Progress Against Heart Attack Death
Two recent medical journal publications have explored the death rate from coronary artery disease. In May a Canadian group reported a study measuring deaths from all heart disease in Ontario between 1994 – 2005, and in June a large Kaiser Permanente study measured the incidence and death from heart attacks. The news in both papers is very good, especially for people in the upper age brackets of over 65. The short version is that death from heart attacks has significantly declined and especially in the decade beginning in 2000.
What Does This Mean?
The fact that death from coronary artery is declining is, of course, very good news. But, it is important to try and understand why this is happening in the U.S. and Canada. Mortality seems to be driven by several factors.
First, is the fact that fewer people are actually having heart attacks – this means that the incidence is dropping and it seems particularly steep in the drop the older we get. Women do not seem to enjoy quite the same decrease as men, but both genders are experiencing a lower incidence of heart attacks.
The second factor is that the “case-fatality” ratio is reduced as well in certain types of heart attacks. When case-fatality is reduced, it means that one has a better chance today of surviving 30 days now than in the past. The mortality with an acute heart attack has dropped from around 10% to about 7.5%. In other words, in one suffers a heart attack and gets prompt treatment the chances of survival is better than it has been for certain types of heart attacks called non-ST elevation myocardial infarctions.
Finally, it appears that there are two medical factors that lead to the reduced mortality: one is the better risk modifications that have been employed to reduce heart attacks and the second is the more widespread use of medicines that are designed to reduce heart attacks. Thus, there are three overall reasons for the drop in death from heart attacks over time – a lower incidence of heart attacks, a better survival rate if one occurs and the aggressive risk modifications and medicines that probably account for a significant part of the lower incidence.
What Should We Be Doing to Prevent Heart Attacks?
We have written several times about this, but now we have evidence in large studies that what has been written actually works. As we age we need to concentrate on a number of controllable factors. We should not smoke and stay away from areas where smoking by others is being done. Diet is important, the aim is to keep our total cholesterol down and our LDL below 130. Another benefit of diet is keeping weight down since obesity increases diabetes and both raise the incidence of heart attack. Regular exercise is very important and is known to contribute to reduced ischemic heart disease. Controlling hypertension is the final strategy that we with our physician can address. This also is known to reduce heart attacks and is thought to be part of the successful strategy for preventing heart attacks.
Medicines are the final preventive strategy. With the exception of aspirin, which many people should take to prevent heart attack, medications require a doctor’s prescription. A physician should also discuss whether aspirin is right for you since there are some people who cannot tolerate or should not take aspirin. The other medications that have been shown to be useful in preventing heart attacks and or death from them are the cholesterol lowering “statins, beta-blockers, and ACE inhibitors.” These three classes of drugs involve a number of different compounds and should be tailored to one’s specific needs by your physician.
The Bottom Line
There is much new good news about heart attacks. The best news is that we can do many of the things ourselves to lower our risk and when working with our physician even more can be done. All the strategies that appeared to hold promise have recently been proven effective in helping our healthy aging.
Heart Attacks in Women
It is a myth that heart disease is a man's disease. In fact, one in 8 women aged 45 to 64 has heart disease. One in four women over the age of 65 has heart disease. Currently, 7.2 million women have heart disease, states the American Heart Association (AHA). Consider the following facts about cardiovascular disease in women:
Coronary heart disease is the single largest cause of death for females in the United States.
Almost 16 percent of girls ages six to 19 are overweight, which is a risk factor for heart disease. About 25 percent of girls in grades nine through 12 report using tobacco, which is a risk factor for heart disease.
At menopause, a woman's heart disease risk starts to increase significantly. Each year, about 88,000 women ages 45 to 64 have a heart attack. Beginning at age 45, more women than men have elevated cholesterol.
Each year, about 372,000 women age 65 and older have a heart attack. About 21 million women age 60 and older have high blood pressure. The average age for women to have a first heart attack is about 70, and women are more likely than men to die within a few weeks of a heart attack.
About 35 percent of women who have had a heart attack will have another within six years.