Executive summary: Tracking Heart Disease and Stroke in Canada 2009

Executive Summary

Cardiovascular diseases (CVD) are chronic, lifelong diseases caused by interactions among genetic predisposition, health behaviours, and the environment. Fortunately, treatment can relieve symptoms, improve the quality of life, and reduce the possibility of early death. But even more importantly, CVD can be prevented by not smoking, regular physical activity, healthy nutrition, healthy weight, early recognition and treatment of high blood pressure and high cholesterol, and effective stress management.

This report provides a comprehensive look at CVD to increase awareness about Canada’s progress in preventing CVD and its outcomes. It is hoped that governments, volunteer organizations, professional bodies, academics, health service providers, and the public will gain new knowledge from this report to use in decisions to reduce the risk of developing CVD and improving its outcome among Canadians.

A conservative estimate is that 1.6 million Canadians have heart disease or are living with the effects of a stroke. Among seniors, 14.8% of those ages 65 to 74 years report having heart disease, with the proportion climbing to 22.9% over age 75. In this same age group, 7.1% of Canadians report living with the effects of a stroke.

CVD have a major impact on individuals and families, with many individuals reporting fair or poor perceived health, activity restriction, and needing help for daily activities. Anxiety disorders and depression can arise and may influence coping and health outcomes.

In 2000, CVD were the second most costly contributor to total health costs in Canada ($22.2 billion), including $7.6 billion in direct costs and $14.6 billion in indirect costs. In 2000, hospital care was the largest contributor to CVD health care costs ($4.0 billion). Drug costs ($2.1 billion) contributed more than physician care ($1.5 billion). Premature death due to CVD contributed an estimated $9.3 billion in lost productivity. An additional $4.2 billion was lost due to long-term disability and $1.2 billion to short-term disability.

Progress is being made in reducing mortality from CVD. After adjusting for changes in the size and in the aging of the population, the mortality rate for CVD has decreased dramatically from 1960 to 2004. While the exact reason for this decrease is not known, it is likely the result of a combination of factors, including a reduction in the risk of developing CVD with lower rates of smoking and physical inactivity, increased consumption of vegetables and fruit, better diagnosis and treatment of high blood pressure and dyslipidemia, and also better management of individuals with CVD resulting in longer survival.

While the mortality rate is decreasing, the actual number of deaths due to CVD has only recently started to decrease because even with risk reduction and better management, the size of the population is increasing and the population is aging. CVD death rates are highest among those over age 65. In the future, there may be an increase in the number of deaths due to CVD as aging of the population continues in addition to increases in the prevalence of obesity and diabetes, which are two risk factors for CVD.

This report shows that Canadians still run a high risk of developing CVD. Nine out of ten individuals over the age of 20 years have at least one of the following risk factors: smoking, physical inactivity during leisure time, less than recommended daily consumption of vegetables and fruit, stress, overweight or obesity, high blood pressure, or diabetes. Two in five have three or more of these risk factors. Addressing these risk factors will reduce the risk not only of CVD, but also of many other chronic diseases that share the same risk factors.

Some progress is being made in reducing risk in the population for CVD with continued decreased rates since 2000 of smoking and more recently of physical inactivity during leisure time, and increased consumption of vegetables and fruit. However, more needs to be done. The increasing rate of obesity, along with an associated increase in diabetes, has become one of the most important public health challenges facing Canadians. High rates of smoking and obesity among First Nations, Inuit, and Métis are also of concern.

Progress is being made in understanding the genetic susceptibility to CVD. Usually the increased risk for CVD comes from polygenic conditions, or the impact of specific DNA code variations in many genes, rather than from one gene with a large effect. Small changes in genes, called single nucleotide polymorphisms (SNPs), can influence numerous factors that affect the development of CVD such as blood lipids, blood pressure, obesity, diabetes, and insulin resistance.

The most common forms of heart disease are ischemic heart disease including heart attack, and congestive heart failure. Heart disease affects men at an earlier age than women. The rates of hospitalization and death for ischemic heart disease and heart attack among men become noticeable at about 45 years of age and among women at 55 years of age.

Both hospitalization rates and death rates are decreasing for ischemic heart disease and heart attack, suggesting that both prevention and treatment efforts are having a positive effect. These successes, however, are being challenged by the aging of the population, which may increase the number of people with heart disease in the future.

Progress is being made in reducing mortality rates due to stroke. Since 1995, there has been a decline in hospitalization rates for acute stroke. This decrease over time may reflect fewer admissions for both minor and major stroke, as well as lower rates of stroke due to a lower rate of smoking, better management of high blood pressure and dyslipidemia, and better use of preventative treatments such as aspirin. The aging of the population and the large number of baby boomers becoming seniors, along with the increasing rates of obesity and diabetes, may signal an increased number of strokes over the next two decades.

In summary, the ongoing decline in CVD mortality rates is cause for celebration, but not for complacency. Unhealthy behaviours which currently permeate our society continue to put Canadians at risk for developing CVD. Over the next two decades a significant increase may occur in the number of individuals developing heart disease or stroke among the aging baby boomers. This will compromise the health of Canadians, put a strain on the health care system, and have a major economic impact on Canada.