Preventing cardiovascular disease in Kentucky: epidemiology, trends, and strategies for the future.

Cardiovascular disease (CVD) is the leading cause of death in the United States despite dramatic improvements in the treatment of heart disease in recent years. Kentucky leads the nation in the prevalence of several individual risk factors for cardiovascular disease, the prevalence of multiple risk factors, and in cardiovascular mortality. While trends in the prevalence of some of these cardiac risk factors have shown improvement, others have remained unchanged or have worsened. The increased prevalence of obesity and diabetes, especially among young persons, is one of the most worrisome trends. The prevalence of smoking in Kentucky remains high, and has not declined substantially in the past fifteen years. As a consequence of poverty, low educational levels, a high unemployment rate, and often limited access to medical care, select populations in the Appalachian region of the state have among the highest rates of cardiovascular disease in the developed world. In the 2004 Behavioral Risk Factor Surveillance System (BRFSS) report of the Centers for Disease Control and Prevention, Kentucky had met none of the stated objectives related to cardiovascular risk for Healthy Kentuckians 2010. Public health initiatives and interventions directed toward the prevention of CVD in Kentucky must address Kentucky's unique challenges if progress is to be made.