Heart disease still the number one killer globally
Since the early 1960s, when the US Surgeon General’s report identified smoking as a risk factor for heart attack, deaths due to heart disease have been in a steady decline. However, a new study has sounded an alarm indicating that this positive trend may be coming to an end.
In the May 17, 2017 issue of the Journal of the American College of Cardiology, researchers from the University of Washington School of Medicine reported that declines in worldwide mortality rates, particularly among wealthier western nations, have plateaued. The study included 2,300 investigators from 133 nations and looked at mortality data collected from 1990 through 2015.
According to the report, 422 million people around the world are living with cardiovascular disease. In 2015, it was the number one killer, responsible for nearly 18 million deaths globally. That amounts to about one-third of all deaths. Ischemic heart disease, also known as coronary heart disease, and stroke accounted for the majority of illnesses due to cardiovascular disease.
So what’s behind this trend and what are we to make of it here in the United States? The study’s authors offered little explanation, so we asked cardiologist Peter Chiotellis, MD to weigh in on the topic.
“The main reason for heart disease continuing to be the leading killer worldwide, in my opinion, is the priority of our efforts. We have made a lot of advances in interventions once the disease process is underway; remarkable procedures like transcatheter aortic valve replacement (TAVR), MitraClip, etc. And these interventions have helped with the decline of deaths due to heart disease, up until now. But, we haven’t focused enough on prevention,” he said.
And that’s where the obesity epidemic comes in. Nearly 70 percent of Americans today are overweight, according to the American Heart Association. There are twice as many adults and three times as many children who are obese today than in 1980, according to the Robert Wood Johnson Foundation.
Obesity is defined by a body mass index (BMI) – a measurement of body fat determined by height and weight – of 30 and above. Carrying too much weight puts a strain on our bodies and increases the risk of developing obesity-related diseases like Type 2 diabetes, heart disease, high blood pressure, and stroke, among others.
“People with obesity tend to have high blood pressure and high cholesterol, and will eventually progress on to diabetes,” said Dr. Chiotellis. “People with diabetes will have accelerated atherosclerosis (clogged arteries), so we have to take these patients a lot more seriously. So we may be treating more heart disease, but we’re not tackling the obesity and diabetes epidemic that are two really huge risk factors.”
The obesity rates among the youth, and the risk for their future, worries Dr. Chiotellis.
“You see the younger population – who are probably less active than they ever were – being sedentary with their smart phones playing games and not running around getting exercise. It’s scary. It’s a huge problem.”
Heart disease begins as an inflammatory process. Coronary artery disease and the development of diabetes is influenced by both genetics and diet. While you can’t control your genetics, eating a nutritionally-balanced diet rich in vegetables and plants can help.
“Dietary changes that lower the intake of carbohydrates seem to be effective,” said Dr. Chiotellis. “There is some emerging evidence that switching to plant-based diets can possibly cause the regression of plaque. More research is needed, however, to say for certain.”
Once cardiovascular disease is underway, it is still possible to reduce your risk of a cardiac event. Lifestyle changes like quitting smoking, getting more exercise and losing weight are one way. Receiving regular medical care is another.
For patients with obesity, overcoming shame or embarrassment and seeking routine health care is vitally important, according to Dr. Chiotellis.
“We know from studies that being obese is linked to a reluctance in self-care habits, like going to the dentist. While not true for everyone, this is indicative of avoidance of regular medical care,” he said.
Genetics also matters. While you can’t change your family history, you can change lifestyle.
“A lot of patients come to see me around age 55, which is the age their father was when he had a heart attack. I like to see patients before then so we can prevent it from happening. You can’t defy your genetics, but you can take care of yourself as prevention,” said Dr. Chiotellis.
What other things can you do to reduce the risk of mortality from heart disease, even if the disease is already underway? Dr. Chiotellis recommends the following:
- Get aerobic exercise, where your heart rate goes up, at least three times a week.
- Reduce your intake of carbohydrates by avoiding white processed flour products like baked goods, white rice and pasta.
- Reduce consumption of alcohol; follow guidelines that call for not more than two drinks per day for men, one per day for women.
- Follow-up regularly with your primary care doctor and cardiologist.
- Take your medications as prescribed.
- Stay busy, active and socially engaged, especially as you age, to avoid depression.
- Take control of your health, because no one is going to do it for you.
- Do not ignore any new signs or symptoms, especially heartburn or chest pain that isn’t relieved by rest
Call 911 immediately if you experience the signs of a heart attack: chest pain, jaw pain, shortness of breath, sweating, nausea and vomiting, light headedness, and anxiety.