PHOENIX, AZ — Whereas in 1999, cardiovascular disease (CVD) excluding stroke was the main cause of death in all US states except Alaska, 14 years later, deaths from cancer surpassed those from CVD in almost half of the states, a new study reports[1].

Dr Michael C Harding (Brigham Young University, Provo, UT) presented these findings from the US Center for Disease Control and Prevention (CDC) National Vital Statistics System at a moderated poster session at the recent American Heart Association (AHA) Epidemiology and Prevention and Lifestyle and Cardiometabolic Health (EPI/Lifestyle) 2016 Scientific Sessions.

"Although we should encourage and continue our efforts to decrease the burden of cardiovascular disease, we should also do a better job of preventing and controlling cancer," he told heartwire from Medscape.

About half of the dramatic reduction in heart-disease mortality can be attributed to better treatments such as revascularization and about half to reductions in risk factors such as smoking, cholesterol, and blood pressure, but not BMI or diabetes, according to a study by Earl Ford and colleagues[2], Harding pointed out.

An audience member observed that smoking, for example, is a risk factor for both heart disease and cancer, which could muddy the findings. Since cancer has a longer lag time, reductions in lung cancer may be seen at a later date, Harding conceded.

In 2013, CVD was a highly predominant cause of death in three states—Alabama, Oklahoma, and New York, he told heartwire . The researchers plan to examine how age, sex, race/ethnicity, the prevalence of cigarette smoking, or other factors may be influencing how the leading cause of death is shifting from CVD to cancer.

Deaths from Cancer vs Heart Disease in 50 States

Since the 1940s, heart disease and cancer have been the number-one and number-two causes of death, respectively, in the US, Harding explained. But the gap has narrowed due to a steep decline in CVD mortality and a relatively modest decline in cancer mortality, he noted.

The researchers analyzed mortality data from the National Vital Statistics System for each state and each year from 1999 to 2013. They hypothesized that the transition from cardiovascular disease to cancer as the leading cause of death is hidden on a national level but would be visible on a state level.

From 1999 to 2013, on a national level, CVD mortality fell from 265.9 per 100,000 to 193.3 per 100,000, and cancer mortality fell from 201.6 per 100,000 to 185.0 per 100,000. That is, nationally, the ratio of CVD mortality to cancer mortality fell from 1.32 to 1.04.

On a state level, in 1999, the unadjusted median ratio of state-specific CVD mortality to cancer mortality was 1.29. This ratio ranged from 0.89 in Alaska (the only state where cancer was the main cause of death) to 1.57 in New York (where CVD deaths predominated more so than in any other state).

By 2013, CVD was the leading cause of death in 27 states, and the median ratio of state-specific CVD mortality to cancer mortality dropped to 1.08. New York State still had the greatest preponderance of deaths from CVD; the ratio of CVD mortality to cancer mortality was 1.23.

These findings show that the public-health message that "CVD is the leading cause of death" is oversimplified, since it was true for the overall country, but not for all states.

The results can help identify regional differences in the risk of dying from CVD and cancer, which can be used to implement more targeted risk-reduction strategies and treatments, according to Harding.

The authors have no relevant financial relationships.


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