# 12 {#section .Chapter-# .unnumbered}

# Heart Disease and Stroke

#### Heart Disease

12-1 Coronary heart disease (CHD) deaths

12-2 Knowledge of symptoms of heart attack and importance of calling 911

12-3 Artery-opening therapy

12-4 Bystander response to cardiac arrest

12-5 Out-of-hospital emergency care

12-6 Heart failure hospitalizations

12-6a 65 to 74 years

12-6b 75 to 84 years

12-6c 85 years and older

#### Stroke

12-7 Stroke deaths

12-8 Knowledge of early warning symptoms of stroke

#### Blood Pressure

12-9 High blood pressure

12-10 High blood pressure control

12-11 Action to help control blood pressure

12-12 Blood pressure monitoring

#### Cholesterol

12-13 Mean total blood cholesterol levels

12-14 High blood cholesterol levels

12-15 Blood cholesterol screening

12-16 LDL-cholesterol level in CHD patients

### Heart Disease

  ----------------------- -----------------------------------------------
  12-1. Reduce coronary   
  heart disease deaths.   

  **National Data         National Vital Statistics System (NVSS), CDC,
  Source**                NCHS.

  **State Data Source**   National Vital Statistics System (NVSS), CDC,
                          NCHS.

  **Healthy People 2000   15.1 (Heart Disease and Stroke) (also, 1.1,
  Objective**             2.1, 3.1), age adjusted to the 2000 standard
                          population.

  **Measure**             Rate per 100,000 population (age adjusted---see
                          Comments).

  **Baseline**            208 (1998).

  **Numerator**           Number of coronary heart disease-related deaths
                          (ICD-9 codes 402, 410-414, 429.2).

  **Denominator**         Number of persons.

  **Population Targeted** U.S. resident population.

  **Questions Used To     Not applicable.
  Obtain the National     
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            Data are age adjusted to the 2000 standard
                          population. Age-adjusted rates are weighted
                          sums of age-specific rates. For information on
                          age adjustment, see Part A, section 5.

                          This objective differs from Healthy People 2000
                          objective 15.1, which adjusted the death rates
                          using the 1940 standard population. See
                          Appendix C for comparison data.

                          See Part C for a description of NVSS and
                          Appendix A for focus area contact information.
  ----------------------- -----------------------------------------------

  ----------------------- -----------------------------------------------
  12-2. (Developmental)   
  Increase the proportion 
  of adults aged 20 years 
  and older who are aware 
  of the early warning    
  symptoms and signs of a 
  heart attack and the    
  importance of accessing 
  rapid emergency care by 
  calling 911.            

  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          A proposed national data source is the National
                          Health Interview Survey (NHIS), CDC, NCHS.

                          Proposed questions to be used to obtain the
                          national data are scheduled to be included in
                          the 2001 NHIS.

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

  ----------------------- -----------------------------------------------
  12-3. (Developmental)   
  Increase the proportion 
  of eligible patients    
  with heart attacks who  
  receive artery-opening  
  therapy within an hour  
  of symptom onset.       

  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          A proposed national data source is the National
                          Registry of Myocardial Infarction, National
                          Acute Myocardial Infarction Project, HCFA.

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

  ----------------------- -----------------------------------------------
  12-4. (Developmental)   
  Increase the proportion 
  of adults aged 20 years 
  and older who call 911  
  and administer          
  cardiopulmonary         
  resuscitation (CPR)     
  when they witness an    
  out-of-hospital cardiac 
  arrest.                 

  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          A proposed national data source is the National
                          Health Interview Survey (NHIS), CDC, NCHS.

                          Proposed questions to be used to obtain the
                          national data are scheduled to be included in
                          the 2001 NHIS.

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

  ----------------------- -----------------------------------------------
  12-5. (Developmental)   
  Increase the proportion 
  of eligible persons     
  with witnessed          
  out-of-hospital cardiac 
  arrest who receive      
  their first therapeutic 
  electrical shock within 
  6 minutes after         
  collapse recognition.   

  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          A proposed national data source is the Medical
                          Expenditure Panel Survey (MEPS), AHRQ (formerly
                          AHCPR).

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

12-6. Reduce hospitalizations of older adults with congestive heart
failure as the principal diagnosis.

12-6a. Adults aged 65 to 74 years.

+----------------------+-----------------------------------------------+
| **National Data      | National Hospital Discharge Survey (NHDS),    |
| Source**             | CDC, NCHS.                                    |
+----------------------+-----------------------------------------------+
| **State Data         | State hospital discharge data systems.        |
| Source**             |                                               |
+----------------------+-----------------------------------------------+
| **Healthy People     | Not applicable.                               |
| 2000 Objective**     |                                               |
+----------------------+-----------------------------------------------+
| ###### Measure {#m   | Rate per 1,000 population.                    |
| easure .Heading6THP} |                                               |
+----------------------+-----------------------------------------------+
| **Baseline**         | 13.2 (1997).                                  |
+----------------------+-----------------------------------------------+
| **Numerator**        | Number of discharges among adults aged 65 to  |
|                      | 74 years with a principal diagnosis of        |
|                      | congestive heart failure (ICD-9-CM code       |
|                      | 428.0).                                       |
+----------------------+-----------------------------------------------+
| **Denominator**      | Number of adults aged 65 to 74 years.         |
+----------------------+-----------------------------------------------+
| **Population         | U.S. civilian population.                     |
| Targeted**           |                                               |
+----------------------+-----------------------------------------------+
| **Questions Used To  | Not applicable.                               |
| Obtain the National  |                                               |
| Data**               |                                               |
+----------------------+-----------------------------------------------+
| **Expected           | Annual.                                       |
| Periodicity**        |                                               |
+----------------------+-----------------------------------------------+
| **Comments**         | Principal diagnosis is the diagnosis chiefly  |
|                      | responsible for admission of the person to    |
|                      | the hospital.                                 |
+----------------------+-----------------------------------------------+
|                      | See Part C for a description of NHDS and      |
|                      | Appendix A for focus area contact             |
|                      | information.                                  |
+----------------------+-----------------------------------------------+

12-6b. Adults aged 75 to 84 years.

+----------------------+-----------------------------------------------+
| ####                 | National Hospital Discharge Survey (NHDS),    |
| ## National Data Sou | CDC, NCHS.                                    |
| rce {#national-data- |                                               |
| source .Heading6THP} |                                               |
+----------------------+-----------------------------------------------+
| **State Data         | State hospital discharge data systems.        |
| Source**             |                                               |
+----------------------+-----------------------------------------------+
| **Healthy People     | Not applicable.                               |
| 2000 Objective**     |                                               |
+----------------------+-----------------------------------------------+
| **Measure**          | Rate per 1,000 population.                    |
+----------------------+-----------------------------------------------+
| **Baseline**         | 26.7 (1997).                                  |
+----------------------+-----------------------------------------------+
| **Numerator**        | Number of discharges among adults aged 75 to  |
|                      | 84 years with a principal diagnosis of        |
|                      | congestive heart failure (ICD-9-CM code       |
|                      | 428.0).                                       |
+----------------------+-----------------------------------------------+
| **Denominator**      | Number of adults aged 75 to 84 years.         |
+----------------------+-----------------------------------------------+
| **Population         | U.S. civilian population.                     |
| Targeted**           |                                               |
+----------------------+-----------------------------------------------+
| **Questions Used To  | Not applicable.                               |
| Obtain the National  |                                               |
| Data**               |                                               |
+----------------------+-----------------------------------------------+
| **Expected           | Annual.                                       |
| Periodicity**        |                                               |
+----------------------+-----------------------------------------------+
| **Comments**         | See Comments provided with objective 12-6a    |
|                      | for more information.                         |
+----------------------+-----------------------------------------------+

12-6c. Adults aged 85 years and older.

  ----------------------- -----------------------------------------------
  **National Data         National Hospital Discharge Survey (NHDS), CDC,
  Source**                NCHS.

  **State Data Source**   State hospital discharge data systems.

  **Healthy People 2000   Not applicable.
  Objective**             

  **Measure**             Rate per 1,000 population.

  **Baseline**            52.7 (1997).

  **Numerator**           Number of discharges among adults aged 85 years
                          and older with a principal diagnosis of
                          congestive heart failure (ICD-9-CM code 428.0).

  **Denominator**         Number of adults aged 85 years and older.

  **Population Targeted** U.S. civilian population.

  **Questions Used To     Not applicable.
  Obtain the National     
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            See Comments provided with objective 12-6a for
                          more information.
  ----------------------- -----------------------------------------------

### Stroke

  ----------------------- -----------------------------------------------
  12-7. Reduce stroke     
  deaths.                 

  **National Data         National Vital Statistics System (NVSS), CDC,
  Source**                NCHS.

  **State Data Source**   National Vital Statistics System (NVSS), CDC,
                          NCHS.

  **Healthy People 2000   15.2 (Heart Disease and Stroke) (also 2.22,
  Objective**             3.18), age adjusted to the 2000 standard
                          population.

  **Measure**             Rate per 100,000 population (age adjusted---see
                          Comments).

  **Baseline**            60 (1998).

  **Numerator**           Number of stroke deaths (ICD-9 codes 430-438).

  **Denominator**         Number of persons.

  **Population Targeted** U.S. resident population.

  **Questions Used To     Not applicable.
  Obtain the National     
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            Data are age adjusted to the 2000 standard
                          population. Age-adjusted rates are weighted
                          sums of age-specific rates. For information on
                          age adjustment, see Part A, section 5.

                          This objective differs from Healthy People 2000
                          objective 15.2, which adjusted the death rates
                          using the 1940 standard population. See
                          Appendix C for comparison data.

                          See Part C for a description of NVSS and
                          Appendix A for focus area contact information.
  ----------------------- -----------------------------------------------

  ----------------------- -----------------------------------------------
  12-8. (Developmental)   
  Increase the proportion 
  of adults who are aware 
  of the early warning    
  symptoms and signs of a 
  stroke.                 

  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          A proposed national data source is the National
                          Health Interview Survey (NHIS), CDC, NCHS.

                          Proposed questions to be used to obtain the
                          national data are scheduled to be included in
                          the 2001 NHIS.

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

### Blood Pressure

+----------------------+-----------------------------------------------+
| 12-9. Reduce the     |                                               |
| proportion of adults |                                               |
| with high blood      |                                               |
| pressure.            |                                               |
+----------------------+-----------------------------------------------+
| **National Data      | National Health and Nutrition Examination     |
| Source**             | Survey (NHANES), CDC, NCHS.                   |
+----------------------+-----------------------------------------------+
| **State Data         | Not identified.                               |
| Source**             |                                               |
+----------------------+-----------------------------------------------+
| **Healthy People     | Not applicable.                               |
| 2000 Objective**     |                                               |
+----------------------+-----------------------------------------------+
| **Measure**          | Percent (age adjusted---see Comments).        |
+----------------------+-----------------------------------------------+
| **Baseline**         | 28 (1988--94).                                |
+----------------------+-----------------------------------------------+
| **Numerator**        | Number of adults aged 20 years and older with |
|                      | high blood pressure.                          |
+----------------------+-----------------------------------------------+
| **Denominator**      | Number of adults aged 20 years and older.     |
+----------------------+-----------------------------------------------+
| **Population         | U.S. civilian, noninstitutionalized           |
| Targeted**           | population.                                   |
+----------------------+-----------------------------------------------+
| **Questions Used To  | From the 1988--94 National Health and         |
| Obtain the National  | Nutrition Examination Survey:                 |
| Data**               |                                               |
+----------------------+-----------------------------------------------+
|                      | -   Are you now taking prescribed medicine?   |
+----------------------+-----------------------------------------------+
| **Expected           | Annual, beginning with 1999 data.             |
| Periodicity**        |                                               |
+----------------------+-----------------------------------------------+
| **Comments**         | Adults are defined as having high blood       |
|                      | pressure if they either: (a) have a           |
|                      | measurement of systolic blood pressure (SBP)  |
|                      | \> 140 mmHg or diastolic blood pressure (DBP) |
|                      | \> 90 mmHg or (b) report they are taking high |
|                      | blood pressure medicine.                      |
+----------------------+-----------------------------------------------+
|                      | Measurements were taken using a               |
|                      | sphygmomanometer according to the             |
|                      | standardized blood pressure measurement       |
|                      | protocols recommended by the American Heart   |
|                      | Association.**^1^**                           |
+----------------------+-----------------------------------------------+
|                      | A detailed description of the procedures for  |
|                      | blood pressure measurement in the NHANES has  |
|                      | been published elsewhere.**^2,\ 3^**          |
+----------------------+-----------------------------------------------+
|                      | Data are age adjusted to the 2000 standard    |
|                      | population. Age-adjusted percents are         |
|                      | weighted sums of age-specific percents. For   |
|                      | information on age adjustment, see Part A,    |
|                      | section 5.                                    |
+----------------------+-----------------------------------------------+
|                      | See Part C for a description of NHANES and    |
|                      | Appendix A for focus area contact             |
|                      | information.                                  |
+----------------------+-----------------------------------------------+

+----------------------+-----------------------------------------------+
| 12-10. Increase the  |                                               |
| proportion of adults |                                               |
| with high blood      |                                               |
| pressure whose blood |                                               |
| pressure is under    |                                               |
| control.             |                                               |
+----------------------+-----------------------------------------------+
| **National Data      | National Health and Nutrition Examination     |
| Source**             | Survey (NHANES), CDC, NCHS.                   |
+----------------------+-----------------------------------------------+
| **State Data         | Not identified.                               |
| Source**             |                                               |
+----------------------+-----------------------------------------------+
| **Healthy People     | 15.4 (Heart Disease and Stroke) (also 2.26),  |
| 2000 Objective**     | age adjusted to the 2000 standard population. |
+----------------------+-----------------------------------------------+
| **Measure**          | Percent (age adjust---see Comments).          |
+----------------------+-----------------------------------------------+
| **Baseline**         | 18 (1988--94).                                |
+----------------------+-----------------------------------------------+
| **Numerator**        | Number of adults aged 18 years and older who  |
|                      | have been told by a doctor or other health    |
|                      | professional to take prescribed blood         |
|                      | pressure medicine and are now taking it and   |
|                      | whose systolic blood pressure is less than    |
|                      | 140 mmHg and diastolic blood pressure is less |
|                      | than 90 mmHg.                                 |
+----------------------+-----------------------------------------------+
| **Denominator**      | Number of adults with high blood pressure     |
|                      | aged 18 years and older.                      |
+----------------------+-----------------------------------------------+
| **Population         | U.S. civilian, noninstitutionalized           |
| Targeted**           | population.                                   |
+----------------------+-----------------------------------------------+
| **Questions Used To  | From the 1988--94 National Health and         |
| Obtain the National  | Nutrition Examination Survey:                 |
| Data**               |                                               |
+----------------------+-----------------------------------------------+
|                      | -   Because of your high blood                |
|                      |     pressure/hypertension, have you ever been |
|                      |     told by a doctor or other health          |
|                      |     professional to take prescribed medicine? |
+----------------------+-----------------------------------------------+
|                      | -   Are you now taking prescribed medicine?   |
+----------------------+-----------------------------------------------+
| **Expected           | Annual beginning with 1999 data.              |
| Periodicity**        |                                               |
+----------------------+-----------------------------------------------+
| **Comments**         | See Comments provided with objective 12-9.    |
+----------------------+-----------------------------------------------+

+----------------------+-----------------------------------------------+
| 12-11. Increase the  |                                               |
| proportion of adults |                                               |
| with high blood      |                                               |
| pressure who are     |                                               |
| taking action (for   |                                               |
| example, losing      |                                               |
| weight, increasing   |                                               |
| physical activity,   |                                               |
| or reducing sodium   |                                               |
| intake) to help      |                                               |
| control their blood  |                                               |
| pressure.            |                                               |
+----------------------+-----------------------------------------------+
| **National Data      | National Health Interview Survey (NHIS), CDC, |
| Source**             | NCHS.                                         |
+----------------------+-----------------------------------------------+
| **State Data         | Behavioral Risk Factor Surveillance System    |
| Source**             | (BRFSS), CDC, NCCDPHP.                        |
+----------------------+-----------------------------------------------+
| **Healthy People     | Adapted from 15.5 (Heart Disease and Stroke). |
| 2000 Objective**     |                                               |
+----------------------+-----------------------------------------------+
| **Measure**          | Percent (age adjusted---see Comments).        |
+----------------------+-----------------------------------------------+
| **Baseline**         | 82 (1998).                                    |
+----------------------+-----------------------------------------------+
| **Numerator**        | Number of adults aged 18 years and older with |
|                      | high blood pressure who are dieting, reducing |
|                      | salt or sodium intake, exercising, reducing   |
|                      | alcohol consumption or taking high blood      |
|                      | pressure medications.                         |
+----------------------+-----------------------------------------------+
| **Denominator**      | Number of adults with high blood pressure     |
|                      | aged 18 years and older.                      |
+----------------------+-----------------------------------------------+
| **Population         | U.S. civilian, noninstitutionalized           |
| Targeted**           | population.                                   |
+----------------------+-----------------------------------------------+
| **Questions Used To  | From the 1998 National Health Interview       |
| Obtain the National  | Survey:                                       |
| Data**               |                                               |
+----------------------+-----------------------------------------------+
|                      | \[NUMERATOR:\]                                |
|                      |                                               |
|                      | -   Has a doctor or other health professional |
|                      |     EVER advised you to go on a diet or       |
|                      |     change your eating habits to help lower   |
|                      |     your blood pressure?                      |
+----------------------+-----------------------------------------------+
|                      | > \[If yes:\]                                 |
|                      |                                               |
|                      | -   Are you NOW following this advice?        |
+----------------------+-----------------------------------------------+
|                      | -   Has a doctor or other health professional |
|                      |     EVER advised you to cut down on salt or   |
|                      |     sodium in your diet to help lower your    |
|                      |     blood pressure?                           |
+----------------------+-----------------------------------------------+
|                      | > \[If yes:\]                                 |
|                      |                                               |
|                      | -   Are you NOW following this advice?        |
+----------------------+-----------------------------------------------+
|                      | -   Has a doctor or other health professional |
|                      |     EVER advised you to reduce alcohol        |
|                      |     consumption to help lower your blood      |
|                      |     pressure?                                 |
+----------------------+-----------------------------------------------+
|                      | > \[If yes:\]                                 |
|                      |                                               |
|                      | -   Are you NOW following this advice?        |
+----------------------+-----------------------------------------------+
|                      | -   Has a doctor or other health professional |
|                      |     EVER advised you to exercise to help      |
|                      |     lower your blood pressure?                |
+----------------------+-----------------------------------------------+
|                      | > \[If yes:\]                                 |
|                      |                                               |
|                      | -   Are you NOW following this advice?        |
+----------------------+-----------------------------------------------+
|                      | -   Was any medication EVER prescribed by a   |
|                      |     doctor to help lower your blood pressure? |
+----------------------+-----------------------------------------------+
|                      | > \[If yes:\]                                 |
|                      |                                               |
|                      | -   Are you NOW following this advice?        |
+----------------------+-----------------------------------------------+
|                      | \[DENOMINATOR:\]                              |
|                      |                                               |
|                      | -   Were you told on two or more DIFFERENT    |
|                      |     visits that you had hypertension, also    |
|                      |     called high blood pressure?               |
+----------------------+-----------------------------------------------+
|                      | > \[If yes:\]                                 |
|                      |                                               |
|                      | -   Was this only during pregnancy?           |
+----------------------+-----------------------------------------------+
| **Expected           | Periodic.                                     |
| Periodicity**        |                                               |
+----------------------+-----------------------------------------------+
| **Comments**         | People with high blood pressure are defined   |
|                      | as those who are told on two or more          |
|                      | occasions by a physician or other health      |
|                      | professional that they had high blood         |
|                      | pressure. Pregnancy-related high blood        |
|                      | pressure is excluded.                         |
+----------------------+-----------------------------------------------+
|                      | Adults are classified as taking action to     |
|                      | control their blood pressure if they are now  |
|                      | following advice on [any]{.underline} of the  |
|                      | actions listed above: diet/change eating      |
|                      | habits, cut down on salt intake, reduce       |
|                      | alcohol consumption, exercise, or take        |
|                      | medication.                                   |
+----------------------+-----------------------------------------------+
|                      | Data are age adjusted to the 2000 standard    |
|                      | population. Age-adjusted percents are         |
|                      | weighted sums of age-specific percents. For   |
|                      | information on age adjustment, see Part A,    |
|                      | section 5.                                    |
+----------------------+-----------------------------------------------+
|                      | This objective is adapted from Healthy People |
|                      | 2000 objective 15.5, which tracked the        |
|                      | proportion of people with high blood pressure |
|                      | who were taking medication, dieting to lose   |
|                      | weight, cutting down on salt, and exercising  |
|                      | to help control their blood pressure. This    |
|                      | measure tracks the proportion of adults with  |
|                      | high blood pressure who are reducing alcohol  |
|                      | consumption, in addition to the other         |
|                      | actions, to help control their blood          |
|                      | pressure; the measure is age adjusted to the  |
|                      | 2000 standard population.                     |
+----------------------+-----------------------------------------------+
|                      | In Healthy People 2000, a person with high    |
|                      | blood pressure was defined as "...EVER been   |
|                      | told by a doctor or other health professional |
|                      | that you had hypertension, also called high   |
|                      | blood pressure" while in Healthy People 2010, |
|                      | a person is defined as "...told on two or     |
|                      | more DIFFERENT visits that you had high blood |
|                      | pressure."                                    |
+----------------------+-----------------------------------------------+
|                      | See Part C for a description of NHIS and      |
|                      | BRFSS, and Appendix A for focus area contact  |
|                      | information.                                  |
+----------------------+-----------------------------------------------+

+----------------------+-----------------------------------------------+
| 12-12. Increase      |                                               |
| proportion of adults |                                               |
| who have had their   |                                               |
| blood pressure       |                                               |
| measured within the  |                                               |
| preceding 2 years    |                                               |
| and can state        |                                               |
| whether their blood  |                                               |
| pressure was normal  |                                               |
| or high.             |                                               |
+----------------------+-----------------------------------------------+
| **National Data      | National Health Interview Survey (NHIS), CDC, |
| Source**             | NCHS.                                         |
+----------------------+-----------------------------------------------+
| **State Data         | Not identified.                               |
| Source**             |                                               |
+----------------------+-----------------------------------------------+
| **Healthy People     | 15.13 (Heart Disease and Stroke), age         |
| 2000 Objective**     | adjusted to the 2000 standard population.     |
+----------------------+-----------------------------------------------+
| **Measure**          | Percent (age adjusted---see Comments).        |
+----------------------+-----------------------------------------------+
| **Baseline**         | 90 (1998).                                    |
+----------------------+-----------------------------------------------+
| **Numerator**        | Number of adults aged 18 years and older who  |
|                      | had their blood pressure measured within the  |
|                      | preceding 2 years and can state level.        |
+----------------------+-----------------------------------------------+
| **Denominator**      | Number of adults aged 18 years and older.     |
+----------------------+-----------------------------------------------+
| **Population         | U.S. civilian, noninstitutionalized           |
| Targeted**           | population.                                   |
+----------------------+-----------------------------------------------+
| **Questions Used To  | From the 1998 National Health Interview       |
| Obtain the National  | Survey:                                       |
| Data**               |                                               |
+----------------------+-----------------------------------------------+
|                      | -   About how long has it been since you had  |
|                      |     your blood pressure checked by a doctor   |
|                      |     or health professional?                   |
|                      |                                               |
|                      |     0\) Never\                                |
|                      |     (Number) \_\_\_\_\_\_\_\_Days\            |
|                      |     \_\_\_\_\_\_\_\_Weeks\                    |
|                      |     \_\_\_\_\_\_\_\_Months\                   |
|                      |     \_\_\_\_\_\_\_\_Years                     |
+----------------------+-----------------------------------------------+
|                      | -   At that time, did the doctor or health    |
|                      |     professional say your blood pressure was  |
|                      |     high, low, or normal?                     |
|                      |                                               |
|                      |     1\) Not told\                             |
|                      |     2) High\                                  |
|                      |     3) Low\                                   |
|                      |     4) Normal\                                |
|                      |     5) Borderline\                            |
|                      |     6) Other - Specify \_\_\_\_\_\_\_\_       |
+----------------------+-----------------------------------------------+
| **Expected           | Periodic.                                     |
| Periodicity**        |                                               |
+----------------------+-----------------------------------------------+
| **Comments**         | An adult was considered able to state their   |
|                      | blood pressure level if they responded high,  |
|                      | low, normal, or borderline (categories 2-5)   |
|                      | to the second question above.                 |
+----------------------+-----------------------------------------------+
|                      | Data are age adjusted to the 2000 standard    |
|                      | population. Age-adjusted percents are         |
|                      | weighted sums of age-specific percents. For   |
|                      | information on age adjustment, see Part A,    |
|                      | section 5.                                    |
+----------------------+-----------------------------------------------+
|                      | See Part C for a description of NHIS and      |
|                      | Appendix A for focus area contact             |
|                      | information.                                  |
+----------------------+-----------------------------------------------+

### Cholesterol

  ----------------------- -----------------------------------------------
  12-13. Reduce the mean  
  total blood cholesterol 
  levels among adults.    

  **National Data         National Health and Nutrition Examination
  Source**                Survey (NHANES), CDC, NCHS.

  **State Data Source**   Not identified.

  **Healthy People 2000   15.6 (Heart Disease and Stroke) (also 2.27),
  Objective**             age adjusted to the 2000 standard population).

  **Measure**             Mean (age adjusted---see Comments).

  **Baseline**            206 (1988--94).

  **Numerator**           Sum of all cholesterol values for adults aged
                          20 years and older.

  **Denominator**         Number of cholesterol measurements for adults
                          aged 20 years and older.

  **Population Targeted** U.S. civilian, noninstitutionalized population.

  **Questions Used To     Not applicable.
  Obtain the National     
  Data**                  

  **Expected              Annual beginning with 1999 data.
  Periodicity**           

  **Comments**            Total cholesterol is a combination of
                          high-density lipoproteins (HDL), low-density
                          lipoproteins (LDL), and very-low density
                          lipoproteins (VLDL).

                          Total blood cholesterol is measured
                          enzymatically in a series of coupled reactions.
                          A description of the laboratory procedures for
                          the total cholesterol measurement in NHANES is
                          published by NCHS.**^4,\ 5^**

                          Data are age adjusted to the 2000 standard
                          population. Age-adjusted percents are weighted
                          sums of age-specific percents. For information
                          on age adjustment, see Part A, section 5.

                          See Part C for a description of NHANES and
                          Appendix A for focus area contact information.
  ----------------------- -----------------------------------------------

  ----------------------- -----------------------------------------------
  12-14. Reduce the       
  proportion of adults    
  with high total blood   
  cholesterol levels.     

  **National Data         National Health and Nutrition Examination
  Source**                Survey (NHANES), CDC, NCHS.

  **State Data Source**   Not identified.

  **Healthy People 2000   15.7 (Heart Disease and Stroke) (also 2.25),
  Objective**             age adjusted to the 2000 standard population.

  **Measure**             Percent (age adjusted---see Comments).

  **Baseline**            21 (1988--94).

  **Numerator**           Number of adults aged 20 years and older with
                          total blood cholesterol \> 240 mg/dL.

  **Denominator**         Number of adults aged 20 years and older.

  **Population Targeted** U.S. civilian, noninstitutionalized population.

  **Questions Used To     Not applicable.
  Obtain the National     
  Data**                  

  **Expected              Annual, beginning with 1999 data.
  Periodicity**           

  **Comments**            Total cholesterol is a combination of HDL, LDL,
                          and VLDL.

                          Total blood cholesterol is measured
                          enzymatically in a series of coupled reactions.
                          A description of the procedures for the total
                          cholesterol measurement in NHANES has been
                          published by NCHS.**^4,\ 5^**

                          Blood cholesterol levels less than 200 mg/dL
                          are considered desirable. Levels of 240 mg/dL
                          or above are considered high. Levels of 200-239
                          mg/dL are considered borderline.

                          Data are age adjusted to the 2000 standard
                          population. Age-adjusted percents are weighted
                          sums of age-specific percents. For information
                          on age adjustment, see Part A, section 5.

                          See Part C for a description of NHANES and
                          Appendix A for focus area contact information.
  ----------------------- -----------------------------------------------

+----------------------+-----------------------------------------------+
| 12-15. Increase the  |                                               |
| proportion of adults |                                               |
| who have had their   |                                               |
| blood cholesterol    |                                               |
| checked within the   |                                               |
| preceding 5 years.   |                                               |
+----------------------+-----------------------------------------------+
| **National Data      | National Health Interview Survey (NHIS), CDC, |
| Source**             | NCHS.                                         |
+----------------------+-----------------------------------------------+
| **State Data         | Behavioral Risk Factor Surveillance System    |
| Source**             | (BRFSS), CDC, NCCDPHP.                        |
+----------------------+-----------------------------------------------+
| **Healthy People     | 15.14 (Heart Disease and Stroke), age         |
| 2000 Objective**     | adjusted to the 2000 standard population.     |
+----------------------+-----------------------------------------------+
| **Measure**          | Percent (age adjusted---see Comments).        |
+----------------------+-----------------------------------------------+
| **Baseline**         | 67 (1998).                                    |
+----------------------+-----------------------------------------------+
| **Numerator**        | Number of adults aged 18 years and older who  |
|                      | have had their cholesterol checked within 5   |
|                      | years.                                        |
+----------------------+-----------------------------------------------+
| **Denominator**      | Number of adults aged 18 years and older.     |
+----------------------+-----------------------------------------------+
| **Population         | U.S. civilian, noninstitutionalized           |
| Targeted**           | population.                                   |
+----------------------+-----------------------------------------------+
| **Questions Used To  | From the 1998 National Health Interview       |
| Obtain the National  | Survey:                                       |
| Data**               |                                               |
+----------------------+-----------------------------------------------+
|                      | -   When was the last time that you had your  |
|                      |     blood cholesterol level checked by a      |
|                      |     doctor or health professional?            |
|                      |                                               |
|                      |     0\) Never\                                |
|                      |     1) A year ago or less\                    |
|                      |     2) More than 1 year but not more than 2   |
|                      |     years\                                    |
|                      |     3) More than 2 years but not more than 3  |
|                      |     years\                                    |
|                      |     4) More than 3 years but not more than 5  |
|                      |     years\                                    |
|                      |     5) Over 5 years                           |
+----------------------+-----------------------------------------------+
| **Expected           | Periodic.                                     |
| Periodicity**        |                                               |
+----------------------+-----------------------------------------------+
| **Comments**         | An adult was considered as having had their   |
|                      | blood cholesterol checked within the          |
|                      | preceding 5 years if they responded to        |
|                      | [any]{.underline} of the categories in 1      |
|                      | through 4 of the question above.              |
+----------------------+-----------------------------------------------+
|                      | Data are age adjusted to the 2000 standard    |
|                      | population. Age-adjusted percents are         |
|                      | weighted sums of age-specific percents. For   |
|                      | information on age adjustment, see Part A,    |
|                      | section 5.                                    |
+----------------------+-----------------------------------------------+
|                      | See Part C for a description of NHIS and      |
|                      | BRFSS and Appendix A for focus area contact   |
|                      | information.                                  |
+----------------------+-----------------------------------------------+

  ----------------------- -----------------------------------------------
  12-16. (Developmental)  
  Increase the proportion 
  of persons with         
  coronary heart disease  
  who have their          
  LDL-cholesterol level   
  treated to a goal of    
  less than or equal to   
  100 mg/dL.              

  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          A proposed data source is the National Health
                          and Nutrition Examination Survey (NHANES), CDC,
                          NCHS.

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

## References

1\. U.S. Department of Health and Human Services (HHS), National Center
for Health Statistics (NCHS). *Third National Health and Nutrition
Examination Survey, 1998--1994*, NHANES III Adult Household
Questionnaire Data Files (CD-ROM). Public Use Data File Documentation
No. 76200. Hyattsville, MD: Centers for Disease Control and Prevention
(CDC), 1996.

2\. HHS, NCHS. *Third National Health and Nutrition Examination Survey,
1998--1994*, NHANES III Examination Data Files (CD-ROM). Public Use Data
File Documentation No. 76200. Hyattsville, MD: CDC, 1996.

3\. Frohlich, E.D.; Grim, C.; Labarthe, D.R.; et al. Recommendations for
human blood pressure determination by sphygmomanometer. *Hypertension*
11:210A-222A, 1988.

4\. HHS, NCHS. *Third National Health and Nutrition Examination Survey,
1998--1994*, NHANES III Laboratory Data Files (CD-ROM). Public Use Data
File Documentation No. 76200. Hyattsville, MD: CDC, 1996.

5\. Gunter, E.W.; Lewis, B.G.; and Koncikowski, S.M. *Laboratory
Procedures Used for the Third National Health and Nutrition Examination
Survey (NHANES III), 1988--94*. HHS, Public Health Service, CDC, 1996.