More people than ever are dying from heart disease but doctors are not completely sure why. Better, more widely available health care including improved medical procedures to reduce mortality from heart attacks should be reversing this trend, they say.
But the death rate is still rising.
Part of the explanation appears to lie in rising obesity rates, and the increased incidence of diabetes, a major risk factor for heart attacks and strokes.
But many patients are also resisting widely available treatments for heart disease that could help treat the disease, making death more likely, doctors say.
Available data suggest a stark trend line. Between 2011 and 2017, the death rate from heart disease rose 20.7% according to a study published last week in the journal JAMA Cardiology.
Most of these rising deaths are found among people over 65, but the rate among younger cohorts is rising, too, and is likely to get worse, according to the new study.
Overall, an estimated 6.2 million Americans suffer from heart failure, according to federal statistics. The American Heart Association predicts that more than 8 million will have the condition by 2030 – a 30% increase.
As a result of these trends, US life expectancy has fallen for the first time in years.
Heart failure occurs when the heart can’t pump enough blood for the body’s needs. It can be caused by long-term high blood pressure or by damage to the heart.
Because of medical advances, more people today survive heart attacks than in past year. But even survivors may be left with hearts that fail to pump blood adequately.
In fact, the one in 5 people who suffer a heart attack are more likely to suffer a second one within 5 years, research shows.
Patient resistance to treatments that could stave off a heart attack, or help them recover from one, is growing doctors say.
“There’s still a lot of suspicion about very common, but very effective medications. We still have a lot of problems getting the right medications to the right people,” notes Dr. Haider Warraich, a fellow in cardiovascular medicine at the Duke University Medical Center.
Warraich says the main problem is trust in the medical community. For example, many patients have read on the Internet about complications or side effects resulting from statins – a cholesterol-reducing medication – which studies show can reduce the risk of heart attack, stroke, and even death from heart disease by about 25% to 35%.
There are known side effects from certain kinds of statins for some patients, but the risk of serious complications is actually minimal. And in most cases, the risk can be reduced by simply prescribing a different class of statins.
But many patients avoid taking statins altogether.
“We, as a scientific community, have to convince patients that they can trust us,” Warraich insists.
Medical experts say that more emphasis also needs to be placed on the specific risk factors for heart disease, including hypertension and diabetes.
“The way we’re going to stop these increasing burdens of heart failure and overall heart deaths is going to be controlling risk factors,” says Dr. Keith Ferdinand, a preventive cardiologist, and professor of medicine at Tulane University School of Medicine.
“We’re not going to operate ourselves out of these big public-health challenges.”
More patients need to be placed on blood-pressure medication and should also be prescribed a new class of drugs called SGLT-2 inhibitors that have been shown in recent research to lower the risk of heart failure in diabetes patients, Ferdinand says
Ultimately, though, improved patient self-care through the adoption of lifestyle changes are the key to reducing the rate of heart disease, experts say.
Some of the lifestyle changes that reduce the risk of hypertension or diabetes – a reduction in red meat and sodium intake, for example — are also recommended for heart disease.
But some measures, like quitting smoking and increased cardio training, are more specific to controlling heart disease.
Studies show that heart attack patients who participated in a formal exercise program were 50% less likely to die within the next four years, and 20-25% less likely overall.