Today's news about the health of Americans is typically pretty grim: nearly two-thirds are obese, 21 million have diabetes, almost half are physically inactive just to start the list.
But the American Heart Association (AHA; Dallas) has just reported that U.S. deaths from heart disease and stroke dropped about 25% from 1999 to 2005, five years ahead of goals.
How did that happen?
"This is wonderful news for the American public," Dan Jones, MD, AHA president told Medical Device Daily. "When this goal was set in 1990s, it appeared to be an extraordinarily ambitious goal. But it's been achieved. The good news and bad news is that a lot of the benefit is on the end of treating the disease. We're much better at treating people than keeping them alive."
But in case we start applauding too loudly, he added: "We will start to lose some of the progress because we have increases in diabetes, hypertension and obesity."
Back in 2010, the AHA set strategic goals for reducing deaths from coronary heart disease by 25% (which has been achieved) and for stroke (which has been nearly achieved), ahead of schedule.
A variety of factors have led to the reduction in deaths, which equates to 160,000 lives saved in 2005 — the most recent year for which data is available — compared to the 1999 baseline data.
"If I were pinned down to a single overriding cause for the reduction in deaths, I'd point to research," Jones said, referring to ongoing scientific investigations that have led to improvements in both medications and in technology. The development of evidence-based practice guidelines has helped healthcare providers know what is effective both for the treatment and prevention of heart attacks and strokes.
He also credited the use of medical device technology, saying that stents "that open arteries have been an important part of the improvement we've seen in heart and stroke mortality, and adding: "We need to continue to work on better approaches to help people survive."
If the current mortality trends hold, AHA analysts project a 36% decline in the age-adjusted coronary heart disease death rate and a 34% decline in the age-adjusted stroke death rate when the 2008 data are released in a few years all of this underlined by the assumption that these figures may not hold true, given the current trends in risk factors.
Again, setting aside that assumption, the size of the U.S. population in 2008 also will be larger, so it is projected that the estimated lives saved in 2008 could be about 240,000.
Some of the advances are complex and others are simple, including getting patients to the hospital more quickly for timely angioplasty or thrombolysis, the development of more primary stroke centers and the dissemination of evidence-based clinical guidelines.
Among the practice measures cited as making a difference are better control of blood pressure and cholesterol levels, both with lifestyle change and with medications, according to the AHA. In addition, the reduction in smoking has made a difference, driven by a variety of strategies: tobacco excise taxes, clean indoor air legislation and smoking cessation efforts.
But not everyone is receiving these life-saving therapies.
Coronary heart disease age-adjusted death rates for women have dropped 26.9% since 1999. But, age-adjusted stroke death rates among women are down by only 23.7%, lower than the overall age-adjusted stroke death rate reduction and the age-adjusted stoke death rate reduction for men, which is 25.8%.
The age-adjusted death rate for blacks is down 23.8% for coronary heart disease (compared to 25.6% for whites) and 20.3% for stroke (compared to 25% for whites.)
These disparities in the outcomes for women and minority populations are echoed in the statistics for those living in certain parts of the country, such as the Stroke Belt in the South, and for those with lower incomes.
While there is progress on some risk factors for heart disease and stroke, others are not being reduced enough, because of not meeting the AHA 25% reduction goal. The number of people with uncontrolled hypertension has fallen by 16% since the AHA set its 2010 strategic goals; the number of people with elevated blood cholesterol is down 19.2% and tobacco use is down just 15.4%.
Despite the encouraging news, heart disease and stroke remain the No. 1 and No. 3 causes of death in the U.S.
The AHA is formulating a new set of goals for 2020, Jones said, going on to list the top three drivers for continued improvement in death rates are:
- Continued investment in research.
- Provision of successful existing therapies to more people.
- Improvement in prevention.
"We have so much opportunity in terms of prevention," Jones said. "We need to work hard on lifestyle changes."