Bending the Curve in Cardiovascular Disease Mortality: Bethesda + 40 and Beyond

Abstract

More than 40 years after the 1978 Bethesda Conference on the Declining Mortality from Coronary Heart Disease provided the scientific community with a blueprint for systematic analysis to understand declining rates of coronary heart disease, there are indications the decline has ended or even reversed despite advances in our knowledge about the condition and treatment. Recent data show a more complex situation, with mortality rates for overall cardiovascular disease, including coronary heart disease and stroke, decelerating, whereas those for heart failure are increasing. To mark the 40th anniversary of the Bethesda Conference, the National Heart, Lung, and Blood Institute and the American Heart Association cosponsored the "Bending the Curve in Cardiovascular Disease Mortality: Bethesda + 40" symposium. The objective was to examine the immediate and long-term outcomes of the 1978 conference and understand the current environment. Symposium themes included trends and future projections in cardiovascular disease (in the United States and internationally), the evolving obesity and diabetes epidemics, and harnessing emerging and innovative opportunities to preserve and promote cardiovascular health and prevent cardiovascular disease. In addition, participant-led discussion explored the challenges and barriers in promoting cardiovascular health across the lifespan and established a potential framework for observational research and interventions that would begin in early childhood (or ideally in utero). This report summarizes the relevant research, policy, and practice opportunities discussed at the symposium.

Keywords: cardiovascular diseases; health promotion; longevity; primary prevention; trends.

Figure 1.. Trends in unadjusted death rates per 100,000 population attributable to coronary heart disease and stroke as underlying causes of death in the United States, 1950–1998.

Declines in crude death rates per 100,00 population of coronary heart disease and stroke between 1950 to 1998.

Figure 2.. Trends in age-adjusted mortality rates per 100,000 population attributable to total cardiovascular disease and to leading subtypes of cardiovascular disease as underlying causes of death in the United States with average annual percentage change before and after the inflection point* between 1999 to 2011 and 2011 to 2018.

Declines in age-adjusted mortality rates per 100,000 population attributable to total cardiovascular disease and to leading subtypes of cardiovascular disease as underlying causes of death in the United States with average annual percentage change before and after the inflection point* between 1999 to 2011 and 2011 to 2018. CVD = Cardiovascular Disease CHD = Coronary Heart Disease HD = Heart Disease

Figure 3.. Trends in race-sex stratified age-adjusted mortality rates per 100,000 population attributable to total cardiovascular disease and by leading subtypes, coronary heart disease and cerebrovascular disease as underlying causes of death in the United States, 1999–2018.

Declines in total cardiovascular disease, coronary heart disease, and cerebrovascular disease mortality rates between 1999–2018 CVD = Cardiovascular Disease NH = non-Hispanic

Figure 4.. Trends in age-adjusted mortality rates per 100,000 population from total cardiovascular disease for both sexes stratified by urbanization status in the United States, 1999–2018.

Declines in cardiovascular mortality rate per 100,000 stratified by county-level urbanization between 1999–2018

Figure 5.. Trends in age-adjusted mortality rates per 100,000 population attributable to cardiovascular disease stratified by Global Burden of Disease Super Regions, 1999–2017.

Age-adjusted mortality rates per 100,000 population across Global Burden of Disease Super Regions, 1999–2017

Figure 6.. Small-area geographic scale distribution of age-adjusted prevalence of coronary heart disease (per 100,000) and the Centers for Disease Control and Prevention’s Social Vulnerability Index at the census tract level in 3 major metropolitan areas in the United States, both sexes, 2017.

Neighborhood-level differences in age-adjusted prevalence of coronary heart disease and the social vulnerability index in Chicago (A, D), Washington D.C. (B, E), and New Orleans (C, F).