BY TIM BONFIELD
The Cincinnati Enquirer
Getting the message to African Americans and to the poor of all races is seen as the biggest challenge facing public health experts who hope to reduce heart-disease deaths in the 12-state Coronary Valley, which includes Ohio, Kentucky and Indiana.
"We found that our programs have been reaching white, middle-income populations," said Dr. Marilyn Winkelby, a researcher with Stanford University's Center for Research in Disease Prevention.
But data from Coronary Valley states show that heart disease deaths are higher for blacks than whites, and for poor people when compared to richer people. These factors were especially important in New York, the state with the highest heart disease death rate. "Even though cardiovascular disease is declining across all groups, these gaps have not decreased. In fact, there's some evidence they are increasing," Dr. Winkelby said.
Especially striking -- black women were higher than white women in five of the six leading risk factors for heart disease: smoking, physical inactivity, high blood pressure, obesity, and diabetes. The term "Coronary Valley" was coined by Dr. James Muller, chief of cardiovascular medicine at the University of Kentucky in reference to these 12 states (listed in order of the highest coronary death rates): New York, Oklahoma, Missouri, Arkansas, Kentucky, West Virginia, Indiana, Tennessee, Louisiana, Ohio, Michigan and Illinois.
At Dr. Muller's invitation, more than 20 of the nation's top heart experts gathered in Lexington, Ky., last week to discuss strategies for reducing the death rates.
The average heart disease death rate for the Coronary Valley is 116.2 per year, per 100,000 residents. The Lexington conference, which ended Friday, set a 10-year goal to push that death rate down 53 percent, until it matches the current lowest death rate nationwide, New Mexico's, at 54.2 deaths per 100,000 people.
Finding ways to reduce the heart disease gap is becoming increasingly important as the ethnic mix of America continues to change, Dr. Winkelby said.
The U.S. Census Bureau projects that by the year 2050, Caucasians will make up 51 percent of the population, down from 75.5 percent in 1990. African-Americans will grow from 11.4 percent to 16 percent, while Hispanics will grow from 7.4 percent to 20 percent.
Public health agencies need to find better ways to teach ethnic groups about healthful foods, Dr. Winkelby said. Communities need to find and promote safe places for inner-city residents to exercise.
Wider-scale screening programs to detect high blood pressure, diabetes and high cholesterol programs may help. But the bigger, tougher issues for policymakers will be improving access to medical care and improving health coverage for chronic diseases.
