美国心脏协会：2022年美国心脏病和卒中统计数据报告（EN）_487页_12mb

AHA 2022 Statistical Update Summary

Core Content

The 2022 American Heart Association (AHA) Statistical Update provides comprehensive data on heart disease, stroke, and cardiovascular risk factors in the United States and globally. It highlights the impact of lifestyle, health behaviors, and social determinants on cardiovascular health (CVH) and includes updated information on the epidemiology, outcomes, and economic burden of these conditions.

Main Chapters and Key Findings

1. Cardiovascular Health (Chapter 2)

• CVH Metrics: Low and moderate CVH scores were associated with 70.0% of major cardiovascular disease (CVD) events in the U.S.
• Prevention Potential: Achieving high CVH could prevent 2.0 million major CVD events annually.
• Impact of CVH on Mortality: Partial improvement in CVH scores could reduce 1.2 million events yearly.
• COVID-19 Effects: The pandemic caused a significant mortality toll, leading to a decline in U.S. life expectancy in 2020, particularly among non-Hispanic Black, Hispanic, and low-income populations.
• Life Expectancy: NH Black individuals saw a decline from 74.7 to 72.0 years; Hispanic from 81.8 to 78.0 years; NH White from 78.8 to 78.0 years.

2. Smoking/Tobacco Use (Chapter 3)

• Prevalence: 1.6% of middle school and 4.6% of high school students smoked in 2020.
• Disparities: Higher rates observed among American Indian/Alaska Native adults and youth, and LGBTQ+ adults.
• E-Cigarettes: Use among adolescents increased sharply from 1.5% to 19.6% between 2011 and 2020, making them the most common tobacco product.

3. Physical Activity and Sedentary Behavior (Chapter 4)

• High School Students: 44.1% met the PA guidelines, with lower rates in higher grades.
• Adults: 54.2% of adults met the 2018 aerobic PA guidelines.
• Benefits: Physical activity reduces CVD mortality by 25–40%, all-cause mortality by 22–35%, and other risks like breast and prostate cancer, depression, and improves quality of life.

4. Nutrition (Chapter 5)

• Fruit and Vegetable Intake: 5 servings daily were linked to 13% lower total mortality, 12% lower CVD mortality, and 35% lower respiratory disease mortality.
• Fat Intake: Higher intakes of total fat, polyunsaturated, and monounsaturated fatty acids were associated with lower total mortality, but saturated fat remains controversial.
• Vitamin D: No evidence supports vitamin D supplementation for improving cardiometabolic health in children and adolescents.

5. Overweight and Obesity (Chapter 6)

• Youth Obesity: Increased from 13.9% to 19.3% among 2–19 years old between 1999–2000 and 2017–2018.
• Adults: Male obesity prevalence rose from 27.5% to 43.0%, and female from 33.4% to 41.9%.
• Disparities: Increases were observed in all groups except NH Black males, who showed a rise from 1999 to 2006.

6. High Blood Cholesterol and Other Lipids (Chapter 7)

• Adolescents: 6.1% of males and 3.0% of females had LDL ≥130 mg/dL; 18.4% of males and 7.4% of females had HDL <40 mg/dL.
• Adults: 38.1% had total cholesterol ≥200 mg/dL, 27.8% had LDL ≥130 mg/dL, and 17.2% had HDL <40 mg/dL.

7. High Blood Pressure (Chapter 8)

• Mortality Increase: Death rate from high BP rose by 34.2% from 2009–2019.
• Age-Adjusted Rates: Highest among NH Black males (56.7 per 100,000), lowest among NH Asian/Pacific Islander females (14.5 per 100,000).
• BP Control: Improved from 31.8% in 1999–2000 to 48.5% in 2007–2008, but declined to 43.7% in 2017–2018.

8. Diabetes (Chapter 9)

• Diagnosed Diabetes: 28.2 million adults (10.4%) in 2015–2018.
• Prediabetes: 113.6 million adults (45.8%) had prediabetes.
• CVH Metrics: Proportion with ideal CVH metrics improved from 31.6% to 56.2% over time.

9. Metabolic Syndrome (Chapter 10)

• Socioeconomic Factors: Lower maternal education and socioeconomic disadvantage were linked to higher MetS risk.
• Incidence Risk: Higher MetS severity correlated with increased ischemic stroke risk (HR, 1.75), especially in White females (HR, 2.63).

10. Adverse Pregnancy Outcomes (Chapter 11)

• Prevalence: 10–20% of pregnancies experienced adverse outcomes.
• CVH and Preeclampsia: Lower CVH at 28 weeks was associated with higher preeclampsia risk.
• Preterm Birth: Linked to increased risk of type 1 and type 2 diabetes, hypertension, and lipid disorders.

11. Kidney Disease (Chapter 12)

• Prevalence: 14.9% of U.S. adults had chronic kidney disease (CKD) in 2015–2018.
• End-Stage Renal Disease: 2242 per million people in 2018, highest among Black adults.
• Costs: Medicare spent $81 billion on CKD and $49.2 billion on end-stage renal disease in 2018.

12. Sleep (Chapter 13)

• Sleep Duration: 65.2% of U.S. adults met the recommended 7 hours of sleep.
• HF Risk: Short or long sleep duration increased the risk of heart failure (HR, 1.24–2.48).
• Obstructive Sleep Apnea: Linked to increased cerebrovascular disease risk (HR, 1.94).

13. Total Cardiovascular Diseases (Chapter 14)

• CVD Mortality: ~19 million global deaths in 2020, up 18.7% from 2010.
• Risk by CVH: White males had the highest 35-year CVD risk (65.5%) among low CVH individuals.
• Preexisting CVD and COVID-19 Mortality: Relative risk of 2.25 for death from COVID-19.

14. Stroke (Chapter 15)

• Incidence Decline: Ischemic stroke rates decreased from 282 to 211 per 100,000 in males and from 229 to 174 per 100,000 in females.
• Racial Disparities: Black and Hispanic females ≥70 years had higher stroke risk than White females.
• BP Control: Tight BP control (<130 mmHg) was associated with 42% lower stroke incidence.

15. Brain Health (Chapter 16)

• Alzheimer's: Fourth most prevalent neurological disorder in 2017 (2.9 million people), leading cause of mortality (38 per 100,000).
• Dementia Risk: BP lowering reduced dementia and cognitive impairment risk (OR, 0.93).

16. Congenital Cardiovascular Defects and Kawasaki Disease (Chapter 17)

• Prevalence: 466,566 individuals in the U.S. (2017), 157 per 100,000 globally.
• Socioeconomic Factors: Higher prevalence among low-income and low-education mothers.
• Multisystem Inflammatory Syndrome: 4196 cases and 37 deaths reported in U.S. children by June 2021.

17. Disorders of Heart Rhythm (Chapter 18)

• Air Pollution and AF: PM2.5 and PM10 were associated with increased AF risk (OR, 1.01–1.07).
• AF Detection: Screening with ECG patch and home BP machine detected AF in 5.3% of participants compared to 0.5% with usual care.
• AF and Mortality: AF increased mortality risk in patients with COVID-19 (pooled effect size, 1.14).

18. Sudden Cardiac Arrest (Chapter 19)

• Pandemic Impact: Out-of-hospital cardiac arrest increased by 119% during the pandemic.
• Survival Rates: 22.4% survived to hospital discharge, with 79.5% having good functional status.
• Delays and Outcomes: Increased delays in CPR and reduced survival, but no change in bystander CPR frequency.

19. Subclinical Atherosclerosis (Chapter 20)

• CAC Progression: 53% of MESA participants had CAC >0 after 10 years, with 8% having CAC >100.
• Cancer Mortality: 1.55-fold higher in individuals with CAC ≥1000.
• CVH Decline: CVH scores declined from childhood to adulthood, linked to increased carotid intima-media thickness.

20. Coronary Heart Disease, Acute Coronary Syndrome, and Angina Pectoris (Chapter 21)

• Door-to-Balloon Time: Increased by 4.1% during the pandemic (March–April 2020 vs. 2019).
• Ischemia Time: Increased by 2.8% (11.7% vs. 9.1%).
• Socioeconomic Disparities: Patients in deprived practices had higher odds of adverse outcomes.

Conclusion

The AHA Statistical Update is a vital resource for understanding the burden and prevention of cardiovascular diseases. It emphasizes the importance of CVH, highlights disparities in health outcomes, and underscores the role of social determinants, environmental factors, and lifestyle choices in shaping cardiovascular risk. The report also includes insights into the impact of the pandemic on CVD and stroke outcomes, and the rising prevalence of conditions like obesity and diabetes.