Cardiovascular Disease (also called heart disease) is a term that refers to several types of heart conditions, including coronary heart disease, heart attack, and stroke. The most common type of cardiovascular heart disease is coronary artery disease, also known as coronary heart disease. Cardiovascular disease, including coronary heart disease and stroke, is the second leading cause of death in Vermont (after cancer which is #1).

Cardiovascular disease is caused by both preventable and unpreventable risk factors. Risk factors are conditions or habits that make a person more likely to develop a disease. They can also increase the chances that an existing disease will get worse. Preventable risk factors for cardiovascular include: high blood pressure, high blood cholesterol, diabetes and prediabetes, smoking, being overweight or obese, being physically inactive, having an unhealthy diet, and having a history of preeclampsia during pregnancy. Risk factors that are not preventable include: age, sex, race/ ethnicity, and having a family history of heart disease. For more information visit the Department of Health’s Cardiovascular webpage.

According to the Vermont Behavioral Risk Factor Surveillance System (BRFSS), about 8% of Vermont adults were diagnosed with cardiovascular disease in 2015. This has remained about the same since 2005, during which time cardiovascular disease diagnoses was ranged between 7% and 8% each year. BRFSS data from 2014 tells us that among Vermonters with cardiovascular disease, almost half (46%) have high blood pressure, almost two-thirds (65%) have high cholesterol, almost a third smoke (29%), and more than a third (41%) are overweight. Males were significantly more likely to have CVD than females. The prevalence of CVD significantly increased with advancing age. Those with lower socioeconomic status are significantly more likely to have CVD.

A diagnosis of cardiovascular disease increases with age. According to 2010 census data, Vermont is the second oldest state (in terms of median age) in the country. Although cardiovascular disease increases as you get older, people of all ages (including children) can have risk factors like high blood pressure and cholesterol that contribute to cardiovascular disease.

This indicator is important because cardiovascular disease can lead to heart attack or stroke, aneurysm,
heart failure, vision loss, loss of kidney function, gum disease and other oral health complications and cognitive issues. Controlled hypertension and cholesterol are key priorities, as are eating a healthy diet and getting enough physical activity. The Department of Health receives grant funds from the CDC to coordinate activities and partnerships that support strategies to reduce high blood pressure, tobacco use, and promote physical activity and healthy nutrition across the state. These Health Department activities are managed in the Division of Health Promotion and Chronic Disease Prevention, which houses other programs like the Tobacco Control Program, The Physical Activity and Nutrition Program, the heart health side of the Ladies First Program and Diabetes Prevention Activities – all of which promote strategies that play a role in lowering the risks for developing cardiovascular disease.

The Department of Health works with the partners listed below to promote evidence based guidelines of care, support clinical quality improvement activities, increase referrals to and enrollment into self-management programs, provide education and workshops to providers, practices, and other stakeholders, and provide education related to appropriate policy initiatives.    

• Vermont Blueprint for Health and its statewide network of Community Health Teams
• American Heart Association of Vermont
• AARP
• Primary Care Providers (no link available – these are individual practices)
• Community Clinics
• Million Hearts ^®
• Association of State and Territorial Leaders (ASTHO) 
• American Lung Association of Vermont

Identifying people with risk factors for cardiovascular disease is critical. For example, it is important that primary care providers screen patients for high blood pressure, high cholesterol, tobacco use, and overweight and obesity to make sure people with those risk factors for cardiovascular disease know it and can get information about how to control the condition or make behavior changes. Evidence based strategies include maintaining a healthy weight, not smoking, getting adequate exercise, limiting alcohol, and eating a healthy diet rich in fruits, vegetables and fiber and low in fats and sugars. Several programs housed within the Department of Health’s Division of Health Promotion and Chronic Disease Prevention and Division of Alcohol and Drug Prevention support activities that promote those strategies.

National organizations including the CDC, Million Hearts ®, American Heart Association, and American Lung Association recommend a number of evidence-based interventions to help prevent conditions like high cholesterol and high blood pressure from developing, and to assist people with to reduce and control their risk factors. These include:

• Working with a health care team
• Making lifestyle changes (healthy diet, being active, not smoking and limiting alcohol).
• Using self-measured Blood Pressure techniques
• Getting your cholesterol checked
• Primary Care Providers using evidence based treatment protocols
• Million Hearts Healthy Eating and Lifestyle Resource Center

Self-management education programs like the Chronic Disease Self-Management Program (CDSMP) and the YMCA Diabetes Prevention Program (YDPP) help teach people with or at risk for cardiovascular disease to manage lifestyle and behaviors that will lead to better blood pressure control and other lifestyle changes that can help lower reduce risk factors for cardiovascular disease. The CDSMP is called “Healthier Living Workshop” in Vermont and is offered throughout the state. The program specifically addresses arthritis, diabetes, lung and heart disease, but teaches skills useful for managing a variety of chronic diseases. This program was developed at Stanford University and helps individuals develop skills to cope with their condition, improve energy levels, manage pain, and learn to make the best choices for their condition and lifestyle. It covers topic such as: techniques to deal with problems associated with chronic disease, appropriate exercise, appropriate use of medications, communicating effectively with family, friends, and health professionals, nutrition, and how to evaluate new treatments. Participants who took CDSMP demonstrated significant improvements in exercise, ability to do social and household activities, less depression, fear and frustration or worry about their health, reduction in symptoms like pain, and increased confidence in their ability to manage their condition.

An important first step is to make an appointment with your primary care provider to have your blood pressure and cholesterol levels taken. Your provider can help identify ways to maintain healthy blood pressure and cholesterol levels, or develop a plan that could include lifestyle changes and possibly medications, to help lower blood pressure and cholesterol levels. Recommendations from health care providers are among the most influential factors in convincing people to be physically active and join a self-management program.

It is very important for people of all ages to engage in healthy lifestyle behaviors, including not using tobacco, eating a healthy diet, and being physically active. The behaviors that contribute to cardiovascular disease also lead to other chronic diseases. There are three behaviors that lead to four chronic diseases that result in more than 50% of deaths in Vermont. Tobacco use, physical inactivity and poor nutrition all contribute significantly to cancer, heart disease and stroke, diabetes, and pulmonary diseases like asthma and COPD. We call this the 3.4.50 message. For more information, visit the Department of Health’s 3.4.50 webpage.

The Vermont Department of Health is funded by the CDC to work on cardiovascular disease, diabetes, and obesity prevention activities through a grant called State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity, and Associated Risk Factors and Promote School Health. The Department also receives CDC funds for the comprehensive Tobacco Control Program. Our strategy is to work with providers, clinics, schools and community partners to create healthy environments, promote best practices, and support Vermonters to make healthy choices that will prevent or help control cardiovascular disease risk factors.

By focusing on the health and well-being of all Vermonters through quality health systems, promoting physical activity, nutrition, and tobacco prevention and cessation interventions – the most effective ways to lower your risk of developing cardiovascular disease – we can help to address the behaviors and risk factors that contribute to cardiovascular disease and ensure better quality of life for those who are living with those conditions that increase risk.

Behavioral Risk Factor Surveillance System (BRFSS)

Vermont tracks risk behaviors and chronic disease using a telephone survey of adults called the Behavioral Risk Factor Surveillance Survey (BRFSS). Since 1990, Vermont, along with the 49 other states, Washington D.C. and U.S. territories, has participated in the BRFSS with the Centers for Disease Control and Prevention (http://www.cdc.gov/brfss). The CDC provides the Vermont Department of Health with funding each year to carry out the survey. Several thousand Vermonters are randomly and anonymously selected and called annually, on both landlines and cell phones. An adult (18 or older) is asked a uniform set of questions. The results are weighted to represent the adult population of the state.

Note that beginning in 2011 the CDC implemented changes to the BRFSS weighting methodology in order to more accurately represent the adult population. While this makes calculations more representative of the population, the changes in methodology also limit the ability to compare results from 2011 forward with those from previous years. The Vermont Department of Health recommends that comparisons between BRFSS data from 2011 forward and earlier years be made with caution. Statistical differences may be due to methodological changes, rather than changes in opinion or behavior.

Vital Statistics

The Vermont vital statistics system monitors vital events (births, deaths, marriages and civil unions, divorces and dissolutions, etc.). Death certificates are often completed by the funeral directors who obtain all necessary information from the family. However, a physician is required to complete and certify the cause of death in the Electronic Death Registration System (EDRS). Mortality rates are calculated based on the ICD-10 code for the underlying cause of death listed on death records received by Vital Records. Only Vermont residents are included in these calculations. Rates were calculated by comparing the number of deaths in a given time period to the overall population of Vermont in the same time period.

When a measure is age adjusted

Age adjustment is used for comparison of regions with varying age breakdowns. In order to remain consistent with the methods of comparison at a national level, some statistics in Vermont are age adjusted. In cases where age adjustment was noted as being part of the statistical analysis, the estimates were adjusted based on the proportional age breakdowns of the U.S. population in 2000.For more detailed information on age adjustment visit http://www.cdc.gov/nchs/data/statnt/statnt20.pdf

Methods

Prevalence and percentages are calculated by using descriptive statistical procedures using software such as SPSS, SAS, and/or SUDAAN. These statistics describe the proportion of individuals with a given trait in the population during a specified period of time.

Discharge rates are calculated using the Vermont Uniform Hospital Discharge data set. We look at all hospital and ED discharge among Vermont residents who utilized services at regional hospitals (including hospitals in bordering states).We compared the number of discharges in a given time period to the Vermont population in the same time period to calculate discharge rates.