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Why This Measure?

Coronary heart disease and stroke are the most common types of cardiovascular disease which is the leading cause of death in the U. S. (44% of all deaths) (Personal Health: A Multicultural Approach, 1995). Major modifiable risk factors for cardiovascular disease are high blood pressure, high blood cholesterol, and tobacco smoking--all preventable, in large part, by exercise and changes in diet and lifestyle habits.

Lead Indicator

People with hypertension (high blood pressure) have three to four times the risk of developing coronary heart disease (heart attacks and angina), and as much as seven times the risk of stroke as do people with normal blood pressure.  Hypertension, which usually has no symptoms or warning signs, is called "the silent killer;" about 35% of the people with high blood pressure are not aware of it (Personal Health, 1995).

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Sources: Montana BRFS Surveys 1999

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How are we doing?

We think there is room for improvement. If we assume that we are similar to the nation (with a rate of 30% hypertension), then there are still many people who don’t know their status. In 1997, only 62% of Missoulians had their blood pressure checked in the previous six months, and 19% had been told their blood pressure was too high (Missoula BRFSS 1997). We don’t know how many people have taken effective steps to reduce their high blood pressure once they became aware of their condition.


Key Definitions

Angina (angina pectoris): A pain or discomfort in the chest that occurs when some part of the heart does not receive enough blood. It is a common symptom of coronary heart disease. Angina often recurs in a regular or characteristic pattern. However, it may first appear as a very severe episode or as frequently recurring bouts. When an established stable pattern of angina changes sharply—for example, it may be provoked by far less exercise than in the past, or it may appear at rest—it is referred to as unstable angina.

Angioplasty: A nonsurgical procedure used to treat blockages in blood vessels, particularly the coronary arteries that feed the heart. Also known as percutaneous transluminal coronary angioplasty (PTCA). A thin tube (catheter), fed through blood vessels to the point of blockage, is used to open the artery.

Anticoagulants: Drugs that delay the clotting (coagulation) of blood. When a blood vessel is plugged up by a clot and an anticoagulant is given, it tends to prevent new clots from forming or the existing clot from enlarging. An anticoagulant does not dissolve an existing blood clot.

Arrhythmia: A change in the regular beat or rhythm of the heart. The heart may seem to skip a beat, or beat irregularly, or beat very fast or very slowly.

Atherosclerosis: A type of hardening of the arteries in which cholesterol and other substances in the blood are deposited in the walls of arteries, including the coronary arteries that supply blood to the heart. In time,narrowing of the coronary arteries by atherosclerosis may reduce the flow of oxygen-rich blood to the heart.

Atrial fibrillation (AF): The most common sustained irregular heart rhythm encountered in clinical practice. AF occurs when the two small upper chambers of the heart (the atria) quiver instead of beating effectively, and blood cannot be pumped completely out of them when the heart beats, allowing the blood to pool and clot. If a piece of the blood clot in the atria becomes lodged in an artery in the brain, a stroke may result. AF is a risk factor for stroke and heart failure.

Blood pressure: The force of the blood pushing against the walls of arteries. Blood pressure is given as two numbers that measure systolic pressure (the first number, which measures the pressure while the heart is contracting) and diastolic pressure(the second number, which measures the pressure when the heart is resting between beats). Blood pressures 140/90 mmHg or above are considered high, while blood pressures in the range of 130-139/85-89 are high normal. Less than 130/85 mmHg is normal.

Body mass index (BMI): A number that indicates a person’s body weight relative to height. BMI is a useful indirect measure of body composition, because it correlates highly with body fat in most people.

Cardiovascular disease (CVD): Includes a variety of diseases of the heart and blood vessels, coronary heart disease (coronary artery disease, ischemic heart disease), stroke (brain attack), high blood pressure (hypertension), rheumatic heart disease, congestive heart failure, and peripheral artery disease.

Cerebrovascular disease: Affects the blood vessels supplying blood to the brain. Stroke occurs when a blood vessel bringing oxygen and nutrients to the brain bursts or is clogged by a blood clot. Because of this rupture or blockage, part of the brain does not get the flow of blood it needs and nerve cells in the affected area die. Small stoke-like events like transient ischemic attacks (ITAs), which resolve in a day or less, are symptoms of cerebrovascular disease.

Cholesterol: A waxy substance that circulates in the bloodstream. When the level of cholesterol in the blood is too high, some of the cholesterol is deposited in the walls of the blood vessels. Over time, these deposits can build up until they narrow the blood vessels, causing atherosclerosis, which reduces the blood flow. The higher the blood cholesterol level, the greater is the risk of getting heart disease. Blood cholesterol levels of less than 200 mg/dL are considered desirable. Levels of 240 mg/dL or above are considered high and require further testing and possible intervention. Levels of 200-239 mg/dL are considered borderline. Lowering blood cholesterol reduces the risk of heart disease.

Congestive heart failure (or heart failure): A condition in which the heart cannot pump enough blood to meet the needs of the body's other organs. Heart failure can result from narrowed arteries that supply blood to the heart muscle and other factors. As the flow of blood out of the heart slows, blood returning to the heart through the veins backs up, causing congestion in the tissues. Often swelling (edema) results, most commonly in the legs and ankles, but possibly in other parts of the body as well. Sometimes fluid collects in the lungs and interferes with breathing, causing shortness of breath, especially when a person is lying down.

Coronary heart disease (CHD): A condition in which the flow of blood to the heart muscle is reduced. Like any muscle, the heart needs a constant supply of oxygen and nutrients that are carried to it by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged, they cannot supply enough blood to the heart. If not enough oxygen-carrying blood reaches the heart, the heart may respond with pain called angina. The pain usually is felt in the chest or sometimes in the left arm or shoulder. When the blood supply is cut off completely, the result is a heart attack. The part of the heart muscle that does not receive oxygen begins to die, and some of the heart muscle is permanently damaged.

Coronary stenting: A procedure that uses a wire mesh tube (a stent) to prop open an artery that recently has been cleared using angioplasty. The stent remains in the artery permanently, holding it open to improve blood flow to the heart muscle and relieve symptoms, such as chest pain.

HDL (high-density lipoprotein) cholesterol: The so-called good cholesterol. Cholesterol travels in the blood combined with protein in packages called lipoproteins. HDL is thought to carry cholesterol away from other parts of the body back to the liver for removal from the body. A low level of HDL increases the risk for CHD, whereas a high HDL level helps protect against CHD.

Heart attack (also called acute myocardial infarction): Occurs when a coronary artery becomes completely blocked, usually by a blood clot (thrombus), resulting in lack of blood flow to the heart muscle and therefore a loss of needed oxygen. As a result, part of the heart muscle dies (infarcts). The blood clot usually forms over the site of a cholesterol-rich narrowing (or plaque) that has burst or ruptured.

Heart disease: The leading cause of death and a common cause of illness and disability in the United States. Coronary heart disease and ischemic heart disease are specific names for the principal form of heart disease, which is the result of atherosclerosis, or the buildup of cholesterol deposits in the coronary arteries that feed the heart.

High blood pressure: A systolic blood pressure of 140 mmHg or greater or a diastolic pressure of 90 mmHg or greater. With high blood pressure, the heart has to work harder, resulting in an increased risk of a heart attack, stroke, heart failure, kidney and eye problems, and peripheral vascular disease.

Ischemic heart disease: Includes heart attack and related heart problems caused by narrowing of the coronary arteries and therefore a decreased supply of blood and oxygen to the heart. Also called coronary artery disease and coronary heart disease.

LDL (low-density lipoprotein): The so-called bad cholesterol. LDL contains most of the cholesterol in the blood and carries it to the tissues and organs of the body, including the arteries. Cholesterol from LDL is the main source of damaging buildup and blockage in the arteries. The higher the level of LDL in the blood, the greater is the risk for CHD.

Lipid: Fat and fat-like substances, such as cholesterol, that are present in blood and body tissues.

Peripheral vascular disease: Refers to diseases of any blood vessels outside the heart and to diseases of the lymph vessels. It is often a narrowing of the blood vessels that carry blood to leg and arm muscles. Symptoms include leg pain (for example, in the calves) when walking and ulcers or sore on the legs and feet.

Stroke: A form of cerebrovascular disease that affects the arteries of the central nervous system. A stroke occurs when blood vessels bringing oxygen and nutrients to the brain burst or become clogged by a blood clot or some other particle. Because of this rupture or blockage, part of the brain does not get the flow of blood it needs. Deprived of oxygen, nerve cells in the affected area of the brain cannot function and die within minutes. When nerve cells cannot function, the part of the body controlled by these cells cannot function either.


Factors Influencing Cardiovascular Disease

Cardiovascular Disease (CVD) encompasses diseases of the heart and blood vessels. Chief among these are coronary heart disease and stroke. Coronary heart disease is a general term covering heart attacks and angina. Both of these conditions involve an insufficient supply of blood to the coronary arteries encircling the heart, and the consequent lack of oxygen to the heart muscle. CVD also includes atherosclerosis (degeneration and hardening of the arteries), rheumatic fever, and congenital defects.

Many factors influence not only whether a person will develop coronary heart disease but also how rapidly atherosclerosis progresses. Genetic predisposition, gender, and advancing age are recognized factors over which individuals have no control. Key modifiable factors include cigarette smoking, high blood cholesterol, high blood pressure, excessive body weight, and long-term physical inactivity (HP 2000).



The causal relationship of high blood cholesterol to coronary heart disease also has been demonstrated. Coronary heart disease mortality and morbidity increase as blood cholesterol levels rise (HP 2000). Total cholesterol is defined as high at 240 and borderline high at 200. In 1997, 74% of Missoulians had their cholesterol tested, and nearly one-third were told their cholesterol level was too high (Missoula BRFSS 1997).

A 1% reduction in serum cholesterol is associated with a 2% reduction in the risk of a heart disease death (Chronic Disease Epidemiology and Control 1993, APHA). Reducing dietary fat intake to an average of 30% of calories or less and average saturated fat intake to less than 10% of calories are dietary guidelines which can help reduce serum cholesterol levels. Other options include exercise programs and prescription medications.

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Sources: Montana BRFS Surveys 1999

Missoula/Montana Heart Disease/Stroke Mortality Rates

Source: MDPHHS Vital Statistics

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