Cardiovascular Disease: Still Number 1

 

Only six in 10 Americans believe that cardiovascular disease, in the form of heart attacks and strokes, remains the leading cause of death in the United States.1. This is surprising, since the 2003 facts on cardiovascular disease are eye catching. 40 percent of all deaths are cardiovascular. Seventeen million Americans currently live with a cardiovascular disease diagnosis.3. This year there were over one million heart attacks in our country, and if you are searching for the leading cause of disability in the US, you don't have to look far. It is cardiovascular disease.4.

As bad as the facts are, they're better than they used to be. In fact, death rates from heart attack and stroke have declined by more than 50 percent since 1950.5. A variety of factors have contributed to the decline, including decreased cigarette smoking, decreases in our nation's mean blood pressure, and decreases in cholesterol. So why the concern?

The concern is that the positive trends are showing signs of reversing. Dr. Peter Libby, Chief of the Cardiovascular Division at Harvard Medical School, says: "The rising tide of cardiovascular risks like obesity is affecting more and more of the younger segments, as well as the older segments of our population. We have to stem that rising tide to prevent the next wave of cardiovascular events, heart attack and stroke from happening."6.

Just over the horizon, cardiovascular trouble is clearly brewing. The rate of decrease in cardiovascular death is slowing. Cases of heart failure and stroke are on the rise. Fewer young people have healthy lifestyles, with two thirds of Americans at 40 now showing some blockage of their coronary arteries by plaque. And then there are the "boomers," a large demographic surge of Americans, poised together to enter the senior ranks.3.

The risk factors associated with cardiovascular disease are becoming increasingly clear, thanks to the participation of some 10,000 citizens of Framingham, Massachusetts, a community 20 miles west of Boston.7. These citizens have continuously participated in the Framingham Heart Study, which began in 1948. By tracking their progress over the past 50 years, our understanding of cardiovascular disease and how to address this disease has made considerable progress.

In fact, the connection between risk factors, disease and death has never been clearer. In the U.S. population today, there are some 11 million Americans with diabetes. 50 million citizens have high blood pressure. 61 million are obese, with weights 20 percent or more above average. 105 million have total cholesterol levels that exceed 200.2,3. If one looks in the aggregate, 22 percent of American men and 27 percent of American women have three or more risk factors for cardiovascular disease.8. And this at-risk population accounts for 75 percent of all heart attacks.9.

The truth is that Americans have become amazingly complacent about heart disease and stroke, considering the risks and damage involved. Recent studies clearly show that we overestimate, by a large degree, our cardiovascular health. 76 percent say they try to maintain a healthy weight, but only 36 percent do. 68 percent say they try to exercise regularly, but only 19 percent do. And more than 60 percent say they try to avoid high fat, high cholesterol foods, but only 10 percent follow national nutrition guidelines. 1.

What's clear is that we're in cardiovascular denial. 57 percent do not believe they're at "much risk" for cardiovascular disease, and 59 percent do not believe it's our number one killer, even though the disease is responsible for 40 percent of all mortality and the majority of morbidity and disability in the U.S.1.

51 years ago, the famous preventative cardiologist, Dr. Paul Dudley White, said: "Heart disease before 80: It's man's fault, not God or Nature's will."6. He was right then. He's still right today. What do the experts advise doctors and nurses who are working with patients to do in order to help patients change their own behaviors? First, start in the waiting room, with highly visible promotional materials from the American Heart Association or others. Second, keep track of the numbers and make the cardiovascular risk assessment part of the medical record. Third, reward positive behavior. Find ways to root for and with the patient. Fourth, make it a team effort, taking advantage of including pharmacists, dieticians, therapists, web managers and self-help groups. And finally, involve the family, with group visits to define family-wide strategies.

With cardiovascular disease, we've made great progress. It would be unfortunate to let those gains slip away.

Until next week, for Health Politics, I'm Mike Magee.

References

1.Harris Poll. The Pfizer Journal Survey on Preventative Cardiovascular Health. www.pfizerjournal.com. 2003

2.CDC. Chronic diseases and their risk factors. 12/99. At: www.cdc.gov. Accessed 06/02/03.

3.US HHS. A Public Health Action Plan to Prevent Heart Disease and Stroke. Atlanta, GA: CDC: 2003.

4.American Heart Association (AHA). Heart Disease and Stroke Statistics-2003 Update. Dallas TX: AHA: 2002.

5.CDC. Achievements in public health. 1990-1999: decline in deaths from heart disease and stroke-US, 1990-1999. MMWR. 1999:48:649-656.

6.Heart Disease: An All Out Attack on Risk. The Pfizer Journal. Volume VII: 4: 2003. p.5

7.Messerli FH, Mittler BS. Framingham at 50. Lancet. 1998;352:1006.

8.Kannel WB. Risk Stratification in hypertension: new insights from the Framingham study. A, J Hypertens. 2000;13:3S-10S.

9.Magnus P, Beaglehole R. The real contribution of the major risk factors to the coronary epidemics: time to end the "only-50%" myth. Arch Intern Med. 2001:161:2657-2660.