Progress against Heart Disease is the title of a book published in 2004. It might well have been a title 40 years earlier. And since 2004, enormous progress continues to be made.
Make no mistake about it: coronary heart disease is still the number one killer of American men and women. But heart attacks are decreasing, and persons who have an attack are more likely to survive–continuing a trend that started many years ago and is gathering momentum.
The good news in the 1970s and 1980s resulted from ground-breaking events–the development and use of coronary artery bypass graft surgery and balloon angioplasty; the Framingham Heart Study and better understanding of the role of diet and exercise in the prevention of heart disease; and new drugs to lower cholesterol and treat high blood pressure.
The results of these and continuing advances in treatment are now beginning to show up. Data from three million members of Kaiser Permanente Northern California health system found a 24 percent decline in the number of heart attacks and a similar decrease in heart attack deaths from 1999 through 2008. And for ST-elevation heart attacks, the most damaging kind, the drop was 62 percent.
Those results, published in the New England Journal of Medicine [June 10, 2010], were echoed by a Canadian study [Canadian Medical Association Journal, May, 2009] finding a 30 percent decrease in heart attack deaths from 1994 through 2004. A British study more recently reported a decline of more than 50 percent in fatal heart attacks from 2002 to 2010.
Fewer Heart Attacks
The Kaiser Permanente study found that while the heart attack rate increased the first year (1999-2000), it decreased every year after that.
Authors of the study stressed the importance of adopting healthier lifestyles on a large scale. During the study period, Kaiser patients did something positive about their risk factors: average blood pressure and cholesterol readings were lower and the rate of smoking declined.
We know the risk imposed by tobacco, and the decline in cigarette smoking is undoubtedly based on increased acceptance of that fact.
Less widely known is research showing that exposure to second-hand smoke creates a cardiovascular risk nearly as great as that of active smoking. And several studies have documented dramatic declines in heart attacks following passage of laws restricting smoking in public places.
The American diet has been changing gradually over the past four decades. We know what constitutes a heart-healthy diet and, for the most part, we’re trying to follow it. The early emphasis on strictly low fat eating has been modified somewhat, now focusing on replacing unhealthy saturated and trans fats with healthy ones (monounsaturated oils, nuts, fatty fish). Through the Mediterranean diet and similar plans, it’s possible to pursue pleasurable eating and good health at the same time.
Americans still consume too many calories and too much sugar (much of it in the form of soft drinks). Obesity, particularly among children and adolescents, continues at an epidemic pace. Obesity leads to diabetes, and diabetes increases the risk of heart disease. Considering these facts, the progress found in the study is heartening...although clearly the battle is far from over.
The American Heart Association’s guidelines for regular exercise are also well known. Those who follow those guidelines have a way of controlling their weight, blood pressure and cholesterol through activities that strengthen the heart and blood vessels.
In addition to making lifestyle changes, Kaiser Permanente patients were increasingly likely over the course of the study to use prescribed medications such as aspirin, anticoagulants and blood pressure medications.
During the 1980s and 1990s, coronary artery bypass graft surgery and balloon angioplasty were widely used to treat narrowing of coronary arteries and relieve symptoms such as angina and shortness of breath. Today, cholesterol-lowering statins have taken over much of that role.
Largely because of preventive measures, the heart attack rate has been dropping for at least two decades, but the drop since 2000 is particularly impressive considering that new technology has emerged that allows doctors to detect less serious heart attacks that may have gone undetected previously. It’s easier now to diagnose a heart attack, but the overall rate has fallen anyway.
Better Survival
As the number of heart attacks has declined, so has the rate of heart attack deaths–from 10.5 percent within 30 days of an attack in 1999 to 7.8 percent in 2008. Better detection is believed to be at least one factor in the decline.
In 1999, according to the Kaiser study, 47 percent of heart attacks were the more serious type, but by 2008 this number had fallen to 23 percent. One reason for this decline was prevention; another was undoubtedly better detection of less serious attacks, prompting more aggressive attention to risk factors.
Most heart attacks follow a buildup of plaque that ruptures, creating a clot that blocks passage of blood through a crucial coronary artery. In a non-ST-segment elevation heart attack (the less serious kind), movement of blood is slow but only partially blocked. This can be treated with the use of clot-dissolving medications.
The more severe ST-segment elevation heart attack involves a complete blockage of a coronary artery, and instant action must be taken to prevent death or serious damage to the heart muscle. Today, this is most commonly achieved through balloon angioplasty or coronary artery bypass graft surgery. And doctors have become increasingly proficient at performing these procedures on an emergency basis.
Having proper facilities, equipment and personnel is crucial, of course. But so is timing. Reducing the “door-to-balloon” time has been a major priority of hospitals; this is the time that elapses from the moment the patient enters the door of the emergency room until life-saving treatment is administered.
The battle against heart disease is being waged on many fronts. Prevention–through lifestyle changes and medication–is working. And when heart attacks occur, doctors are prepared to take definitive action.
REFERENCES:
Erin Allday, “Heart attacks down 24% in decade, 62% for worst,” San Francisco Chronicle, June 10, 2010.
Carmen Chai, “Fatal heart attack rates declining by 50 percent, experts say,” Global News, January 25, 2012.
“Deaths from heart disease in Canada decreased 30 percent: 10-year national study,” e! Sciences News, June 22, 2009.
“Decline in incidence of heart attacks appears associated with smoke-free workplace laws,” ScienceDaily, October 29, 2012.
Gene Emery, “U.S. heart attack rates declining: study,” Reuters Health, June 9, 2010.
Leon Michaels, “Progress against Heart Disease (review),” Journal of the History of Medicine and Allied Sciences, July, 2005.
National Health Service, UK News, “Massive decline in deadly heart attacks,” NHS Choices, January 26, 2012.
Progress against heart attack death,” Medical University of South Carolina Healthy Aging
Winston Wong, M.D., et al, “Community implements Permanente’s cardiovascular risk reduction strategy,” Permanente Journal, Winter, 2011.
01/08/2013
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