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CDC Vital Signs: Predicted Heart Age and Racial Disparities in Heart Age Among U.S. Adults at the State Level

Abstract

Cardiovascular disease is a leading cause of morbidity and mortality in the United States.

Heart age (the predicted age of a person’s vascular system based on their cardiovascular risk factor profile) and its comparison with chronological age represent a new way to express risk for developing cardiovascular disease.

This study estimates heart age and differences between heart age and chronological age (excess heart age) and examines racial, socio-demographic, and regional disparities in heart age among U.S. adults aged 30–74 years.

Cardiovascular disease (CVD) is responsible for nearly 800,000 deaths and approximately $320 billion in costs in the United States each year (1).

Studies have identified a number of modifiable CVD risk factors, including high blood pressure, smoking, high blood cholesterol, diabetes, and being overweight or obese (1,2).

Differences in prevalence of CVD risk factors play important roles in persistent racial, socioeconomic, and regional disparities in CVD morbidity and mortality in the United States (3,4).

Results:
Overall, average predicted heart age for adult men and women was 7.8 and 5.4 years older than their chronological age, respectively. Statistically significant (p<0.05) racial/ethnic, socio-demographic, and regional differences in heart age were observed: heart age among non-Hispanic black men (58.7 years) and women (58.9 years) was greater than other racial/ethnic groups, including non-Hispanic white men (55.3 years) and women (52.5 years). Excess heart age was lowest for men and women in Utah (5.8 and 2.8 years, respectively) and highest in Mississippi (10.1 and 9.1 years, respectively).

Among 236,101 men and 342,424 women, the mean weighted chronological ages were 47.8 and 47.9 years, respectively (Table 1). The corresponding predicted heart ages and excess heart ages were 55.6 and 53.3 and 7.8 and 5.4 years for men and women, respectively (Table 1).

Among men, blacks had the highest predicted heart age (58.7 years) followed by Hispanics (55.7 years), whites (55.3 years) and others (54.7 years).

Among women, the corresponding values by race/ethnicity were 58.9 years, 53.5 years, 52.5 years, and 52.3 years, respectively.

Excess heart age increased with age and decreased as education and household income increased.

Overall, approximately 69.1 million (43.7%) U.S. adults aged 30–74 years had excess heart age ≥5 years.† Prevalence of excess heart age ≥5 years was 48.8% among men and 38.5% among women; among both sexes, prevalence was higher among blacks compared with whites, increased with age, and decreased with greater education and household income (Table 1).

Among men, the adjusted difference in excess heart age between blacks and whites was 2.7 years, -1.2 years between Hispanics and whites, and 3.8 years between blacks and Hispanics (Table 2). The corresponding numbers for women were 5.3 years, -1.6 years, and 7.0 years, respectively.

The racial differences in predicted excess heart age tended to increase with greater age, education, and household income for blacks compared with whites, but decrease for Hispanics compared with whites (Table 2). For blacks compared with Hispanics, predicted excess heart age tended to increase with greater age, but decrease with greater education and household income.

At the state level, age-standardized excess heart age was lowest in Utah for men (5.8 years) and women (2.8 years) and was highest in Mississippi for men (10.1 years) and women (9.1 years) (Table 3).

Similar patterns were observed in the distribution of prevalence of excess heart age ≥5 years by sex and state (Table 3).

Conclusions and Implications for Public Health Practice:
The predicted heart age among U.S. adults aged 30–74 years was significantly higher than their chronological age.

Use of predicted heart age might 1) simplify risk communication and motivate more persons to live heart-healthy lifestyles and better comply with recommended therapeutic interventions, and 2) motivate communities to implement programs and policies that support cardiovascular health.

The predicted heart age among surveyed U.S. adults aged 30–74 years was substantially higher than their chronological age.

On average, men and women had a predicted heart age 7.8 and 5.4 years older, respectively, than their chronological age, if the selected CVD risk factors were in an ideal range (not smoking, having normal systolic blood pressure (≤120 mmHg) and BMI <25, and not having diabetes).

One in two men and two in five women had a predicted heart age ≥5 years older than their chronological age.

This finding of high prevalence of excess heart age was consistent with the findings of other studies that have documented only a small proportion of U.S. adults meeting ideal cardiovascular health metrics (13,14).

Among younger adults, predicted excess heart age was higher among men compared with women.

For example, among men aged 30–39 years, the average predicted heart age was 3.8 years older than their chronological age, compared with -0.3 years among similarly aged women.

This disparity aligns with other findings showing that the mean chronological age of men who have suffered an initial heart attack is about 7 years younger than that of women (65.0 versus 71.8 years) (1).

This pattern of greater excess heart age among men was consistent across all the age groups until age 60–74 years, where women’s excess heart age surpassed that of men’s…

[CDC MMWR Early Release, September 1, 2015 / 64(Early Release);1-9
Quanhe Yang, PhD1; Yuna Zhong, MSPH1; Matthew Ritchey, DPT1; Mark Cobain, PhD2; Cathleen Gillespie, MS1; Robert Merritt, MA1; Yuling Hong, MD, PhD1; Mary G. George, MD1; Barbara A Bowman, PhD1]