Cardio-vascular disease in the United States - Essay Example

Cardiovascular Disease in the United s Cardiovascular Disease (CVD) is the leading cause of mortality among American women and men, afflicting 33.3 million and 31.1 million, respectively, with illness (“Heart Disease and Stroke Statistics – 2004 Update.”3). Greater numbers of women of all races are more frequently affected over men, this gap widening after age 75. CVD is also the number three cause of death in children under the age of 15. (ibid.) However, CVD risk and inadequate treatment among American females create the largest component of America’s number one cause of death and illness, costing $368.

4 billion for CVD in 2001(ibid.). In order to target this leading national health problem, The American Heart Association (AHA) updated CVD prevention guidelines for women in early 2007, encouraging the pursuit of a healthy lifestyle early on. In previous decades, CVD was thought to affect greater proportions of American men than women. This was an incorrect conclusion, but reinforced by the fact that clinical trials predominantly used male subjects instead of females, and that women are less likely to show cardiovascular symptoms as early as males.

In fact, on average, women begin to show symptoms 10 years later in life then do men. It is evident in the research literature as well as in formal published insurance analyses (Murasko 1746) that women continue to receive less aggressive treatment for CVD events than is provided to men and this inadequate treatment worsens with the patient’s increasing age (Murasko 1755-6, Sarafidis 224; Alter et al. 1916). At the same time, women survive CVD events such as myocardial infarction (MI) more frequently than do men (ibid.), adding to the US population segment comprised of the elderly with cardiac history, inadequate treatment, and higher long-term medical expenses, because their risk of additional CVD events is 1.

5 – 15% higher than average: “After adjusting for baseline differences, the relative rates of angiography and follow-up specialist care for women relative to men, respectively, fell 17.5% (95% confidence interval [CI], 13.6 to 21.3, p < 0.001) and 10.2% (95% CI, 7.1 to 13.2, p < 0.001) for every 10-year increase in age. Conversely, long-term AMI survival rates in women relative to men improved with increasing age, such that the relative survival in women rose 14.2% (95% CI, 10.1 to 17.5, p < 0.001) for every 10-year age increase” (Alter, et al. 1915).“… for individuals with previously diagnosed heart disease or stroke, a lack of coverage is more strongly associated with lower rates of screening, pharmaceutical management, and physician contact in women than men.

” (Murasko 1755).This increases the total health cost burden of the nation. Additionally, American females outlive males by 5 years on average and females older than 75 comprise the fastest growing segment of the US population (“Heart Disease and Stroke Statistics – 2004 Update.” 3). Overall, CVD is showing an accelerating prevalence among older women, increasing health care costs, and becoming a hallmark disease of elderly American females who do not receive adequate treatment. This serious US public health problem needs attention in screening, testing, and treatment procedures.

Among women, up to 20% of CVD events occur without the presence of the following major risk factors: age, diabetes, hypertension, hyperlipidemia, and smoking. Additionally, in up to 64% of cases among females, women experience their first CVD event without any previous cardiac history. CVD is therefore more difficult to detect in screenings among women than men, who usually do have physical CVD symptoms, most notably chest pain (“Heart Disease and Stroke Statistics – 2004 Update”10; Ridker, 611-12).

The AHA has established three new levels of CVD risk in 2007: high risk, at risk, and optimal risk, replacing the previously held four levels: high, intermediate, lower, and optimal (Framingham model). Dr. Mosca notes that the new model is better in that it accounts for overall lifetime risk, diversity and stroke risk (ibid.). However, this model may be improved by additional recent research findings. Ridker et al., in a 10-year study of 16,400 females ages 45 and older, concluded in 2006 that two criteria added to CVD assessment would aid doctors in pinpointing more finely the accurate CVD risk for women over a subsequent 20-30 years.

The result is the Reynolds Risk Score for use in accurately measuring CVD risk in order to provide early prevention. This is a huge step forward in addressing cardiovascular disease in the US. The added criteria are 1) an accurate family health history, including CVD, and 2) the level of inflammation present in the patient, as determined by C-reactive protein levels (CRP). The simple inclusion of these two easily measured factors aids in determining women who could benefit from early prevention, such as low-does daily aspirin and lipid-lowering therapies.

More pertinently, family health history is to be included in any medical case as standard practice and CRP can be added via a simple procedure. The Reynolds Risk Score will 1) identify asymptomatic females at risk for CVD, 2) provide the impetus needed to provide these individuals with preventive therapies, 3) reduce health cost outlay by females and government insurance and health programs, and 4) increase the quality of life for the fastest growing segment of the American population. The Reynolds Risk Score may also be used among males to reduce further their incidence of CVD events, through facilitating early preventive measures.

These preventive measures can reduce the overall health burden of CVD on the United States in a dramatic and powerful manner.REFERENCESAlter D.A.; Naylor C.D.; Austin P.C.; Tu JV. “Biology or bias: practice patterns and long-termoutcomes for men and women with acute myocardial infarction.” Journal of the American College of Cardiology. 19 June 2002. 39 (12):1909-1916Anderson R.D. and Pepine C.J. “Gender differences in the treatment for acute myocardial infarction: bias or biology?” American Heart Association’s Circulation. 2007. 115(7):823-826 “Heart Disease and Stroke Statistics – 2004 Update.

” Learn and Live.2004. [American Heart Association; Lori Mosca, MD, MPH spokesperson.] http://www.americanheart.org/downloadable/heart/1079736729696HDSStats2004UpdateREV3-19-04.pdf Retrieved 8 Mar. 2007.Murasko, J.E. “Gender differences in the management of risk factors for cardiovascular disease: the importance of insurance status.” Social Science and Medicine. Oct. 2006. 63(7):1745-56.Ridker Paul M. , MD, MPH; Buring, Julie E., ScD; Rifai, Nadir, PhD; Cook, Nancy R., ScD. “Development and Validation of Improved Algorithms for the Assessment of Global Cardiovascular Risk in Women.

” Journal of the American Medical Association. 2007. 297:611-619Sarafidis, P.A.; McFarlane, S.I.; Bakris, G.L. Gender disparity in outcomes of care and management for diabetes and the metabolic syndrome. Current Diabetes Reports. June 2006. 6(3):219-24.