Life Extension Update Exclusive
Risk factor reduction and medical/surgical treatment cut heart disease deaths in half
A study published in the June 7, 2007 issue of the New England Journal of Medicine provides an explanation for the finding that deaths from heart disease in the U.S. in the year 2000 have declined to half of what they were just twenty years ago. From 1980 to 2000, deaths from coronary heart disease were reduced in men from 542.9 to 266.8 per 100,000 U.S. residents, and from 263.3 to 134.4 among women.
Simon Capewell, MD of the University of Liverpool, England, along with researchers at the Centers for Disease Control and Prevention in Atlanta applied data from the U.S. Census Bureau and the National Vital Statistic System of the National Center for Health Statistics to the IMPACT mortality model which incorporates major risk factors for coronary heart disease in addition to usual heart disease treatments. They found that approximately 47 percent of the decline in deaths was due to treatments for the disease, including 11 percent attributable to secondary preventive therapies after heart attack or revascularization, 10 percent attributable to initial angina or heart attack treatments, 9 percent to heart failure treatments, 5 percent to revascularization for chronic angina, and 12 percent to other treatments.
Risk factor reduction accounted for 44 percent of the decline, which resulted in approximately 149,635 fewer deaths over the two decades. These improved risk factors included cholesterol reduction, systolic blood pressure reduction, smoking cessation, and improved physical activity levels, although these were offset in part by increases in body mass index and diabetes. Earlier studies which examined U.S. populations from 1968 to 1976, and from 1980 to 1990 found similar reductions in major coronary heart disease risk factors associated with a decline in deaths from the disease.
“Our analyses suggest that approximately half the recent decrease in deaths from coronary heart disease in the United States may be attributable to reductions in major risk factors and approximately half to evidence-based medical therapies,” the authors conclude. “Future strategies for preventing and treating coronary heart disease should therefore be comprehensive, maximizing the coverage of effective treatments and actively promoting population-based prevention by reducing risk factors.
Coronary artery disease
The treatment of atherosclerosis depends on the stage of the disease. Severe disease, in which an artery has significant blockage or unstable plaque deposits, may require intensive care. In most cases, however, less severe disease is treated with a combination of lifestyle changes (including dietary changes) and medication. The following dietary and lifestyle changes have been shown to slow, or even reverse, the effects of atherosclerosis:
- Reduce dietary saturated fats, cholesterol, and trans-fatty acids.
- Increase intake of fiber to at least 10 g daily.
- Consume at least five servings of fruits and vegetables daily.
- Ensure adequate intake of folic acid (400 to 1000 mg daily) to reduce homocysteine levels.
- For obese people, lower weight and increase physical activity to reduce the risk factors for metabolic syndrome and to help control blood pressure and reduce cardiac workload.
- For people with hypertension, limit sodium intake and maintain adequate intake of potassium, calcium, and magnesium.
- Stop smoking. This is essential.
Blood testing is a very important part of any risk-reduction program for coronary heart disease. Healthy adults should have their blood tested at least once a year. People who have heart disease or multiple risk factors should have their blood tested twice a year to monitor their progress. A comprehensive blood test will measure levels of blood lipids, C-reactive protein, homocysteine, fibrinogen, and other blood markers. Regular blood pressure monitoring is also important.
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