The good news is: Deaths from ischemic heart disease, which clogs coronary arteries, were cut by more than half in the United States from 1990 to 2023 thanks to better control of up to 12 risk factors. What remains controversial is that nearly nine out of 10 recent deaths could have been prevented if these risk factors had been better controlled.
Much of the progress recorded since the inception of the Global Burden of Disease Study, published Wednesday in JAMA Cardiology, is due to deaths caused by smoking (33.3% decrease) and particulate air pollution (74.9% decrease). However, in the final year of the study, 419,000 (88.8%) of the estimated 473,000 deaths from coronary artery disease were still associated with modifiable risk factors.
Coronary artery disease warning signs in 2023 are well known. Rising BMI (12.5% increase) and elevated blood sugar levels (10.5%) since 1990 have been cited as serious problems coinciding with the increasing prevalence of diabetes and the development of the newly recognized cardiovascular-renal-metabolic syndrome, a collective term that includes heart disease, kidney disease, diabetes, and obesity.
Statins and blood pressure drugs alter health risks of obesity, study suggests
“I think it bears repeating that coronary artery disease is preventable,” study co-author Gregory Ross, a professor of cardiology at the University of Washington, told STAT. “For those of us in the medical field, it may seem obvious, but every week we see patients who don’t know that we know how to modify their risk factors and potentially eliminate 80 or 90 percent of the leading causes of death in the United States.”
High blood pressure, high “bad” cholesterol, and impaired kidney function also contribute to deadly heart disease. Behavioral risk factors include poor diet, decreased physical activity, smoking, and alcohol use. Environmental risks arise from pollution, heat, and lead exposure.
“It’s true that mortality rates for ischemic heart disease are decreasing. We’re making progress, but we seem to be losing ground, especially in areas like BMI and diabetes,” Sadiya Khan, a professor of cardiovascular epidemiology at Northwestern Medical School, told STAT. She was not involved in the study. “We can celebrate our successes without saying the job is done. These data are important in driving where we prioritize our attention.”
A systematic analysis of data from the U.S. National Vital Statistics System revealed that where people lived made a difference.
The highest rates of death from coronary artery disease were in Kentucky, Tennessee, West Virginia, Mississippi, and Arkansas, and the lowest were in Massachusetts, Oregon, Hawaii, Colorado, and Minnesota.
Looking back to 1990, when adjusting for the age of the population, Massachusetts, New Jersey, and Minnesota experienced the largest declines, with deaths from coronary artery disease on average more than 63 percent lower than in 1990.
Union cardiovascular health: Benefits, but not everyone.
For example, states that adopted policies to address smoking saw improvements in heart disease. “We want to communicate with individuals about the choices they have, but we really want to get this information to the people who are in a position to guide health care policy,” Ross said.
Almost half of heart disease deaths in 2023 will be due to metabolic and behavioral risks, with hypertension (47.2%), diet (38.6%), and LDL cholesterol (28.5%) leading the way. The new deaths come against a backdrop of slow progress since 2010, when improvements in risk factors stalled as the U.S. population grows and ages.
Robert Khalif, a cardiologist, former Food and Drug Administration commissioner, and member of the Duke Clinical Research Institute, identified cardiovascular, renal and metabolic syndromes, social media, and conflicting public policies as targets.
“It is ironic that a society with so many resources is not proactively addressing this problem, even though a combination of policy interventions, attention to reliable health communication in the information ecosystem, and broader use of generic medicines has an overwhelming chance of dramatically reducing the scourge of CKM syndrome,” he wrote in an editorial published in a research paper published in JAMA Cardiology.
“The recent swing in policy that emphasizes individual choice over public health is concerning because there is evidence that policies that promote and subsidize unhealthy environments for food, exercise, and air can reverse progress and cause further harm,” Khalif continued.
Khalif cited a shortage of primary care physicians and CKM specialists to meet the growing demand for care. He also cited a disconnect between federal recommendations in the new Dietary Guidelines for Americans and the American Heart Association’s Dietary Guidelines for Improving Cardiovascular Health, which advises people to eat more plant-based foods and reduce fat.
Such conflicting advice comes in a data-poor and confusing social media environment, he said.
“We must join the fight on social media and use modern methods to effectively communicate reliable and useful information to counter the overwhelming amount of misinformation used to sell ineffective, unproven health interventions and unhealthy food choices,” Khalif wrote.
Significant changes in cardiovascular guidelines recommend taking statins as young as 30 years old
Study co-author Ross said that at the individual level, prevention is the best tool. This means detecting coronary artery disease before it causes a heart attack or sudden death from artery blockage. The challenge is to find diseases that can slowly hide in most people’s lives. It can take years for symptoms to develop without causing any symptoms that cause concern or prompt medical attention.
High blood pressure, high cholesterol, and impaired kidney function may be invisible to the naked eye, but testing during an annual health check can set off alarm bells. Blood tests are the first signal, followed by a CT scan if needed to determine treatment. Medical societies are recommending screening tests at an earlier age than in the past, but this could mean taking statins to lower cholesterol at age 30, knowing that heart disease develops over decades.
“The main message is not that people need drugs,” Ross said. “The main message is that these risk factors are modifiable. I see situations all the time where people don’t understand the long-term effects on their health.”
North West’s Mr Khan invoked a comprehensive approach.
“Weight loss drugs are now very effective and can help reduce cardiovascular risk in appropriate patients,” she said. “But let’s talk about the food environment, let’s talk about green space, let’s make sure there are safe spaces and places for healthy lifestyles, opportunities for structured exercise. And let’s talk about what are the right medicines and the right steps to make sure that the right medicines are available at an affordable price.”
Ross said newer, more expensive obesity drugs could feature prominently in the next analysis of heart disease mortality, which extends from 2023 to 2025.
“We’re seeing a tremendous shift in the way the federal government decides to invest in the health of its people by changing Medicare and Medicaid,” he said. “These new drugs that we keep hearing about are not reaching most patients, so we need to consider all risk factors holistically.”
STAT’s chronic health coverage is supported by a grant from. bloomberg philanthropy. our financial supporter It has no role in any of our journalism decisions.
