HEART DISEASE: Causing Fewer Deaths, But Prevention Lags
While heart disease remains the leading cause of death in the United States, it is killing fewer Americans each year, according to a study in today's New England Journal of Medicine. However, the number of people suffering from heart attacks is not changing much, and for certain populations -- such as black women -- it is even increasing. Overall, between 1987 and 1994, researchers found that heart disease deaths among 35- to 74-year-olds fell 31% for women and 28% for men. White men saw the most improvement, with deaths declining 4.7%, followed by a 4.5% decline in deaths among white women. Black women showed a 4.1% improvement in mortality, but heart disease deaths among black men declined only 2.5% over the period. Looking at the number of first-time heart attacks suffered by Americans each year, the researchers' findings were not optimistic -- there was no decline among the general population, and the numbers actually increased in the black population. The rate of hospital admission for first-time heart attacks increased 7.4% for black women and 2.9% for black men. However, the study found that rates of recurring heart attacks decreased, and survival after heart attacks improved. The study looked at hospital data from four communities -- Forsyth County, NC; Jackson, MS; eight Minneapolis suburbs; and Washington County, MD (Rosamond et al, 9/24 issue). Click here to read an abstract of the study.
Prevention Still Lagging
According to the researchers, their findings demonstrate that heart disease "treatment is outstripping prevention," the AP/Boston Globe reports. "What we're seeing is that improvement is slowing and there are still pockets of the population we need to get our prevention message to," lead author Dr. Wayne Rosamond of the University of North Carolina-Chapel Hill said. The unchanged number of first-time heart attacks reveals "that efforts to recognize heart disease early and to get people to adopt healthier habits are falling short," according to Rosamond. Gregory Heath, chief of heart health at the Centers for Disease Control and Prevention, agreed with Rosamond that prevention efforts need to improved. He noted that Americans suffer from heart attacks because they "do not get enough exercise, depend too much on their cars and do not eat right."
But Dr. Valentin Fuster, president of the American Heart Association, said the trend "toward overall improvement" is due to better preventive measures. He noted that "[m]ore people are taking drugs to control their cholesterol or blood pressure, and more patients recognize the early warning signs of heart attacks and get to a hospital" (9/24). USA Today reports that an accompanying NEJM editorial "says prevention is working better than the study implies" (Painter, 9/24). In the editorial, Drs. Daniel Levy and Thomas Thom of the National Heart, Lung and Blood Institute contend that the "steep declines" in heart disease mortality "are best explained by the joint contributions of primary and secondary prevention." They also suggest that the reason the incidence of heart attacks remains largely unchanged could be that better surveillance techniques are catching more heart attacks (NEJM, 9/24 issue). Click here to read the complete editorial.