WRITING GROUP MEMBERS Emelia J. Benjamin, MD, SCM, FAHA Michael J. Blaha, MD, MPH Stephanie E. Chiuve, ScD Mary Cushman, MD, MSc, FAHA Sandeep R. Das, MD, MPH, FAHA Rajat Deo, MD, MTR Sarah D. de Ferranti, MD, MPH James Floyd, MD, MS Myriam Fornage, PhD, FAHA Cathleen Gillespie, MS Carmen R. Isasi, MD, PhD, FAHA Monik C. Jiménez, ScD, SM Lori Chaffin Jordan, MD, PhD Suzanne E. Judd, PhD Daniel Lackland, DrPH, FAHA Judith H. Lichtman, PhD, MPH, FAHA Lynda Lisabeth, PhD, MPH, FAHA Simin Liu, MD, ScD, FAHA Chris T. Longenecker, MD Rachel H. Mackey, PhD, MPH, FAHA Kunihiro Matsushita, MD, PhD, FAHA Dariush Mozaffarian, MD, DrPH, FAHA Michael E. Mussolino, PhD, FAHA Khurram Nasir, MD, MPH, FAHA Robert W. Neumar, MD, PhD, FAHA Latha Palaniappan, MD, MS, FAHA Dilip K. Pandey, MBBS, MS, PhD, FAHA Ravi R. Thiagarajan, MD, MPH Mathew J. Reeves, PhD Matthew Ritchey, PT, DPT, OCS, MPH Carlos J. Rodriguez, MD, MPH, FAHA Gregory A. Roth, MD, MPH Wayne D. Rosamond, PhD, FAHA Comilla Sasson, MD, PhD, FAHA Amytis Towfighi, MD Connie W. Tsao, MD, MPH Melanie B. Turner, MPH Salim S. Virani, MD, PhD, FAHA Jenifer H. Voeks, PhD Joshua Z. Willey, MD, MS John T. Wilkins, MD Jason HY. Wu, MSc, PhD, FAHA Heather M. Alger, PhD Sally S. Wong, PhD, RD, CDN, FAHA Paul Muntner, PhD, MHSc On behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart Disease and Stroke Statistics—2017 Update

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

Author(s): Writing Group Members; Mozaffarian, Dariush; Benjamin, Emelia J; Go, Alan S; Arnett, Donna K; Blaha, Michael J; Cushman, Mary; Das, Sandeep R; de Ferranti, Sarah; Despres, Jean-Pierre; Fullerton, Heather J; Howard, Virginia J; Huffman, Mark D; Isasi, Carmen R; Jimenez, Monik C; Judd, Suzanne E; Kissela, Brett M; Lichtman, Judith H; Lisabeth, Lynda D; Liu, Simin; Mackey, Rachel H; Magid, David J; McGuire, Darren K; Mohler, Emile R; Moy, Claudia S; Muntner, Paul; Mussolino, Michael E; Nasir, Khurram; Neumar, Robert W; Nichol, Graham; Palaniappan, Latha; Pandey, Dilip K; Reeves, Mathew J; Rodriguez, Carlos J; Rosamond, Wayne; Sorlie, Paul D; Stein, Joel; Towfighi, Amytis; Turan, Tanya N; Virani, Salim S; Woo, Daniel; Yeh, Robert W; Turner, Melanie B; American Heart Association Statistics Committee; Stroke Statistics Subcommittee

Heart Disease and Stroke Statistics—2016 Update: A Report From the American Heart Association

Author(s): Go, Alan S; Mozaffarian, Dariush; Roger, Veronique L; Benjamin, Emelia J; Berry, Jarett D; Borden, William B; Bravata, Dawn M; Dai, Shifan; Ford, Earl S; Fox, Caroline S; Franco, Sheila; Fullerton, Heather J; Gillespie, Cathleen; Hailpern, Susan M; Heit, John A; Howard, Virginia J; Huffman, Mark D; Kissela, Brett M; Kittner, Steven J; Lackland, Daniel T; Lichtman, Judith H; Lisabeth, Lynda D; Magid, David; Marcus, Gregory M; Marelli, Ariane; Matchar, David B; McGuire, Darren K; Mohler, Emile R; Moy, Claudia S; Mussolino, Michael E; Nichol, Graham; Paynter, Nina P; Schreiner, Pamela J; Sorlie, Paul D; Stein, Joel; Turan, Tanya N; Virani, Salim S; Wong, Nathan D; Woo, Daniel; Turner, Melanie B; American Heart Association Statistics Committee and Stroke Statistics Subcommittee

Heart Disease and Stroke Statistics—2013 Update A Report From the American Heart Association

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .e3

1. About These Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .e7

2. American Heart Association's 2020 Impact Goals. . . . . . . . . . . . . . . . .e10

3. Cardiovascular Diseases . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .e21

4. Subclinical Atherosclerosis . . . . . . . . . . . . . . . . . . . . .e45

5. Coronary Heart Disease, Acute Coronary Syndrome, and Angina Pectoris . . . . . . . . .e54

6. Stroke (Cerebrovascular Disease) . . . . . . . . . . . . . . . . . . . . . . . . . . . .e68

7. High Blood Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .e88

8. Congenital Cardiovascular Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . .e97

9. Cardiomyopathy and Heart Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . .e102

10. Disorders …

Heart Disease and Stroke Statistics—2012 Update A Report From the American Heart Association

Each chapter listed in the Table of Contents (see next page) is a hyperlink to that chapter. The reader clicks the chapter name to access that chapter.

Each chapter listed here is a hyperlink. Click on the chapter name to be taken to that chapter. 

Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together in a single document the most up-to-date statistics related to heart disease, stroke, and the cardiovascular risk factors listed in the AHA’s My Life Check - Life’s Simple 7 (Figure1), which include core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure [BP], and glucose control) that contribute to cardiovascular health. The Statistical Update represents …

Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association.

Electronic cigarettes and public health: a policy brief.

There is limited research about tobacco-related behaviours and attitudes among rural populations in the Eastern Mediterranean Region. The aim of this study was to determine smoking behaviours and attitudes among the nomadic Bedouin in rural southern Jordan. Patients visiting a village clinic over 2 months of 2009 were invited by the attending physician to participate in the survey, which was adapted from the California Tobacco Survey. The smoking prevalence among the 92 participants was 46.7%. Most smokers were men who smoked heavily (> 1 pack/day) (90.7%). There was general low self-efficacy to quit among smokers, yet 81.4% acknowledged that smoking was harming their health. Although 79.1% of smokers and 89.1% of non-smokers believed second-hand smoke was harmful to non-smokers, most of them had no restrictions on smoking for residents and guests (66.3%) and most had children at home (73.9%). These data demonstrate contradictions between attitudes and behaviours about smoking of this rural population.

/pdf/behaviours-and-attitudes-related-to-smoking-among-a-bedouin-w4luz9itko.pdf

Behaviours and attitudes related to smoking among a Bedouin population in rural Jordan.

Ischaemic heart disease (IHD) is one of the more extensively researched diseases and most of its risk factors have been identified by consistent data from different studies. Diet and dietary patterns have been found to be correlated with the risk of IHD, for example, the dietary pattern of fruits and vegetables, whole-meal bread, low fat dairy and little alcohol has an inverse association with the risk, 1 while high intake of red and processed meat, refined grains and sugars, French fries and high fat dairy is associated with increased IHD risk. 2 Milk has been less consistently correlated with IHD and two recent reviews of published literature suggest there is no increased risk. 3,4 Milk is a rather complex food because it is a rich source of protein, saturated fat, calcium and lactose sugar. Saturated fat from dairy products, including whole milk has been found to be related to IHD. 5 Calcium from milk and dairy products is a major source of daily human consumption but the studies have failed to find an association with IHD. 6,7 Lactose is rather specific to unfermented milk and if found related to IHD could specifically point to unfermented milk as the causative nutrient. This is the basis of the paper by Siegel titled: Hypothesis: Is lactose a dietary risk factor for IHD? 8 published 28 years ago in this journal. The association between lactose and IHD was a reasonable and novel hypothesis to pursue three decades ago given the era of increasing awareness of IHD and the search for possible explanations from available data. This was similar to the study by Keys in 1980, 9 which suggested that saturated fat is associated with IHD based on correlational ecological data. However, a closer look at the paper by Segall reveals some methodological problems that undermine the eloquent argument for the observed association between lactose and IHD. This might also explain why no subsequent data was published to support this hypothesis. The paper does present the arguments for a hypothesis rather than a causal association, and therefore an ecological study design for the purpose of promoting such a hypothesis is acceptable. The term ‘ecological fallacy’ was coined in the 1950s and the bias introduced by attempting to apply findings from aggregate or geographical data to the individual-level is well-known. 10 Comparisons of countries without adjustment for important confounders between these countries, which are usually not available from aggregate data, can lead to false conclusions. The well known example of finding higher suicide rates in predominantly Protestant European countries compared with predominantly Catholic countries has been attributed to this fallacy. 11 In his paper, Segall does present the possibility that environmental factors explain the observed association given that the group of countries with high lactose exposure [low prevalence of lactose malabsorption also known as lactose intolerance (LI)] and high IHD were the developed countries with high socioeconomic status. This explanation is then dismissed based on low IHD in Japan and high IHD in the Punjab. The data on LI from the Punjab was based only on 18 subjects, and in the cited IHD study on Punjabis, 91% of the cases were from the high and middle income Punjabi social class, while the unique diet in Japan of fish and seafood high in omega-3 fatty acids (that is mostly protective against IHD) could explain why a country with high socioeconomic status would have low IHD. In a letter to the editor on the inverse association between wine and IHD in European countries, Segall argues about the ‘possible coincidental presence of a geographical factor of unknown identity that explains this association’, 12 an argument that can also explain the findings in the paper on milk and IHD published by Segall.

/pdf/commentary-lactose-and-ischaemic-heart-disease-a-weak-28-2sbm7xi3wy.pdf

Commentary: Lactose and ischaemic heart disease: a weak 28-year-old hypothesis

Fecal microbiota transplant (FMT) is a treatment modality that involves the introduction of stool from a healthy pre-screened donor into the gastrointestinal tract of a patient. It exerts its therapeutic effects by remodeling the gut microbiota and treating microbial dysbiosis-imbalance. FMT is not regulated in Jordan, and regulatory effort for FMT therapy in Jordan, an Islamic conservative country, might be faced with unique cultural, social, religious, and ethical challenges. We aimed to assess knowledge, attitudes, and perceptions of ethical and social issues of FMT use among Jordanian healthcare professionals.
 An observational, cross-sectional study design was used to assess knowledge, attitudes, and perceptions of ethical and social issues of FMT among 300 Jordanian healthcare professionals. A large proportion (39 %) thought that the safety and efficacy of this technique are limited and 29.3 % thought there is no evidence to support its use. Almost all (95 %) responded that they would only perform it in certain cases, if ethically justified, and 48.3 % would use it due to treatment failure of other approaches. When reporting about reasons for not using it, 40 % reported that they would not perform it due to concerns about medical litigation, fear of infections (38 %), and lack of knowledge of long safety and efficacy (31.3 %). Interestingly, all practitioners said they would perform this procedure through the lower rather than upper gastrointestinal tract modality and the majority will protect the patient’s confidentiality via double-blinding (43.3 %). For a subset of participants (n = 100), the cultural constraints that might affect the choice of performing FMT were mainly due to donor’s religion, followed by dietary intake, and alcohol consumption. Our healthcare practitioners are generally reluctant to use the FMT modality due to religious and ethical reasons but would consider it if there was a failure of other treatment and after taking into consideration many legislative, social, ethical and practice-based challenges including safety, efficacy and absence of guidelines.

/pdf/knowledge-attitudes-ethical-and-social-perspectives-towards-56qse44epy.pdf

Wael K. Al-Delaimy

Papers

Electronic cigarettes and public health: a policy brief.

Behaviours and attitudes related to smoking among a Bedouin population in rural Jordan.

Commentary: Lactose and ischaemic heart disease: a weak 28-year-old hypothesis

Knowledge, attitudes, ethical and social perspectives towards fecal microbiota transplantation (FMT) among Jordanian healthcare providers.

Hair in Maori culture: an example of transcultural research