Overview of the New Report on Heart Health

The sudden death of 58-year-old “Meet the Press” host Tim Russert in June from a massive heart attack shocked millions of middle-aged Americans.

Diagnosed with high cholesterol and high blood pressure, the gregarious NBC Washington bureau chief had been taking cholesterol and blood-pressure medications and aspirin and was told to diet and exercise, says Roger S. Blumenthal, an associate professor of medicine at the Johns Hopkins University Hospital in Baltimore.

“He exercised, but, like many other patients, he was not able to motivate himself” to diet, and “he knew that he had a tendency to overeat and to gorge when he was stressed,” says Blumenthal.

The American diet – built all too often on a shaky, fast-food foundation – leaves most of us with arteries coated with fatty plaques, especially once middle age approaches. Some of those plaques – medical science doesn’t yet know which ones – have a tendency to break away from the blood-vessel wall. Then blood cells called platelets can stick to the dislodged plaque, forming a blood clot that can trigger a heart attack.

Russert had just returned to work after a family trip to Italy when he suffered such a plaque rupture, possibly triggered by stress and lack of sleep, along with another potentially fatal complication – a heart arrhythmia. He died before he could be taken to a hospital. Although his office had a publicly accessible AED – automated external defibrillator – his colleagues waited for an ambulance crew to arrive rather than trying to shock his heart back into rhythm.

“One in every six heart attacks has sudden death as its first, last and only symptom,” says William B. Kannel, a Boston University professor of medicine and public health. And among heart-attack fatalities, nearly half are sudden-death events, he adds.

Overall, about 40 percent of both women and men die of a heart-related ailment, says Blumenthal. “Most of us face it after the age of 60.” On the plus side, he notes, the death rate is declining.

In 1999, the American Heart Association (AHA) declared a goal of reducing deaths from cardiovascular illnesses by 25 percent by 2010, “and we’re there already,” says AHA President-elect Clyde Yancy, medical director of Baylor University Medical School’s Heart and Vascular Institute in Houston, Texas. In January, data from the U.S. Centers for Disease Control and Prevention (CDC) showed coronary heart-disease death rates down by 25.8 percent and stroke deaths down 24.4 percent since 1999.

In fact, it’s “fairly likely that in the next 10 to 15 years cancer will supplant [cardiovascular disease] as the leading cause of death,” says Peter W. Groeneveld, an assistant professor of medicine at the University of Pennsylvania in Philadelphia.

Nonetheless, sedentary lifestyles and a diet heavy in saturated fats and processed carbohydrates have created several generations of young Americans vulnerable to cardiovascular disease. As a result, the downward trend in cardiovascular disease rates is expected to reverse itself in the coming decades.

“In a nation in optimal health,” adults would reach a stable health status around age 20, and then their health status “would stay relatively flat until almost the time they die,” says David Herrington, a professor of internal medicine at the Wake Forest University School of Medicine in Winston-Salem, N.C. “You’d have a very, very long period of being mobile, high-functioning and able to take care of yourself.”

But in American society, he explains, many people experience a gradual decline in health status beginning in their 50s – usually related to cardiovascular conditions, which can cause disability for 10-30 years. Due largely to unhealthy lifestyles, “We already have several generations on this trajectory” who will require “lots of care provided by friends and family, nurses, home-health workers and hospitals, which is an incredible drain on society,” he says.

William Boden, a professor of medicine and public health at the State University of New York’s University at Buffalo, agrees. “In 2008, we’re looking at the tip of the iceberg” on heart disease as a widespread illness, he says. In the next few years, two large waves of patients with cardiovascular disease will sweep through the system, beginning with the nation’s 76 million aging baby boomers – born between 1946 and 1964.

“Because of demographics, the sheer numbers [of cardiovascular diseases] are up,” says Herrington, even though the percentage of people who get the disease has declined. “The number of people who have them is astronomically large.”

The second wave of cardiovascular disease will hit between 2030 and 2050, triggered by the obesity epidemic now plaguing the nation. Two-thirds of Americans are overweight, and a growing number of adolescents are being diagnosed with Type 2 diabetes – both markers for subsequent cardiovascular disease, Boden says. “The lid is going to blow off vascular diseases, and it could bankrupt society.”

Michael A. Blazing, an associate professor of medicine at Duke University, in Durham, N.C., blames the rise in cardiovascular disease in part on the failure of the health-care and insurance industries to focus on healthier lifestyles. Such low-cost initiatives have often been ignored while medical research produced techniques to prolong lives after people have suffered a first stroke or heart attack, he explains.

“We continue to move forward in reducing risk of a second heart attack,” Blazing says. “Today 65-year-olds come in with a heart attack, and they’re golfing a week later.” But cardiovascular illnesses are long-building diseases with well-known risk factors, many of them controllable, he continues. “And the cost of providing the care only after the disease has manifested itself is becoming more and more astronomical.”

Meanwhile, nutrition counseling and other health-education efforts haven’t been reimbursed by public or private insurers, he points out, but physicians “get paid wonderfully” for opening a blocked artery.

In addition, there’s plenty of high-tech waste in the system, says Blumenthal, such as requests for sophisticated diagnostic tests that may not reveal much of significance. “Physicians shouldn’t be reimbursed for giving someone a nuclear stress test every July,” he says, because it not only costs more but also exposes patients to more radiation than traditional stress testing. State-of-the-art procedures like nuclear stress tests, which record the heart’s electrical activity, “take up a bigger and bigger part of the Medicare budget” without providing a clear return, he says.

Other physicians defend Americans’ love affair with high-tech.

“We’ve been telling patients not to eat cheeseburgers for 50 years, and they still don’t believe us,” says Andrew Rosenson, a radiologist in Oak Forest, Ill., outside of Chicago. But when patients actually see the plaque in their arteries, via a high-tech scan, “I’ve had 50-year-old CEOs sitting in my office crying,” pledging to follow the preventive regimens their doctors have long recommended in vain.

Currently, Medicare is experimenting with risk-factor reduction programs with its age-65-and-up enrollees, but such programs should be expanded to people who are 60 or younger, says Kenneth Thorpe, a professor of health policy and management at the Emory University School of Public Health in Atlanta. However, insurance companies and employers who provide health coverage for younger people see no financial benefit in offering preventive services for illnesses that, for most people, won’t become really costly until patients are old enough for Medicare, he says.

Beneficial dietary change would see people switching from McDonald’s fast-food to sweet potatoes and broccoli, says John A. McDougall, an internist in Santa Rosa, Calif., and advocate of a stringent, low-fat vegetarian diet as the only successful preventive strategy. But “there’s no support in our society for this kind of change,” he says. Rather, advertising unceasingly preaches that high-calorie food is good and that medicines are what control disease.

For proof that the health-care system ignores unhealthy lifestyles, one need only note that “in the intensive-care unit you get the same diet served to you that brought you there in the first place,” McDougall says.

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