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Prevention Gets Credit for Fewer Heart Deaths

But increases in diabetes and obesity could reverse the trend, experts warn

TUESDAY, May 11 (HealthDay News) -- Improved treatment, coupled with more effective preventive measures, may be having a positive impact on the death rate from coronary heart disease.

Death rate data from the United States and Canada both indicate a drop in cardiovascular deaths. According to the American Heart Association, the annual death rate from coronary heart disease from 1996 to 2006 declined 36.4 percent and the actual death rate dropped 21.9 percent.

In Canada, according to a study in the May 12 issue of the Journal of the American Medical Association, the death rate from coronary heart disease in the province of Ontario fell by 35 percent from 1994 to 2005.

"The overall good news is that coronary heart mortality continued to go down despite people growing older," said study author Dr. Harindra C. Wijeysundera, a cardiologist at the Sunnybrook Health Sciences Centre Schulich Heart Centre in Toronto.

"Risk factor changes appear to play a very important role," he said, "accounting for just under half the improvement despite increasing availability of better treatments." And, he added, "the new therapies are being well-used."

But there is a cloud on the horizon that darkens the generally cheery report, Wijeysundera noted.

"Diabetes and obesity are on the increase," he said. "It doesn't take much of a negative trend in diabetes and obesity to eliminate the good trends." A 1 percent increase in diabetes correlates to a 6 percent increase in mortality, he said.

Those sentiments are echoed in the United States, where health experts have expressed growing concern about the rising incidence of overweight and obesity in the American population.

Experts contend that preventive measures -- including use of cholesterol-lowering statins and medications to prevent high blood pressure -- are not being used as much as they should be. In the Canadian study, use of statins by people with stable coronary artery disease increased from 8 percent in 1994 to 78 percent in 2005, but that left nearly a quarter of potential users uncovered.

And use of blood-pressure-lowering drugs increased from 28 percent of those who needed them in the mid-1990s to 46 percent in recent years -- "an improvement, but not ideal," Wijeysundera said.

"From patients' perspective, the news is that there are multiple and very good medical and surgical therapies available for people with diabetes and coronary heart disease," he said. "Also, that exercising, watching the diet, avoiding diabetes and taking other preventive measures continues to be important. That is the take-home message of our study."

Those thoughts were echoed by Dr. Timothy J. Gardner, medical director of the Heart Center at the Christiana Health Care System in Bloomington, Del., and a past president of the American Heart Association.

"We've seen a steady decline in coronary artery deaths going back to the 1970s, half from improved treatments such as coronary care units and emergency medical services, the other half from improved prevention, including important things like a decline in smoking," Gardner said.

"The worry we have now is that the continued steady decline in coronary artery deaths will slacken off because people are acquiring risk factors for heart disease," he said. "Attention must be paid to measures such as weight reduction and exercise and control of diabetes."

More information

The American Heart Association has more on the risk factors for coronary heart disease.

SOURCES: Harindra C. Wijeysundera, M.D., staff cardiologist, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto; Timothy J. Gardner, M.D., medical director, Christiana Health Care System, Bloomington, Del.; May 12, 2010, Journal of the American Medical Association

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