RISK FACTORS

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Cigarette/Tobacco Smoke
For the years 1990-94, an average of 430,700 Americans died each year of smoking-related illnesses.


Nearly 1 in 5 deaths from cardiovascular diseases are attributable to smoking.


About 37,000-40,000 nonsmokers die each year from CVD as a result of exposure to environmental tobacco smoke.


Smoking-related illnesses cost the United States about $130 billion annually in medical care.


Studies show that among people age 18 and older in the United States, smoking has declined by over 40 percent since 1965, although recent data indicate that this downward trend may have leveled off.



Age, Sex, Race

Every day 3,000 American young people become smokers, according to estimates by the Centers for Disease Control and Prevention (CDC).


80 percent of adult smokers started before age 18, and the most common ages for starting were 14 and 15, according to CDC estimates.


Recent studies show that from 1980 to 1997 the percentage of high school seniors who smoked in the past month increased almost 20 percent. For males, 39.2 percent and for females, 5.4 percent. For whites it was 37.1 percent and for blacks there was a 41 percent decrease.*


Current estimates for the United States are that 25,030,000 men (25.7 percent) and 22,640,000 women (21.5 percent) are smokers, putting them at increased risk of heart attack and stroke.


1999 National Health Interview Survey (NHIS) estimates from the NCHS of persons age 18 and older who are current smokers:


25.5 percent of non-hispanic white men and 23.1 percent of women smoke.

28.7 percent of non-hispanic black men and 28.7 percent of women smoke.

24.1 percent of Hispanic men and 12.3 percent of women smoke.

Among Asian/Pacific Islanders, 24.3 percent of men and 7.1 percent of women smoke.

Among American Indian/Alaska Natives, 40.9 percent of men and 40.8 percent of women smoke.


47.7 percent of working adults who are 17 years old or older and do not use tobacco reported exposure to environmental tobacco smoke at home or at work.


37.4 percent of nonsmoking adults are exposed to environmental tobacco smoke at home or at work. The ethnic breakdown was 37.4 percent of non-Hispanic whites, 36.9 percent of non-Hispanic blacks and 35.1 percent of Mexican-Americans.


The risk of death from coronary heart disease increases by up to 30 percent among those exposed to environmental tobacco smoke at home or at work.


About 15 million children and adolescents under the age of 18 are exposed to environmental tobacco smoke in the home.
* Institute for Social Research, University of Michigan, Monitoring the Future Project.



Cholesterol

An estimated 102,340,000 American adults have blood cholesterol levels of 200 milligrams per deciliter (mg/dL) and higher. Of these, about 41,260,000 American adults have levels of 240 mg/dL or above.* In adults, cholesterol levels of 240 mg/dL or higher are considered high, and levels from 200 to 239 mg/dL are considered borderline-high.

Studies show that, beginning at age 50, more women than men have blood cholesterol of 200 mg/dL or higher.


For ages 35-44, the mean (average) total blood cholesterol of women is 195 mg/dL, but between ages 45 and 64 the average rises from 217 to 235 mg/dL.


Among non-Hispanic whites age 20-74, 52 percent of men and 49 percent of women have blood cholesterol levels over 200 mg/dL. 18 percent of men and 20 percent of women ages 20-74 have blood cholesterol levels of 240 mg/dL or more.**


Among non-Hispanic blacks age 20-74, 45 percent of men and 46 percent of women have blood cholesterol levels over 200 mg/dL. 15 percent of men and 18 percent of women ages 20-74 have blood cholesterol levels of 240 mg/dL or more.**


Among Mexican-Americans age 20 -74, 53 percent of men and 48 percent of women have blood cholesterol levels over 200 mg/dL. 18 percent of men and 17 percent of women ages 20-74 have blood cholesterol levels of 240 mg/dL or more.**


Among elderly Japanese-American men in the NHLBI's Honolulu Heart Program Fourth Examination (1991-93), 42 percent had cholesterol levels of 200 mg/dL or higher or were taking cholesterol-lowering medication.


Other studies show:


Among Asian/Pacific Islanders age 18 and older, 27.3 percent have high blood cholesterol.


Among American Indian/Alaska Natives in Alaska age 18 and older, 26 percent have been told they have high blood cholesterol.
** Data from the National Health and Nutrition Examination Survey III (NHANES III), 1988-94, NCHS and the American Heart Association.




Physical Inactivity

About 29 percent of Americans age 18 and older report no leisure-time physical activity.


About 27 percent of American adults achieve recommended levels of physical activity.


Physical inactivity is more prevalent among these population groups: women, blacks and Hispanics (compared with whites), older adults and the less affluent. People with less than a 12th grade education are also more likely to be sedentary.


The relative risk of coronary heart disease associated with physical inactivity ranges from 1.5 to 2.4, an increase in risk comparable to that observed for high cholesterol, high blood pressure or cigarette smoking.


Less active, less fit persons have a 30 - 50 percent greater risk of developing high blood pressure.



Age, Sex, Race

Daily enrollment in physical education classes has declined among high school students from 42 percent in 1991 to 29.1 percent in 1999.


The 1996 Surgeon General's Report of Physical Activity and Health showed the number of Americans age 18 or older who reported no physical activity was:


15.8 percent of men and 27.1 percent of women (NCHS data from NHANES III, 1988-91);
21.4 percent of men and 26.9 percent of women (NCHS data from NHIS, 1991);
26.5 percent of men and 30.7 percent of women (CDC data from BRFSS, 1992).



Overweight and Obesity
Based upon NCHS data from NHANES III (1988-94), 108,330,000 American adults, age 20 and older (56,350,000 men and 51,980,000 women) are considered overweight.

Among non-Hispanic white adults ages 20-74, 61.5 percent of men and 46.8 percent of women are overweight or obese (BMI of 25.0 or greater). Among non-Hispanic blacks in the same age group the percentages are 58.4 for men and 68.3 for women. For Mexican-Americans the percentages are 69.3 for men and 69.3 for women.


The 1997 data show overweight prevalence of American Indian/Alaska Natives to be 30.1 percent. For Asian/Pacific Islanders the figure is 4.8.

Diabetes Mellitus

(ICD/9 250)

In 1999 diabetes killed 68,399 Americans. Males - 31,150 deaths (45.5 percent of total deaths from diabetes); females - 37,249 (54.5 percent of total deaths from diabetes).

10,600,000 Americans have physician diagnosed diabetes (about 4,900,000 males and 5,700,000 females).


789,000 new cases of non-insulin dependent diabetes are diagnosed every year.


1999 death rates were 25.8 for white males, 48.6 for black males, 20.5 for white females and 50.4 for black females.


545,000 Americans diagnosed with diabetes mellitus were discharged from hospitals in 1999. Of these, 262,000 were males and 283,000 were females.


2/3 of people with diabetes mellitus die of some form of heart or blood vessel disease.


NCHS data from 1997 BRFSS showed the prevalence of diabetes to be:


For whites, 4.4 percent.
For blacks, 7.6 percent.
For Hispanics, 15.5 percent.
For Asian/Pacific Islanders, 4.6 percent.
For American Indian/Alaska Natives, 7.6 percent.


In the 1991-93 phase of the NHLBI's Honolulu Heart Program, 17 percent of Japanese-American men ages 71-93 had diabetes. In addition, 19 percent had unrecognized diabetes, and 32 percent had impaired glucose tolerance.

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