Spectacular progress combating heart disease, but challenges remain

The progress combating death from heart disease has been nothing short of spectacular.

A recent study of heart-disease deaths in the southern U.S. found that the death rate has declined by more than 50 percent in Dallas and Tarrant counties, and more than 60 percent in Collin and Denton counties, since 1973.

All of the local counties exceeded the decline in cardiovascular deaths throughout the south, which was slightly less than 50 percent. The largest declines were in central and west Texas, and along the Atlantic coast. The rate of avoidable deaths from heart disease, stroke and high blood pressure in Texas declined more than 4 percent annually from 2001 to 2010.

Heart disease is a broad term for several conditions. Coronary heart disease is the result of plaque build-up in the blood vessels. Congestive heart failure occurs when the heart muscle cannot pump blood efficiently. Damage to artery walls from high blood pressure is another variation.

Despite the progress, heart disease is still the leading cause of death. The American Heart Association has established a goal of reducing heart-disease deaths by 20 percent more by the year 2020.

The vast improvement in deaths from heart attacks and strokes is a worldwide phenomenon. During the second half of the 20th century, death rates fell in wealthier nations by as much as 80 percent.

How do we account for this remarkable accomplishment? Researchers credit half of the decrease to reduction in risk factors and the other half to evidence-based medical therapies.

Jeffrey M. Schussler, MD, FACC, FSCAI, a cardiologist who practices at Baylor Jack and Jane Hamilton Heart and Vascular Hospital and Baylor University Medical Center, said the decrease in cardiovascular deaths is “probably a combination of prevention and better treatment. Overall rates of cardiovascular disease have plateaued or dropped, and many feel that this is due largely to decreased rates of smoking. It would be even better if rates of diabetes and obesity were also dropping,” he said.

“Reducing risks won’t get rid of coronary disease, because there are always genetic factors which predispose people to having heart attacks,” Dr. Schussler said. “However, we can help reduce mortality by early recognition of the signs and symptoms of a heart attack. If a person recognizes early into their heart attack that they’re having one, we’re usually better able to help them. Early treatment with angioplasty typically leads to better outcomes, less heart damage, and lives saved,” Dr. Schussler said.

The rate of cigarette smoking has dropped by more than half and bans on smoking in public places have limited second-hand exposure. High cholesterol and high blood pressure are under better control. However, rising obesity and diabetes rates have slowed what could be even greater progress.

We now have groundbreaking procedures such as coronary-artery bypass grafting, coronary angioplasty and stents. We now have game-changing drugs such as angiotensin-converting-enzyme (ACE) inhibitors and statins.

Nearly one-fourth of all cardiovascular disease deaths are avoidable.

Most of the recent progress has been among the elderly. They are more likely to receive treatment for high cholesterol and are much less likely to smoke than younger adults. Black men are 80 percent more likely to experience avoidable heart-disease death than black women or white men because they are more likely to have high blood pressure and diabetes and are less likely to be physically active.

“Reducing risks won’t get rid of coronary disease, because there are always genetic factors which predispose people to having heart attacks,” Dr. Schussler said. “The other way we can help reduce mortality is by early recognition of the signs and symptoms of a heart attack. If a person recognizes early into their heart attack that they’re having one, we’re usually better able to help them. Early treatment with angioplasty typically leads to better outcomes, less heart damage, and lives saved.”

More: Throughout American Heart Month, Baylor Scott & White Health is holding free events focused on heart disease and other women’s health issues. Find out more.