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June 25, 2019

After 60 years of progress, more middle-aged Americans are dying of heart disease. What's going wrong?

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    The United States over the past century saw a substantial decline in deaths from heart attacks and strokes, but progress has stalled in recent years, and heart attack-related deaths are rising among middle-aged U.S. residents, Betsy McKay reports for the Wall Street Journal.

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    According to McKay, heart disease-related deaths was once on track to fall from its place as the leading cause of death in the United States. CDC data show the U.S. cardiovascular disease death rate fell by more than 70% from the 1960s to 2010. According to McKay, that decline stemmed largely from targeted efforts to reduce smoking, as well as advancements in surgery and medications to control blood pressure.

    But in 2011 that progress began to level off, McKay reports. CDC data show the overall rate of cardiovascular disease deaths has fallen by only 4% since 2011—and has actually increased 1.5% among U.S. adults ages 45 to 64.

    A 'new wave' of cardiovascular disease deaths

    Even though the cardiovascular death rate is still declining among U.S. adults ages 75 and older, who account for the majority of cardiovascular deaths, researchers and cardiologists are paying particular attention to what McKay calls a "new wave of cardiovascular disease mortality."

    Steven Nissen, chief academic officer of the Heart and Vascular Institute at the Cleveland Clinic, said today's heart disease patients are significantly different from the patients physicians learned to identify about 50 years ago. Nissen explained that, back then, heart disease patients were usually male smokers with high levels of LDL—or "bad"—cholesterol. Now, patients are younger, more obese, less likely to be smokers, and more likely to be women.

    Nissen said, "I've been working in a coronary-care unit for 40 years, and the patient that comes in now looks completely different from the patient when I was starting out. It is an absolutely striking difference."

    Why heart disease deaths are rising among middle-aged US adults

    Cardiologists and researchers have said the U.S. obesity epidemic and the related increase in Type 2 diabetes are largely responsible for this new wave of cardiovascular patients.

    "The consequences of obesity are eroding the enormous gains brought about by public-health campaigns against smoking, along with medical innovations such as cholesterol-lowering statin drugs," McKay reports.

    Among U.S. adults ages 20 and older, about 40% are obese and a further 32% are overweight, while about 9.4% of U.S. adults ages 18 and older have diabetes. Several studies have shown a link between obesity, diabetes, high blood pressure, and other conditions that increase a patient's risk of a heart attack, heart failure, and stroke, according to McKay.

    Sadiya Khan, a cardiologist and assistant professor of medicine at Northwestern University Feinberg School of Medicine, said, "I think obesity is the new smoking in terms of contribution to heart disease. We've made such great progress in coming up with smoking-cessation programs. For physical activity, healthy diet and weight loss we haven't found the right approach."

    What experts say needs to be done

    Cardiologists and researchers have said the United States must use new approaches and tools to address the increase in cardiovascular disease deaths among today's patient population. The key, experts say, will be identifying at-risk patients before they develop obesity and diabetes and counseling them on nutrition and exercise.

    To do this, Harlan Krumholz, a Yale University cardiologist and health care researcher, said physicians need access to "more granular, more accurate, more timely" digital health data to confirm and understand trends in heart disease deaths (McKay, Wall Street Journal, 6/21).

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