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Colorado Departmentof Public Healthand Environment

IntroductionCardiovascular disease is a broad term that includesheart disease (commonly known as heart attack),stroke, heart failure, hypertensive heart disease, anddiseases of the arteries, veins, and circulatory sys-tem. On average, one Coloradan dies every hour dueto cardiovascular disease. In 2003, there were 9,228deaths caused by cardiovascular disease in Colorado,accounting for 31 percent of the total causes of death.

Cardiovascular disease is the leading cause of deathamong every racial or ethnic group. However, thereis a disproportionate burden of death and disabilityfrom cardiovascular disease present in minority pop-ulations. Health disparities also exist in the preva-lence of modifiable risk factors for cardiovasculardisease.

MethodologyTo determine the presence of racial and ethnic healthdisparities related to cardiovascular disease, threedata sources were used: The Colorado DemographySection, Vital Statistics, and the Behavioral Risk Fac-tor Surveillance System (BRFSS). Population char-acteristics are reported using data from the ColoradoDemography Section. Vital Statistics provided thedata on mortality rates for heart disease and stroke,the two major causes of death categorized as cardio-vascular disease. The BRFSS data were analyzed toassess the prevalence of modifiable risk factorsamong adults in Colorado ages 18 and older.

The data from the aforementioned sources wereorganized using five standard categories to defineracial and ethnic groups:

■ White (including non-Hispanic White);

■ Black (including non-Hispanic Black or AfricanAmerican);

■ Hispanic (including Latino);

■ Asian; and

■ American Indian.

The BRFSS data uses “Other” composed of Asian,Native Hawaiian or Other Pacific Islander, Ameri-can Indian, Alaska Native, and Other.

Population DistributionAccording to the 2000 Census, Colorado’s popula-tion was over 4.3 million and nearly 25% were mem-bers of minority racial and ethnic groups (Figure 1).

Figure 1: Population by Race/Ethnicity, Colorado, 2000

Black3.7%

White73.6%

Two orMore Races

2.8%

AmericanIndian0.7%

Asian2.3%

Hispanic16.9%

Health Disparities and Cardiovascular DiseaseHealth Disparities and Cardiovascular Disease

MortalityCardiovascular disease remains the leading cause ofdeath in Colorado even though there has been a 30percent decrease in the death rate between 1990 and2003. Heart disease and stroke are the first and thirdleading causes of death in Colorado and in the UnitedStates.

The age-adjusted death rates for heart disease byrace and ethnicity from 1990 to 2003 are presentedabove (Figure 2). Blacks have consistently had higherdeath rates than other groups. The rates for Whites,

Blacks, and Hispanics have declined over the 13-yearperiod. Rates for Asians and American Indians havebeen the lowest but show more fluctuation due tosmaller numbers.

The age-adjusted death rates due to stroke by raceand ethnicity from 1990 to 2003 are shown below(Figure 3). Blacks have consistently had higher deathrates than other groups. Rates for Blacks, Asians, andAmerican Indians show more fluctuation due tosmaller numbers.

Figure 2: Trends in Heart Disease by Race/Ethnicity, Colorado, 1990–2003

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Figure 3: Trends in Stroke by Race/Ethnicity, Colorado, 1990–2003

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Risk FactorsRisk factors for heart disease and stroke have beenwell established for many years. Non-modifiable riskfactors include advancing age, family history, gen-der, and genetic determinants. The modifiable riskfactors for cardiovascular disease are summarizedbelow:

■ High blood pressure is a major risk for heart attackand the most important risk factor for stroke.

■ High blood cholesterol, high total cholesterol, highLDL cholesterol, high triglyceride levels, and lowlevels of HDL cholesterol increase risk of heart dis-ease and stroke.

■ Tobacco smoking increases risk of cardiovasculardisease. Breathing second-hand smoke is an addi-tional risk.

■ Adults with diabetes are two to four times morelikely to have a heart attack or suffer a stroke thanadults who do not have diabetes.

■ Adults who are obese are twice as likely to havehigh blood pressure. Obesity is also associatedwith elevated triglycerides and decreased HDLcholesterol.

■ Physical inactivity—increases the risk of heart dis-ease and stroke by 50 percent.

■ Inadequate nutrition is a risk factor for cardiovas-cular disease. Eating five servings of fruits andvegetables every day lowers the risk of ischemicstroke by 30 percent.

A summary of the non-modifiable risk factors fromthe 2003 Behavior Risk Surveillance Survey (BRFSS)shows the disparities within different racial and eth-nic groups (Figure 4). As seen in the chart below,Blacks had the highest prevalence of high blood pres-sure, diabetes, obesity, and inadequate nutrition. His-panics had the highest prevalence of physicalinactivity. Whites had the highest prevalence of highcholesterol. ‘Other’ had the highest prevalence ofcurrent smokers.

Figure 4: Age-Adjusted Prevalence of Risk Factors by Race/Ethnicity, Colorado, 2003

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For the FutureColorado’s health disparities parallel the nationalpicture. African Americans have the highest deathrate due to cardiovascular disease and the shortestlife expectancy. To increase the quality and length oflife among cardiovascular disease survivors and theeliminate health disparities, greater efforts are neededto implement prevention and intervention activitiesamong population groups, particularly AfricanAmericans.

Racial and ethnic health disparities are complex. Fac-tors that explain health disparities include biology,socioeconomic factors, cultural issues, and bias inhealthcare. Modifying risk factors offers the greatestpotential for reducing cardiovascular disease mor-bidity, disability, and mortality.

In collaboration with organizations and healthprofessionals throughout the state, the ColoradoDepartment of Public Health and Environmentestablished a Cardiovascular Disease and StrokePrevention Coalition to implement strategies thatwill decrease mortality, morbidity, and risk fac-tors associated with cardiovascular disease. Thecoalition identified objectives through a strategicplanning process to develop Colorado’s state planto reduce cardiovascular disease. The eliminationof health disparities is an overarching principleof Colorado’s state plan to reduce cardiovasculardisease.

Visit our website at www.cdphe.state.co.us/pp/cvd

For more information, please contact: Gloria Latimer, Program ManagerCardiovascular Disease and Stroke Prevention Program • Colorado Department of Public Health and Environment

(303) 692-2562 • Gloria.Latimer@state.co.us