Cardiovascular Disease Prevention

By Ronald L. Scott
rscott@central.uh.edu

Texas is considering legislation (House Bill 1311- Delisi) that would create a Council on Cardiovascular Disease and Stroke (Council) charged with developing a plan to reduce the morbidity, mortality, and economic burden of cardiovascular disease (CVD) and stroke in Texas. CVD is defined in the bill as "the group of diseases that target the heart and blood vessels and that are the result of complex interactions between multiple inherited traits and environmental factors." Heart disease, stroke and congestive heart failure are common forms of CVD. The Council would conduct health education, coordinate activities with other entities that are concerned with medical conditions that are similar to CVD and stroke, and provide guidance regarding the roles and responsibilities of government agencies, health care providers, employers, third-party payors, and others in the treatment and prevention of CVD and stroke. The Texas Council, if implemented and funded, would serve at least two central public health goals: (1) prevention of CVD and health promotion; and (2) improvement and coordination of research and surveillance on CVD.

Approximately 58.2 million Americans have some form of CVD, and CVD claims more lives that the next seven leading causes of death combined. In Texas, heart disease accounted for 30.3 percent of all deaths in 1996, claiming 42,330 lives, and stroke ranked third with 7.0 percent of all deaths. Together, these two diseases cost Texas more than $9 billion dollars annually, i.e., over $500 per Texan.

Major risk factors for CVD include smoking, high blood pressure, high cholesterol, diet, obesity, and physical inactivity. An interim legislative report concluded that even though prevention can reduce the rate of CVD, resources for research, education, prevention and treatment are "insufficient and uncoordinated." The report noted that there is no targeted state funding to evaluate and address the burden of CVD in Texas, and that surveillance information to evaluate the effectiveness of existing programs is lacking. Existing Texas resources include the Texas Department of Health (TDH) as well as voluntary and private sector resources such as the American Heart Association and the Texas Medical Foundation.

Other states have recently begun efforts to more effectively combat CVD. The California Cardiovascular Disease Outreach, Resources and Epidemiology (CORE) program is conducted by the University of California, San Francisco, Institute for Health & Aging, under agreement with the California Department of Health Services. The purpose of CORE is to conduct epidemiological investigations of geographic variation in patterns of CVD mortality in California, and to determine the reasons for such variations. CORE also seeks to identify and implement successful community-based CVD intervention strategies. Further information about CORE is available in the Report, or on the Internet at http://nurseweb.ucsf.edu/iha/CORE.htm.

In 1995, the North Carolina General Assembly created and funded a task force charged with adopting and promoting a statewide plan to reduce the impact of CVD in North Carolina. The goals of the task force are to reduce the incidence of smoking, encourage low-fat diets and reduce the incidence of high cholesterol, and to build coalitions of community organizations to combat CVD.

In 1995, Washington created a coordinated statewide plan to provide a framework for prevention of these CVD. An Advisory Committee for the Heart Disease and Stroke Prevention Plan ("Washington Plan") was appointed in 1993. Members represented health care professions, voluntary organizations, the educational system, research, the public, the legislature, and various levels of government.

The Washington Plan defines the partnership roles of public health, the provider community, voluntary and other community organizations in CVD and stroke prevention. The goals of the Washington Plan are to: (1) reduce the risk of developing heart disease and stroke; (2) detect and treat risk factors for heart disease and stroke at the earliest possible time; (3) prevent recurrence and complications of heart disease and stroke; and (4) reduce coronary heart disease and stroke death rates. Details of the Washington Plan are available at http://weber.u.washington.edu/~hserv/hsic/resource/wahealth/heart1.html#summary.

05/07/99