Fewer deaths doesn't mean better health

Fewer people are dying from heart disease now than in 1980, but that doesn't mean Americans are getting any healthier, one group of researchers recently reported.

A study in the Feb. 19, 1997, issue of the Journal of the American Medical Association looked at the significant decline in heart disease deaths that occurred between 1980 and 1990. Prior to this study, the decline in the number of deaths was documented, but no one was sure which factors contributed to the saved lives.

The results were surprising. Researchers found that close to 75 percent of the decline could be attributed to steps taken after heart disease had already occurred. In contrast, only 25 percent of the decline was attributed to preventive measures such as diet and exercise. The conclusion was this: It's easier and less expensive to treat heart disease after it's already taken hold than it is to prevent it before it strikes.

"The decline in [coronary-heart disease] mortality has been a well-known fact for more than 20 years," lead researcher Maria Hunink, M.D., Ph.D., of the University of Groningen, Netherlands, says in a statement. "What startled us was that treating patients with CHD was having so much more effect than trying to prevent the disease."

The study was done with the help of a computer model that looked at figures for simulated people between the ages of 35 and 84 years old. The computer figured the rates of disease and death, risk factors and information on the effectiveness of treatments.

It found that 25 percent of the decline was a result of preventive measures in those without heart disease. However, lifestyle changes in patients with heart disease accounted for 29 percent of the decline, while treatment for heart disease or heart attack accounted for 43 percent of the decrease. Eight percent of the decline could not be explained. (These percentages add up to more than 100 percent because there was some overlap in the statistics used in the study.)

The researchers estimate that controlling cholesterol levels plays a significant role in reducing deaths from heart disease. Lowering cholesterol levels is especially beneficial for those who already have heart disease. Improvements in techniques and medications for treating heart disease have also reduced the death rate. For example, better methods of cardiopulmonary respiration and more effective drugs are now able to save the lives of heart attack patients that otherwise would have died.

Despite these findings, experts are rushing to remind consumers of the importance of prevention. Though the number of deaths from heart disease has been decreasing (at a rate of 2 to 4 percent each year), the overall prevalence of the condition is increasing. Heart disease is still the leading cause of death and complications in the United States.

"Probably close to 90 percent of problems can be prevented if people pay more attention to what they're doing," says Lester R. Sauvage, M.D., founder and medical director of the Hope Heart Institute in Seattle (Medical Tribune, March 20, 1997). However, most people don't make the changes necessary to prevent heart disease.

The American Heart Association (AHA) also reminds that secondary prevention (taking steps once disease has been diagnosed) shouldn't take the place of primary prevention (taking steps before disease begins), no matter what studies show to be most cost-effective.

Recent guidelines from the AHA reinforce the importance of simple preventive measures such as losing weight, eating right, exercising regularly and giving up smoking. (See "Taking Your Health To Heart" for AHA recommendations.)

John LaRosa, M.D., coauthor of the AHA guidelines and chancellor of the Tulane University School of Medicine in New Orleans, reminds, "Exercise, diet, blood pressure control and weight reduction are all very important in slowing the disease. Cardiovascular disease is not an inevitable consequence of aging." (Medical Tribune, June 5, 1997)

Taking Your Health to Heart
In the face of studies that show that care after a heart attack may do more to lower the number of deaths from heart disease than prevention before a heart attack, the American Heart Association (AHA) stresses that prevention is still very important. Each year, the AHA reports, 1.5 million Americans suffer from heart attacks. About one-third of those people die.

To emphasize prevention, the AHA recently announced guidelines for physicians--but these suggestions can be taken to heart by consumers. They include the following:

Check blood pressure at least once every two to three years.

Prescribe blood pressure medication for those whose pressure is higher than 140/90 mm Hg after lifestyle changes, or greater than 160/100 mm Hg without changes.

Advise patients to stop smoking.

Encourage weight loss by educating and counseling patients on nutrition.

Provide medications for those who have high levels of low-density lipoproteins, the bad sort of cholesterol.

Encourage patients to get at least 30 minutes of exercise three to four times a week.

Encourage postmenopausal women to consider hormone replacement therapy, especially if they are at risk for heart disease.

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