiber.
fiGUre 33: PreValenCe of ConsUminG fiVe or more frUits and VeGetables Per day in alabama
and the United states, 1996-2009
30
25
23.9
23.7
PerCent
23.8
20
23.2
22.7
22.7
23.2
22.6
24.3
23.3
20.6
20.3
2007
2009
22.6
21.4
21.1
20.1
15
10
1996
1998
2000
alabama
Source: Alabama brFSS
2002
2003
year
United states
2005
• the prevalence of adequate amounts of fruit and vegetable consumption has been roughly the same since 1996 in both
Alabama and the united States.
• the prevalence of individuals consuming five or more fruits and vegetables per day in the united States was 23.3 percent,
slightly higher than Alabama at 20.3 percent in 2009. (Figure 33)
fiGUre 34: PreValenCe of ConsUminG fiVe or more frUits and VeGetables Per day in alabama by
Gender, aGe, and raCe, 2009
40
PerCent
30
20
21.5%
19.6%
20.2%
23.5%
17.6%
17.3%
18.0%
35-44
45-54
21.0%
18.6%
19.9%
18.7%
10
0
oVerall male female
18-24
25-34
55-64
65+
white blaCk
Source: Alabama brFSS
• Females were more likely to consume five or more servings per day of fruits and vegetables compared to males.
• When all age groups were compared, the 25-34 age group consumed the most fruits and vegetables at 23.5 percent.
• Among race and ethnic groups, whites and blacks had similar prevalence of adequate consumption of fruits and vegetables,
with whites slightly higher than blacks. (Figure 34)
26
•
the risk of heart disease and stroke in alabama: bUrden doCUment
fiGUre 35: PerCentaGe of adUlts ConsUminG fiVe serVinGs of frUit and VeGetables in alabama
by PUbliC health area, 2009
area
area
2
LAUDERDALE
1
LIMESTONE
COLBERT
LAWRENCE
23%
MADISON
MORGAN
FRANKLIN
17%
DEKALB
MARSHALL
WINSTON
MARION
JACKSON
area
5
CHEROKEE
CULLMAN
ETOWAH
BLOUNT
WALKER
LAMAR
CALHOUN
ST. CLAIR
4
CLEBURNE
JEFFERSON
21%
16%
TUSCALOOSA
PICKENS
17%
area
FAYETTE
area
6
TALLADEGA
area
RANDOLPH
CLAY
SHELBY
17%
3
BIBB
COOSA
GREENE
TALLAPOOSA
CHILTON
CHAMBERS
HALE
PERRY
ELMORE
SUMTER
AUTAUGA
8
area
7
MARENGO
CHOCTAW
LEE
area
MONTGOMERY
DALLAS
20%
LOWNDES
MACON
26%
RUSSELL
BULLOCK
WILCOX
BARBOUR
PIKE
BUTLER
CLARKE
CRENSHAW
MONROE
area
9
WASHINGTON
15%
HENRY
CONECUH
18%
COFFEE
COVINGTON
ESCAMBIA
area
DALE
10
GENEVA
HOUSTON
17%
MOBILE
area
11
BALDWIN
Source: Alabama brFSS
findinG the Path to CardioVasCUlar health 2010
• 27
eConomiC Cost of CVd
the economic cost associated with any disease can be immense, but this is especially the case with cVd. the American Heart
Association estimates that the cumulative cost associated with cVd in the united States in 2010, is 503.2 billion dollars. this
estimate includes direct costs (concerning doctors and other healthcare professionals, hospitals, medications, and nursing
home facilities) as well as indirect costs (mainly the loss of productivity due to increased morbidity and mortality).
fiGUre 36: estimated Cost (in billions of dollars) of CVd and stroke in the United
states, 2010
600
500
$503.20
PerCent
400
300
200
100
0
$117.10
Coronary
heart
disease
$73.70
$76.60
stroke
hyPertensiVe
disease
$39.20
heart
failUre
total CVd
Source: Personal communication, thomas thom, nHLbI.
• coronary heart disease makes up the largest proportion of the total cost for cVd primarily due to hospital costs and loss of
productivity due to mortality.
• Heart failure represents the smallest proportion of the total cost for cVd with the primary direct cost being hospitalization.
(Figure 36)
28
•
the risk of heart disease and stroke in alabama: bUrden doCUment
aCCess to Care
Access to all types of health care has been and continues to be a serious problem in Alabama. In situations where literally every
second counts, such as during a heart attack or stroke, being able to receive prompt medical care is critical to the survival of
the patient. this can be quite a daunting task in some areas of the state where the nearest hospital can be several hours drive.
Hospitals in Alabama are categorized as follows: General hospitals (including the children’s Hospital), rehabilitation Long
term care, Psychiatric, and the Veterans Administration (VA) hospitals. For the purpose of this report, General, rehabilitation,
and VA hospitals will be highlighted.
When preparing the state to care for patients having a stroke or rehabilitating from a stroke, access to a neurologist is a vital
part of any plan of care. In the united States there are approximately 4.0 neurologists per 100,000 people caring for more
than 700,000 acute strokes per year. In Alabama, there are 44 out of 67 counties without a neurologist. Some stroke victims
have to travel across three counties to access a neurologist for care. Figure 37 and 38 shows obvious gaps in access to care
involving hospitals and neurologists which also correlate to the stroke mortality rate maps included in this document.
once diagnosed with an ischemic stroke the neurosurgeon may be asked to evaluate the patient and determine whether they
are a candidate for surgical intervention. the only university in Alabama training neurosurgeons and is limited to six per year is
the university of Alabama at birmingham (uAb). this past year only one of six neurosurgeons stayed in Alabama to practice.
Please refer to Figure 38 for a comparison of the availability of neurologists and neurosurgeons.
recovering from a stroke can be a long process, financially tasking, and overwhelming to a patient and their family. A
rehabilitation hospital has a team of highly focused professionals that include physicians, nurses, occupational therapists,
physical therapists, and speech therapists. these professionals will custom design programs specific to individual patient’s
needs with therapy and treatment programs that have a goal to ultimately get the patient back to living life to the fullest. When
needing the specialty care of a cardiovascular rehabilitation facility the urban areas have better access than rural. many
counties in the rural southern portions of the state do not have a facility leaving those residents at risk of not receiving proper
rehabilitation. Forty-three counties in the state do not have rehabilitation hospitals or centers of any kind for patients to access.
• In Alabama, hospitals tend to be concentrated in highly populated, urban regions of the counties. Several counties in the
state do not have a hospital: cleburne, choctaw, coosa, Henry, Lamar, Lowndes, and Perry counties.
• only two hospitals in Alabama are Joint commission certified Primary Stroke centers: decatur General in morgan county,
and Huntsville Hospital in madison county. (Figure 37)
findinG the Path to CardioVasCUlar health 2010
• 29
fiGUre 37: hosPitals in alabama by CoUnty, 2010
h
LIMESTONE
hh
COLBERT
MADISON
h
h
LAWRENCE
h
h
LAUDERDALE
JACKSON
hh
h
FRANKLIN
hh h h
hh
WINSTON
h
hh
BLOUNT
h
WALKER
h
h
h
CALHOUN
ST. CLAIR
h
hh h
JEFFERSON
h
h
h
h
h
COOSA
h
h
PERRY
SUMTER
h
ELMORE
hh
AUTAUGA
h
h
MONTGOMERY
DALLAS
h
MARENGO
WILCOX
h
h
h hh
BULLOCK
h
h
CLARKE
h
CRENSHAW
h
MONROE
CONECUH
COFFEE
h
COVINGTON
ESCAMBIA
BALDWIN
h
hh
BARBOUR
PIKE
BUTLER
h
h
h
hh
h hh
hhh
h
RUSSELL
h
h
LOWNDES
CHOCTAW
h hh
h hh
LEE
MACON
h
WASHINGTON
CHAMBERS
TALLAPOOSA
CHILTON
HALE
h
h
hh
BIBB
GREENE
RANDOLPH
CLAY
SHELBY
h
MOBILE
hh
TALLADEGA
TUSCALOOSA
h
CLEBURNE
hh
hhh hhhhh
hh
h
ETOWAH
h
FAYETTE
CHEROKEE
h
CULLMAN
h
hh
PICKENS
DEKALB
MARSHALL
hh
MARION
LAMAR
h
MORGAN
hh
h hh
GENEVA
HENRY
DALE
h
h
HOUSTON
hh
h
h
General Hospital including children’s Hospital
h
VA Hospital
h
rehabilitation Hospital
Joint commission certified Primary Stroke center
*map does not include long
term care or psychiatric
hospitals.
Source: Alabama Hospital Association, the Internet Stroke center
30
•
the risk of heart disease and stroke in alabama: bUrden doCUment
fiGUre 38: alabama neUroloGists and neUrosUrGeons by CoUnty, 2010
n3
LAUDERDALE
n 2
n 15
LIMESTONE
n1
MADISON
JACKSON
n 7
COLBERT
n1
LAWRENCE
n1
MORGAN
FRANKLIN
n2
DEKALB
MARSHALL
n2
WINSTON
MARION
CHEROKEE
n 3
CULLMAN
ETOWAH
n6
BLOUNT
n2
n1
WALKER
LAMAR
FAYETTE
n 80
n5
JEFFERSON
n 13
n5
TALLADEGA
RANDOLPH
CLAY
SHELBY
n 2
CLEBURNE
n2
n 41
TUSCALOOSA
PICKENS
n6
CALHOUN
ST. CLAIR
n 2
BIBB
COOSA
GREENE
HALE
n3
PERRY
n2
ELMORE
SUMTER
CHAMBERS
TALLAPOOSA
CHILTON
LEE
n 4
AUTAUGA
n1
MACON
MONTGOMERY
DALLAS
RUSSELL
n6
MARENGO
LOWNDES
n 6
CHOCTAW
BULLOCK
WILCOX
BARBOUR
PIKE
BUTLER
CLARKE
CRENSHAW
n1
MONROE
CONECUH
WASHINGTON
n1
COFFEE
n 4
COVINGTON
ESCAMBIA
GENEVA
n 16
n 11
MOBILE
n6
BALDWIN
HENRY
DALE
HOUSTON
n8
42 counties without a neurologist or neurosurgeon
n
neurologists
n
neurosurgeons
Source: Alabama board of medical examiners, July 2010
findinG the Path to CardioVasCUlar health 2010
• 31
siGns and symPtoms of a heart attaCk or stroke
one of the Healthy People 2010 objectives is to increase the proportion of people who
are aware of the early warning signs and symptoms of stroke. the time variance between
the onset of symptoms and actually receiving treatment can adversely affect the outcome
of an acute heart attack or stroke event. there are three stages at which time delays can
occur:
• the onset of symptoms and the 911 call for help;
• during pre-hospital care; and
• during transportation.
Stroke: The FAST test
the fast test is an easy way to recognize and remember the signs of stroke or a transient
ischemic attack (tIA). using the fast test involves asking three simple questions.
fast stands for:
F = Facial weakness - can the person smile; has his or her mouth or eyes drooped?
A = Arm weakness - can the person raise both arms; is one arm slightly lower?
S = Speech/sight difficulty - can the person speak or see clearly and understand
what you say?
T = time to act - time loss is brain lost. call 911.
If you suddenly experience any of these symptoms, go to a hospital immediately.
remember, stroke is a life-threatening emergency.
Heart Attack: Signs and Symptoms:
• Pain or discomfort in jaw, neck, or back
• Feeling weak, lightheaded, faint
• chest pain or discomfort
• Shortness of breath
• Pain or discomfort in arms or shoulders
A risk factor that can cause heart attack and stroke is high blood pressure or hypertension.
the national guidelines for defining hypertension are the following:
ClassifiCation of blood PressUre (bP)
cAteGory
normal
SbP mm Hg
Systolic
dbP mm Hg
diastolic
<120
and
<80
Pre-hypertension
120-139
or
80-89
Hypertension, Stage 1
140-159
or
90-99
Hypertension, Stage 2
>160
or
>100
Seventh report of the Joint national committee on Prevention, detection, evaluation, and
treatment of High blood Pressure (Jnc7) Guidelines.
Help For Smoking ceSSATion
Another risk factor that can lead to heart attack and stroke is smoking. Imagine yourself
tobacco free! call the AdPH tobacco Quitline at 1-800-QuIt-noW, or go online at
www.alabamaquitnow.org.
32
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the risk of heart disease and stroke in alabama: bUrden doCUment
sodiUm: the faCts
Americans consume too much sodium. High sodium consumption raises blood pressure, and high blood
pressure is a major risk factor for heart disease and stroke. Heart disease and stroke are the nation’s first
and third leading causes of death.
salt and high blood pressure
• research strongly shows a dose-dependent relationship between consuming too much salt and
raised levels of blood pressure.
• When salt intake is reduced, blood pressure begins decreasing within weeks on average.
• Populations who consume diets low in salt do not experience the increase in blood pressure with age
that is seen in most Western countries.
is it salt or is it sodium?
• Sodium chloride is the chemical name for salt.
• the words salt and sodium are not exactly the same, yet these words are often used in place of each
other. For example, the nutrition Facts Panel uses “sodium,” whereas the front of the package may
say “low salt.”
• ninety percent of the sodium we consume is in the form of salt.
sodium consumption and sodium in our food supply
• We all need a small amount of sodium to keep our bodies working properly.
• the 2005 dietary Guidelines for Americans recommend limiting sodium to less than 2,300 milligrams
(mg) per day (about one teaspoon of table salt). Individuals with hypertension, blacks, and middleaged and older adults should limit intake to 1,500 mg of sodium per day. these specific populations
account for about 70 percent of adults.
• the average daily sodium intake for Americans age two years and older is more than 3,400 mg.
• the majority of the sodium consumed is from processed and restaurant foods; only a small portion is
used in cooking or added at the table.
• nutrition labeling and package messaging are easily misunderstood by consumers.
• Sodium information is not readily available for restaurant foods and can be hard for the consumer
to estimate. For example, consumers might be surprised to find that the restaurant salad they are
consuming may contain more than 900 mg of sodium—and could only find this information on the
company’s website.
reducing sodium, reducing CVd burden
• In general, even if a person does not have high blood pressure, the lower one’s blood pressure, the
lower the risk of heart disease and stroke.
• Sodium intake from processed and restaurant foods contributes to high rates of high blood pressure,
heart attack, and stroke. because nearly 400,000 deaths each year are attributed to high blood
pressure, decreasing sodium intake could prevent thousands of deaths annually.
the abCs of heart disease and stroke
heart disease and stroke are Preventable!
A = Aspirin use. Ask your provider about taking:
• one baby aspirin (81 mg) every day, or
• one regular aspirin (325 mg) every other day.
B = blood pressure treatment and control. bP <120/80
• consume only 2300 mg sodium daily.
c = cholesterol. Ask your provider about how often to check your cholesterol.
• total cholesterol < 200
• LdL (bad cholesterol) < 100
S = Smoking cessation. research shows using a quitline with medication increases abstinence rates.
• call 1-800-QuItnoW for more details or ask your provider.
Source: cdc Salt
findinG the Path to CardioVasCUlar health 2010
• 33
aCknowledGements
Alabama department of Public Health ......................donald e. Williamson, m.d., State Health officer
Alabama department of Public Health ......................thomas m. miller, m.d., m.P.H., Assistant State Health officer
bureau of Health Promotion and chronic disease.....Jim mcVay, dr.P.A., bureau director
chronic disease Prevention office ............................bob Hinds, director
chronic disease epidemiology branch......................Sondra reese, m.P.H., director
brFSS unit .............................................................Jesse Pevear, III, m.S.P.H., coordinator
cardiovascular Health branch ..................................melanie rightmyer, r.n., m.S.n., Program manager
referenCes
American Heart Association. Heart disease and Stroke Statistics – 2008 update. retrieved from:
http://www.americanheart.org
centers for disease control and Prevention (cdc). behavioral risk Factor Surveillance System (brFSS):
overview and a brief History. retrieved from: http://www.cdc.gov/brfss/about.htm
centers for disease control and Prevention (cdc). behavioral risk Factor Surveillance System (brFSS).
retrieved from: http://www.cdc.gov/brfss
centers for disease control and Prevention. cdc Wonder. retrieved from: http://wonder.cdc.gov
united States census bureau. American Fact Finder. (2007). retrieved from: http://www.census.gov
Alabama board of medical examiners. (2010). Systems network.
this publication was supported by Grant/cooperative Agreement number 5u50dP000732-04 from
the cdc. Its contents are solely the responsibility of its authors and do not necessarily represent the
official views of the cdc.
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the risk of heart disease and stroke in alabama: bUrden doCUment