U.S. Experts Concerned About Complacency with Heart Disease

Posted: September 30, 2019 | Word Count: 1,083

Success breeds complacency and in healthcare this is particularly problematic with heart disease. Over the past 50 years, deaths from heart disease have been cut by more than 50% — a public health success story driven largely by medical innovation such as procedures and drugs, according to researchers and U.S. government data.[i],[ii]

However, despite this progress, heart disease remains the number one cause of death.[iii] It kills as many Americans as all cancers and chronic lower respiratory diseases combined.[iii] And after decades of progress, in the past ten years, deaths from heart disease have increased.[iv] Many healthcare professionals worry that no further progress is being made against the number one killer and more treatment innovation is needed.[v]

“Despite it still being the major killer in the United States responsible for about 610,000 deaths [each year, between 1999-2013] according to the American Heart Association (AHA)[vi], [heart disease] seems to generate less fear among the public than cancer … or even the opioid epidemic,” said Mimi Swartz, executive editor at Texas Monthly and contributing opinion writer, writing about coronary complacency in 2018.[vii]

Some argue that these decades of progress have dulled the perception of heart disease as one of the most dangerous public health threats.[viii] Others argue that lowering heart disease risk further is too difficult and too void of medical advances to garner media attention.[v] Health experts warn that heart disease, although blunted by medical advancements, is still a ubiquitous ticking time bomb. Patients and physicians need greater awareness about lowering risk through lifestyle choices. Additional therapies can also lower the risk of heart disease beyond management of blood pressure, diabetes and cholesterol.[ix]

“We may be incubating another [negative] cycle … the skyrocketing increase in obesity, diabetes and the metabolic syndrome even as smoking decreases and hypertension and hyperlipidemia are better treated, may presage such a recurrence,” Henry Greenberg, Susan Raymond and Stephen Leeder, experts affiliated with Columbia University’s Center for Global Health and Economic Development, said in the journal Health Affairs.[x]

The good news, experts say, is there are steps known to help prevent cardiovascular disease and thwart complacency.[xi]

U.S. health authorities recommend the following steps to prevent heart disease. Eat a healthy diet including fresh fruits and vegetables, limited processed foods and low-fat, low-sodium and high-fiber foods. Maintain a healthy weight. Get enough physical activity to keep weight down and lower blood pressure, cholesterol and blood sugar levels. Don’t smoke. And avoid drinking too much alcohol.[xii]

Finally, while advances in medical innovation — the discovery of new ways to prevent and treat cardiovascular disease — have been relatively slow in recent decades, there have been meaningful new findings. Some of these findings have led to corrections in certain prior conventional thinking, such as the lack of value of dietary supplements for treatment of serious diseases.[xiii] Other findings include new therapies which provide opportunities to improve care for many patients.[xiv]

Complacency with taking control of your cardiovascular health can be a killer, but steps — old and new — can help us all try to avoid it and the perils it can bring.

[i] Mensah, George A et al. “Decline in Cardiovascular Mortality: Possible Causes and Implications.” Circulation research vol. 120,2 (2017): 366-380. doi:10.1161/CIRCRESAHA.116.309115

[ii] CDC, NCHS. Death rates for diseases of heart, by sex, race, Hispanic origin, and age: United States, selected years 1950-2016. https://www.cdc.gov/nchs/data/hus/2017/022.pdf

[iii] “Heart Disease and Stroke Statistics – 2019 At-a-Glance.” American Heart Association. 2019.

[iv] Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O’Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS; on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics

Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation. 2019;139:e1–e473. doi: 10.1161/CIR.0000000000000659.

[v] Pattani A. “Rise in heart disease deaths sends experts down new paths.” CNBC, 22 Dec. 2016, https://www.cnbc.com/2016/12/22/as-heart-disease-deaths-rise-health-experts-focus-on-prevention.html

[vi] CDC, NCHS. Underlying Cause of Death 1999-2013 on CDC WONDER Online Database, released 2015. Data are from the Multiple Cause of Death Files, 1999-2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed Feb. 3, 2015.

[vii] Swartz M. “Our Coronary Complacency.” The New York Times, 30 Aug. 2018, https://www.nytimes.com/2018/08/30/opinion/swartz-heart-disease.html

[viii] McKay B. “Heart Attack at 49—America’s Biggest Killer Makes a Deadly Comeback.” The Wall Street Journal, 21 Jun. 2019, https://www.wsj.com/articles/after-decades-of-progress-america-backslides-on-heart-disease-11561129106

[ix] Walker M. “CDC: CV Event Prevention Stalls, Especially Among Middle-Aged Adults.” MedPage Today, 6 Sep. 2018, https://www.medpagetoday.com/cardiology/prevention/74962

[x] Greenberg, H et al. “Cardiovascular Disease And Global Health: Threat And Opportunity.” Health Affairs. 2017. https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.W5.31

[xi] “Preventing Heart Disease: Other Medical Conditions.” Centers for Disease Control and Prevention, https://www.cdc.gov/heartdisease/medical_conditions.htm

[xii] “Preventing Heart Disease: Healthy Living Habits.” Centers for Disease Control and Prevention, https://www.cdc.gov/heartdisease/medical_conditions.htm

[xiii] Jacobsen A et al. “Hypertriglyceridemia Management According to the 2018 AHA/ACC Guideline.” American College of Cardiology, 11 Jan. 2019, https://www.acc.org/latest-in-cardiology/articles/2019/01/11/07/39/hypertriglyceridemia-management-according-to-the-2018-aha-acc-guideline

[xiv] Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, Goldberg R, Heidenreich PA, Hlatky MA, Jones DW, Lloyd-Jones D, Lopez-Pajares N, Ndumele CE, Orringer CE, Peralta CA, Saseen JJ, Smith SC Jr, Sperling L, Virani SS, Yeboah J. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/ APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139:e1082– e1143. DOI: 10.1161/CIR.0000000000000625.

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