Heart Disease Deaths Increasing in Middle-Aged Adults

< Nov. 21, 2007 > -- Does a day of football, pizza, and beer in front of the TV sound good? Before getting comfy on the sofa, young adult couch potatoes should consider new information about heart disease death rates.

Public health officials report that the gains made against coronary death rates in recent decades are starting to slip away for middle-aged Americans.

According to research conducted by the Centers for Disease Control and Prevention (CDC) and published in the Journal of the American College of Cardiology, for US men ages 35 to 54, the average annual rate of death from coronary disease declined by 6.2 percent in the 1980s but only by 2.3 percent in the 1990s. It then dropped at an annual rate of 0.5 percent between 2000 and 2002.

For women between 35 and 54, the average annual death rate from coronary disease dropped by 5.4 percent in the 1980s but then slowed to 1.2 percent in the 1990s. Between 2000 and 2002, the annual death rate for women in this age group actually increased by 1.5 percent annually.

Older Age Groups Fare Better Than Their Younger Counterparts

The worrisome plateau in death rates comes at a time when young Americans are increasingly likely to be obese and suffer from diabetes, high blood pressure, and other cardiovascular risk factors.

Overall, the picture looks rosy, says the report that used US vital statistics data between 1980 and 2002 for all people aged 35 and older. The death rate from coronary disease fell by 52 percent in men and 49 percent in women.

"In older age groups, the reduction is still going on," says lead researcher Dr. Earl S. Ford, a medical officer in the US Public Health Service, who co-authored the report with Dr. Simon Capewell of the University of Liverpool in England.

Reasons for Study Results Unclear

Why are middle-aged adults faring more poorly?

"We can't tie these rates to anything in particular, so we have to speculate," Dr. Ford says. That speculation centers on well-known risk factors for coronary disease, such as obesity, diabetes, high blood pressure, and lack of physical activity.

"There is a major epidemic of obesity in the United States," says Dr. Ford. "There have been no major decreases in smoking. [Changes in] cholesterol levels are also flat. Also, hypertension [high blood pressure] in the United States is something people have to pay more attention to."

There is a steady drumbeat of public warnings and doctors' advice about these risk factors, notes Dr. Philip Greenland, a professor of preventive medicine at the Northwestern University Feinberg School of Medicine, who wrote an accompanying editorial. But somehow the message still is not getting through.

"People do know, and then again, they don't know," he says. "The information we've tried to get to patients is almost common knowledge. We're telling people what they already know. They've heard it a million times. Maybe they're waiting to hear something new."

Confusing Information?

The public may be getting a mixed message, Dr. Greenland adds. "We've been telling people for years that we've conquered heart disease, that the mortality rates are going progressively down. But the risk factors exist, and to say that we've conquered the problem is a non sequitur."

Dr. Greenland says his editorial was aimed at practicing physicians. "There is a tendency for physicians to ignore what is known about heart disease. I was trying to get across the idea that if we in the medical profession don't wake up, the gains we thought we achieved will be slipping away from us."

The increase in death rates has affected other areas of cardiovascular disease, says Dr. Martha Daviglus, a professor of medicine and preventive medicine at Northwestern University, Chicago, and a spokeswoman for the American Heart Association.

"For stroke, it is even worse," she says. "The decline in the last 10 years has been very bad."

The message on obesity and other factors of a healthy lifestyle is being ignored by younger Americans, Dr. Daviglus says.

"Young people think it's not going to happen to them," she says. "They're wrong."

Good habits should start early, Dr. Ford says. “Atherosclerotic changes that lead to coronary heart disease occur at an early age. Therefore, it’s especially important that children learn to develop appropriate behaviors that minimize their risk for heart disease later in life. Cardiovascular health is a life-long commitment.”

Always consult your physician for more information.

Facts about cholesterol:

Cholesterol is a waxy substance that can be found in all parts of your body. It aids in the production of cell membranes, some hormones, and vitamin D. The cholesterol in your blood comes from two sources: the foods you eat and your liver. However, your liver makes all of the cholesterol your body needs.

Cholesterol and other fats are transported in your blood stream in the form of spherical particles called lipoproteins. The two most commonly known lipoproteins are low-density lipoproteins (LDL) and high-density lipoproteins (HDL).

LDL cholesterol is commonly called the "bad" cholesterol, and is a type of fat in the blood that contains the most cholesterol. It can contribute to the formation of plaque buildup in the arteries, known as atherosclerosis.

You want your LDL to be low. To help lower it:

• avoid foods high in saturated fat, dietary cholesterol, and excess calories
• exercise
• maintain a healthy weight
• stop smoking

HDL cholesterol is known as the "good" cholesterol, and is a type of fat in the blood that helps to remove cholesterol from the blood, preventing the fatty buildup and formation of plaque.

You want your HDL to be as high as possible. Some people can raise HDL by:

• exercising for at least 20 minutes three times a week
• kicking the cigarette habit
• avoiding saturated fat intake
• decreasing body weight

For others, medicine may be needed. Because raising HDL is complicated, you should work with your physician on a therapeutic plan.

High blood cholesterol is a significant risk factor in heart disease. Lowering blood cholesterol through increased physical activity, weight loss, smoking cessation, and proper diet lowers that risk. However, blood cholesterol is very specific to each individual and, for that reason, a full lipid profile is an important part of your medical history and important information for your physician to have.

In general, healthy levels are as follows:

• LDL - less than 130 milligrams per deciliter (mg/dl)
• HDL - greater than 40 milligrams per deciliter (mg/dl)
• A total cholesterol level below 200 mg/dL is considered desirable

In some individuals who already have coronary artery disease (CAD) and/or who have an increased number of risk factors for coronary heart disease, a physician may determine that the LDL cholesterol level should be kept lower than 130.

Recent studies have shown that those who are at highest risk for a heart attack should lower their LDL cholesterol level to less than 100, and that an LDL cholesterol level of 70 or less may be optimal for those individuals at the very highest level of risk.

Always consult your physician for more information.