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Are We Losing the War Against Heart Disease?

The once-rapid decline in the heart disease death rate has slowed significantly among young adults.

National efforts such as Healthy People 2010 have focused on improving outcomes for patients who have or are at risk for heart disease. However, a new assessment of U.S. mortality rates in people aged 35 and older from 1980 through 2002 suggests that much work remains.

Although the general trend was encouraging — overall age-adjusted mortality from coronary heart disease fell by 52% in men and 49% in women — unfavorable trends emerged when age-specific data were analyzed. Indeed, the decrease in mortality rates from 1980 to 1990 for both men and women aged 35 to 54 slowed considerably from 1991 to 2002.

Specifically, among men aged 35 to 54, the annual decrease in mortality was 6.2% from 1980 to 1989, 2.3% from 1989 to 2000, and 0.5% from 2000 to 2002. Among women of the same age, the estimated decline in mortality was 5.4% from 1980 to 1989 and 1.2% from 1989 to 2000; from 2000 to 2002, however, the estimated mortality increased 1.5% annually. Conversely, for men and women aged 55 and older, the rate of decrease accelerated with time.

Comment: In this large assessment of U.S. vital statistics, a disturbing increase appears in the age-specific coronary heart disease death rate in young women. Editorialists admit that the analysis may oversimplify the atherosclerotic disease problem but argue that the data are not only the best available but also the same data that have been used to demonstrate declining age-adjusted mortality during the last 20 to 30 years.

This apparent increase has occurred despite substantial efforts to improve evidence-based care of patients with or at risk for heart disease. A likely contributor to these statistics is the increase in risk factors associated with the obesity epidemic. Clearly, urgent strategies are required to address risk factor prevention and lifestyle modification early in life.

— JoAnne M. Foody, MD

Published in Journal Watch Cardiology November 28, 2007

Citation(s):

Ford ES and Capewell S. Coronary heart disease mortality among young adults in the U.S. from 1980 through 2002: Concealed leveling of mortality rates. J Am Coll Cardiol 2007 Nov 27; 50:2128.

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• Medline abstract (Free)

Greenland P and Lloyd-Jones D. Time to end the mixed — and often incorrect — messages about prevention and treatment of atherosclerotic cardiovascular disease. J Am Coll Cardiol 2007 Nov 27; 50:2133.

• Original article (Subscription may be required)
• Medline abstract (Free)