Heart Death Rates Worsening for Middle-Aged Adults

MONDAY Nov. 19, 2007 -- The gains made against coronary death rates in recent decades are starting to slip away for middle-aged Americans, public health officials report.

Overall, the picture looks rosy, said a report that used U.S. 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," said lead researcher Dr. Earl S. Ford, a medical officer in the U.S. Public Health Service, who co-authored the report with Dr. Simon Capewell of the University of Liverpool in England.

But the picture is more bleak for Americans aged 35 to 54.

For men of that age, 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.

"What we are seeing reflects experience among the youngest people we looked at," said Ford, whose team published its findings in the Nov. 27 issue of the Journal of the American College of Cardiology.

Things look better when all patients 35 and older are included. On an annual basis, the coronary disease death rate among men 35 and up declined by 2.9 percent a year during the 1980s, 2.6 percent a year during the 1990s and 4.4 percent a year from 2000 to 2002. For all women aged 35 and over, the annual coronary death rate declined by 2.6 percent, 2.4 percent and 4.4 percent annually for those periods, respectively.

Why are middle-aged adults faring more poorly?

"We can't tie these rates to anything in particular, so we have to speculate," Ford said. 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," Ford said. "There have been no major decreases in smoking. [Changes in] cholesterol levels are also flat. Also, hypertension 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, noted 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 isn't getting through.

"People do know, and then again, they don't know," he said. "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."

The public may be getting a mixed message, Greenland added. "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."

The editorial was aimed at practicing physicians, Greenland said. "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, said 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 said. "The decline in the last 10 years has been very bad."

The message on obesity and other factors of a healthy lifestyle are being ignored by younger Americans, Daviglus said.

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

Posted: November 2007


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