Drop in Cardiac Deaths Tied to Better Treatments, Lifestyles

But rising obesity and diabetes rates could offset those gains, study finds

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HealthDay Reporter

WEDNESDAY, June 6, 2007 (HealthDay News) -- The death rate from heart disease in the United States was cut nearly in half from 1980 to 2000, and that drop was largely due to better medical treatments and a reduction in cardiac risk factors, a new study found.

But, that good news was tempered with some caution, because obesity and diabetes are increasing dramatically, and cardiac complications as a result of those factors could offset the dramatic gains already made.

"This study helps to underscore the importance of risk factors themselves. In a culture where there has been a tendency to rely on miracle drugs and new surgical techniques, we found that as much as half of the decline in coronary heart disease was due to risk reduction," said one of the study's authors, Dr. Darwin Labarthe, director of the division for heart disease and stroke prevention at the U.S. Centers for Disease Control and Prevention in Atlanta.

"While this study shows our strategy is valid and working, we have a long way to go. Many will die immediately from a first heart attack and have no opportunity to benefit from the available treatments. We need to increase our investment in prevention efforts," said Labarthe, adding that prevention would likely be more cost effective than treatment. "You don't have to pay to treat a heart attack that doesn't occur," he said.

Direct and indirect costs of coronary heart disease totaled about $142.5 billion in the United States in 2006, according to the study, which is published in the June 7 issue of the New England Journal of Medicine.

Previous studies had already shown that cardiac deaths had decreased dramatically between 1980 and 2000. But the authors of the new study wanted to gain a better understanding of what factors brought about that reduction, so they could see what works and better allocate health-care resources.

They used a statistical model called IMPACT that incorporates risk factors, such as smoking, high blood pressure, high cholesterol, obesity, diabetes and exercise habits, as well as medical and surgical treatments used to treat heart disease.

Overall, there were 341,745 fewer deaths in 2000 from coronary heart disease than in 1980, according to the study. The researchers found that coronary heart disease deaths in American men dropped from 543 per 100,000 in 1980 to 267 per 100,000 in 2000. In American women, those figures were 263, versus 134 deaths per 100,000, respectively.

When the study authors examined the data to see what factors contributed most to those declines, they found that better medical treatments were responsible for about 47 percent of the decline, while risk factor reduction caused about 44 percent of the drop.

Some of the most significant medical advances were the simplest. Consistent use of aspirin therapy resulted in almost 8,000 fewer deaths in 2000, while the use of aspirin and medications known as beta-blockers after a first heart attack resulted in almost 12,000 fewer deaths. Sometimes, more aggressive intervention was necessary to achieve a reduction in mortality, however. The use of coronary artery bypass graft surgery for people with chronic angina likely saved more than 14,000 lives between 1990 and 2000, according to the study.

But, people also have the capacity to change their cardiovascular risk. A 32 percent decline in smoking saved almost 40,000 people from heart disease death between 1980 and 2000. Lowering blood pressure just 4 percent resulted in 68,800 fewer deaths. Likewise, a small change in cholesterol levels -- an average of 6 percent -- resulted in 82,830 fewer deaths. And increasing physical activity by less than 10 percent saved more than 17,000 lives, according to the study.

The bad news from the study is that obesity is up by 10 percent and diabetes by 44 percent, which together caused approximately additional 60,000 coronary heart disease deaths. If these trends continue, Labarthe said, they could end up canceling out the progress that has been made against heart disease.

Dr. Shukri David, chief of cardiology at Providence Hospital/St. John's Health System in Southfield, Mich., said, "We've made great progress, but we're not done yet. Heart disease is still the number one killer in the U.S. Modifying lifestyle with exercise will have a big impact. People need to realize they can't eat Big Macs and fries and then take cholesterol medicine and not expect to have a heart attack."

Dr. Rudolph Nisi, chief of cardiology at New York Westchester Square Medical Center in New York City, agreed. "Preventive medicine is the best medicine. People think they're invincible, but they need to understand they may be at risk. Once myocardial tissue is gone, it's gone."

More information

To learn more about preventing heart disease, go to the American College of Cardiology Web site.

SOURCES: Darwin Labarthe, M.D., M.P.H., Ph.D., director of the division for heart disease and stroke prevention, U.S. Centers for Disease Control and Prevention, Atlanta; Shukri David, M.D., chief of cardiology, Providence Hospital/St. John's Health System, Southfield, Mich.; Rudolph Nisi, M.D., chief of cardiology, New York Westchester Square Medical Center, New York City; June 7, 2007, New England Journal of Medicine

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