Heart Disease Still Biggest Killer

(HealthScout) -- Despite advances in cardiac care and aggressive efforts to promote heart-healthy lifestyles, coronary heart disease continues to be the leading cause of death in the United States.

And while the number of coronary heart disease deaths in this country fell by 2.7 percent between 1990 and 1997, a new report from the Centers for Disease Control and Prevention (CDC) says that's a smaller drop than in decades past. In 1998 alone, heart disease claimed 459,841 lives.

Health officials estimate 12 million Americans currently have heart disease, and 1.1 million will suffer a heart-related episode, such as a heart attack or angina, this year. Nearly two-thirds will be first-time events.

Janice Williams, a CDC epidemiologist who tracks heart disease trends, says too few Americans are heeding messages to quit smoking, stay active and eat healthy. The nation is facing an obesity epidemic, while high blood pressure and high cholesterol -- both controllable factors strongly linked to cardiac problems -- continue to plague the average person.

"Change is tough, but not only do we need individual level change, we need systems to change," Williams says.

For example, she says health officials push regular exercise, such as brisk walking, yet many cities don't have sidewalks.

The CDC study, part of its Morbidity and Mortality Weekly Report, says of the 459,841 Americans who died from coronary heart disease in 1998, roughly 203,000, or 44 percent, involved acute heart attacks.

The death rate for heart disease was highest among people aged 85 and older. They had triple the rate of those aged 75 to 84, and 21 times more than the rate of those aged 55 to 64, the study shows. Men were significantly more likely than women to suffer fatal heart disease and heart attacks.

White men had the highest rate of deadly heart disease, with 440 cases per 100,000 people. They were followed closely by black men, at 421 cases per 100,000, while Hispanics, American Indians and Asian-Americans had 285, 247 and 258 cases per 100,000 individuals, respectively.

Black women had the highest rates of deadly heart disease and heart attacks, with 302 and 140 cases per 100,000, respectively.

New York had the highest rate of deaths from heart disease, with 440 per 100,000 residents, while New Mexico was at the bottom, with 208 per 100,000 people. New Mexico also fared best in heart attack deaths, with 80 per 100,000, while Arkansas, at about 253 per 100,000, was worst.

Although heart disease deaths rose during the 1950s and 1960s, the 1970s saw an average annual drop in heart-related fatalities of 3.1 percent. In the 1980s, the decline averaged 3.3 percent a year, the study shows.

The 2.7 percent annual decline in the first eight years of the 1990s represents a significant slowdown, experts say.

"It's clearly disappointing that the progress we've made in reducing death from coronary heart disease is slowing down, and that that's true at a time when research has allowed us to make enormous strides in knowing what we need to do to prevent deaths," says Dr. Rose Marie Robertson, president of the American Heart Association.

"It's an astonishing fact that at a time when we have an extraordinary array of anti-hypertensives, with few or no side effects, still less than 30 percent of people with high blood pressure have it adequately controlled," says Robertson.

The picture is equally bleak for patients with high cholesterol, even with a number of drugs that lower fat levels and heart disease risk, she says: "There's no reason we shouldn't be at 100 percent for everybody who could appropriately take those medications."

To be fair, Robertson says part of the onus is on doctors who are overburdened with the growing body of evidence on heart disease and the ever-mounting number of guidelines on how to treat patients with the condition.

The problem is especially worrisome for so-called secondary prevention aimed at keeping patients from returning to the hospital with heart-related illness.

To help doctors slog through the material and comply with secondary prevention recommendations, the heart association has started "Get With the Guidelines," a Web-based checklist that doctors and hospitals can turn to when they're ready to discharge heart patients.

Williams says the CDC continues to support prevention efforts, particularly those that familiarize people with the signs of heart disease.

Chest pressure, pain that radiates from the chest to the neck, shoulders or arms, sweating and nausea may indicate a potentially deadly problem, so call 911, Williams says.

The heart association recommends people get at least 30 minutes of moderate exercise five days a week. Unfortunately, Robertson says 60 percent of Americans don't exercise at all.

Reference Source 101

To learn more about heart disease and how to prevent it, check the American Heart Association, the CDC or the National Heart, Lung, and Blood Institute.

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PreventDisease.com's "Quick Prevention Resources".