Dec. 15, 2008 - Death rates from stroke and coronary heart disease have dropped dramatically in the past decade, but despite repeated warnings to the public, risk factors for the dangerous conditions are still too high, the American Heart Association says.
"The 30% reduction is incredibly good news," Don Lloyd-Jones, MD, ScM, lead author of the update, tells WebMD. "But we don't see that as likely to continue."
However, he says "there's a lot of worry that we are about to reverse" the positive trends. Risk factors for the conditions remain too high, according to the report, "Heart Disease and Stroke Statistics - 2009 Update," published in Circulation: Journal of the American Heart Association.
"The American Heart Association is proud of the progress this country has made against America's No. 1 single cause of death and the No. 3 killer," says Timothy Gardner, MD, president of the AHA. "But our work is not done, since the major risk factors for heart disease and stroke have not seen the same decline as the death rates, and several are rising."
If the trend continues, he says, "death rates could begin to rise again in the years ahead." Although patients are working harder to control high blood pressure and high cholesterol and to quit smoking, "progress continues to lag in obesity, diabetes and physical inactivity."
Heart Disease, Stroke Deaths Down
According to the report:
- Cardiovascular disease remains a major health issue affecting 1 in 3 Americans. Cardiovascular disease accounted for 34.2% of all deaths in the U.S. in 2006.
- Despite recommendations that some proportion of activity be vigorous enough to cause heavy sweating and a significant increase in breathing and heart rate, 62% of adults 18 and older reported no strenuous activity.
- Americans are still too fat and getting fatter. The proportion of obese children ages 6 to 11 skyrocketed from 4% in 1971-1974 to 17% in the 2003-2006 period.
- In adolescents 12 to 19, obesity rates increased from 6.1% to 17.6% in the same time frame.
- On the positive side, since 1999, average cholesterol has fallen from 204 to 199, and that's "a little of a milestone," says Lloyd-Jones, chairman of the AHA's statistics committee.
Edward M. Geltman, MD, professor of medicine at Washington University School of Medicine, says, "We've had great successes in reductions of heart disease, and reductions in stroke death are fabulous," but "the part of the report that's concerning to me is the proportion of people in vigorous activity is much less than it should be. We are a sedentary society and becoming more sedentary."
He says the increase in obesity among youngsters is "terrible, very scary" and that he is concerned about racial disparities. "The death rate from cardiovascular disease for white women is 230.4 per 100,000 and for black females, 319.7," Geltman says. "For white males, it's 324.7 and for black males, 438.4. It's not all socioeconomic. There are genetic markers that predispose some populations to hypertension."
Lloyd-Jones says the obesity epidemic of the past 20 years is causing rising rates of diabetes. "We are in danger of starting to lose a battle that we were well on our way to winning," he tells WebMD. "People who are obese or have diabetes aren't getting the message. We are a nation that consumes far too many calories, we don't do enough physical activity to balance that out, and the net change is going to be a heavier and heavier nation."
"Until we find a way to get leaner again, we are going to pay consequences in terms of cardiovascular disease and cancers," Lloyd-Jones says. He tells WebMD that Americans need more discipline and must reduce intake of calories and get away from highly processed foods. "What has changed in the past 20 years is not our genes, it's the availability of foods that aren't good for us, and we don't get up and move as much. We must reprogram behavior to see improvement."
Gardner says America's challenge is "figuring out what motivates people to change behavior" and to narrow gaps in gender and socioeconomic disparities.
Risk Factors Still Worrisome
The annual update, for the first time, includes data on the early stages of cardiovascular disease as measured by coronary artery calcification scores and ultrasound examinations of neck arteries. Imaging tests are being used more and more to detect problems and start preventive steps earlier.
The report says that in adults 33 to 45, 15% of men and 5.1% of women already had calcification (a marker of atherosclerosis) in their heart arteries. What's more, 1.6% of those checked had calcium scores over 100, high enough to suggest a "significant burden of plaque."
"These data highlight the importance of controlling risk factor levels and obesity in early childhood and young adulthood to prevent the early development of atherosclerosis,'' Lloyd-Jones says. "We have to change."
Adds Geltman, "I'm usually pretty much of an optimist. We have accomplished a great deal. But I'm concerned about consequences down the line if we are not active. I'm not going out of business. What we need now is a public health tsunami of information from public health departments because the best way to reduce health care costs is prevention."