The Collaborative on Health and the Environment – Washington

A Partnership Network for Environmental Health
Established and Coordinated by the Institute for Children's Environmental Health

Cardiovascular Disease

Cardiovascular disease includes conditions such as coronary heart disease, stroke, high blood pressure, and other diseases that affect the heart and circulatory system.

There is strong evidence that particulate matter in the air is a risk factor for cardiovascular disease. In a scientific statement on "Air Pollution and Cardiovascular Disease", the American Heart Association (AHA) concluded that short- and long-term exposure to ambient particulate matter is a risk factor for cardiovascular disease. The Science and Environmental Health Network recently published an article titled, "Heart Disease and the Environment", which looks at environmental risk factors for cardiovascular disease.

Here's a look at some of the cardiovascular disease information available for Washington State:

Proportion of Cardiovascular Disease Attributable to Environmental Contaminants

In its report on "Preventing Disease Through Healthy Environments: Towards an Estimate of the Environmental Burden of Disease 2006", the World Health Organization has estimated that 16% of the total burden of cardiovascular disease can be attributed to environmental pollution, with a range of 7 - 23%.

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Summary of Information on Washington State

From National Organizations:

The Centers for Disease Control and Prevention (CDC) has "Heart Disease and Stroke Maps" for all states including Washington State that can be used to provide age-adjusted, average annual death-rate information for 1991-2000. The average annual heart disease death rate in the State for this study conducted from 1996-2000 was 432 per 100,000 population, and the stroke -related death rate for 1991-1998 was 134 per 100,000.

Counties with the highest heart disease rates – 420-527 deaths per 100,000 – included Adams, Cowlitz, Lewis, Pacific, Thurston, and Wahkiakum. Counties with the highest stroke rates – 146-153 deaths per 100,000 – included Adams, Columbia, Franklin, Garfield, Pacific, Wahkiakum, and Walla Walla.

Death rate information for both heart disease and stroke are also broken down by race/ethnicity for adults age 35 or older from 1996-2000 and 1991-1998 respectively:

A study on "Particulate Air Pollution Attributable Mortality" conducted by the Natural Resources Defense Council (NRDC) during a five-year time period (1990-1994), estimated that approximately 1,400 people die each year in Washington State from cardiopulmonary diseases associated with air particulates.

From State Organizations:

According to the Department of Health's (DOH) 2004 report, "The Burden of Heart Disease and Stroke in Washington State", heart disease and stroke – the two most common forms of cardiovascular disease – are the first and third leading causes of death in Washington State. More than 16,000 Washingtonians died from cardiovascular disease in 2002; this is 36% of all deaths.

From Local Organizations:

Public Health: Seattle & King County

According to the "King County Medical Examiner’s 2003 Report" of the 775 naturally caused deaths in King County, approximately 58% (450) can be linked to cardiovascular disease.

A study on "Cold-related Cardiac Mortality in King County, Washington, USA 1980-2001" found that cardiac deaths in the winter can be predicted from the temperature, rather than from pollution and other factors.

From Academic Institutions:

University of Washington

Researchers at the University of Washington have conducted several studies on cardiovascular disease and air pollution, including:

• "Cardiovascular Damage by Airborne Particles: Are Diabetics More Susceptible?"
• "The Lag Structure Between Particulate Air Pollution and Respiratory and Cardiovascular Deaths in 10 US Cities"
• "Airborne Particles Are A Risk Factor for Hospital Admissions for Heart and Lung Disease"
• "Exposure to Ambient Fine Particulate Matter and Primary Cardiac Arrest among Persons With and Without Clinically Recognized Heart Disease"

The Northwest Center for Particulate Matter and Health at the University of Washington is currently conducting multiple epidemiological studies of particulate matter and cardiopulmonary mortality. One of the UW's 10-year studies, funded by the US Environmental Protection Agency, will explore the connection between cardiovascular disease and air pollution.

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Information on Washington State in Context

The Washington State rate of heart disease is lower than the national average, yet the rate for stroke is higher than the national average.

According to the CDC's "Heart Disease and Stroke Maps" for the years 1996-2000, the heart disease death rate in Washington State was 432 per 100,000, compared to a national rate of 536; and the stroke -related death rate was 134, compared to the national rate of 121.

The American Heart Association compiles "Death Rates by State" from cardiovascular disease. According to AHA's 2002 data, Washington State had a total cardiovascular death rate of 280.2 per 100,000, and ranked 13th in a comparison of all 50 states when ranked from lowest rates to highest (with the average death rate for the entire country at 319).

The AHA also looked at national and state-specific death rates for heart disease and stroke. For heart disease death rates, Washington State ranked 17th in a lowest to highest ranking system, with a rate of 143.8 per 100,000 population. The average death rate from heart disease for the country was 170.8. In comparison, the State ranked 43rd in a lowest to highest ranking for death rates from stroke, with a rate of 65.2 per 100,000. The average death rate from stroke for the country was 56.2.

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Quality of Information on Washington State

There is reasonably good information available on cardiovascular disease in Washington State, especially concerning mortality rates. The CDC offers heart disease and stroke rates for each county, however, their latest data is from 2000.

The Department of Health offers the most current information on cardiovascular disease in its 2004 report, "The Burden of Heart Disease and Stroke in Washington State". This study looks at prevalence of cardiovascular diseases across age, gender and race, as well as by each individual county.

The Department of Health’s report does not identify air quality as a risk factor for cardiovascular disease, however, a current study on "Air Pollution and Cardiovascular Disease" at the University of Washington will help to address this gap with their 10-year plan to explore the connection between cardiovascular disease and air pollution.

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General Information Sources

American Heart Association: www.americanheart.org/

Center for Disease Control and Prevention: www.cdc.gov

Natural Resources Defense Council: www.nrdc.org/

Northwest Center for Particulate Matter & Health: depts.washington.edu/pmcenter/index.html

Public Health Seattle & King County: www.metrokc.gov/health

The Journal of the American Medical Association: jama.ama-assn.org/

University of Washington News and Information: www.uwnews.org/

Washington State Department of Health: www.doh.wa.gov/

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