One of the United States’ major public health success stories of recent years has been the dramatic decline in the proportion of Americans who die of heart disease and stroke.
Between 2000 and 2010, the U.S. death rate for heart disease fell 30 percent and the rate for stroke dropped 36 percent.
By comparison, the rate for cancer-related deaths decreased a more modest (but still encouraging) 13 percent during that same period.
Indeed, the heart disease mortality rate was falling so fast that some experts believed cancer would overtake heart disease as the single leading cause of death in the United States by 2013.
That would have been an incredibly momentous public health event. For, with the exception of the flu pandemic years of 1918-1920, heart disease has been the U.S.’s No. 1 killer since 1910. (Although not in Minnesota. For the past several years, more Minnesotans have died from cancer than heart disease, according to the Minnesota Department of Health.)
We didn’t reach that national heart-disease milestone in 2013, however, or in any year since. Nor is it likely we will reach it very soon.
A study released last week reported the somber news that after more than a decade of steady improvements, the death rates for both heart disease and stroke have slowed in the U.S. In fact, since 2011, those rates have essentially flattened.
This finding is “alarming,” write the authors of the study. They call on health officials, policymakers and the medical community to expand and support “innovated efforts” to improve the prevention of heart disease.
For the study, a team of epidemiologists, led by Dr. Stephen Sidney of the Kaiser Permanente Northern California Division of Research, analyzed data from a death-certificate database maintained by the Centers for Disease Control and Prevention for use in public health research.
The data revealed that the death-rate decline for heart disease and stroke had begun to stall in 2011, and had then remained flat through 2014.
Specifically, the total cardiovascular-related death rate (including from heart disease and stroke) declined at an average rate of 3.8 percent per year between 2000 and 2011. After that, the decline slowed to less than 1 percent per year.
The researchers also found that the slowdown was widespread. It had occurred in both men and women and across all racial and ethnic groups.
No such decline was observed in the cancer death rate, however. It had declined an average of 1.5 percent per year between 2000 and 2010 — a rate that continued through 2014.
‘The time is now’
Experts attribute the decline in heart disease-related deaths during the first decade of the 21st century to improved medical treatments and prevention efforts, including success at encouraging individuals to adopt more heart-healthy lifestyles, especially by not smoking and by increasing physical activity.
Yet, those positive developments are now being offset by two prevailing negative trends: the increasing number of Americans who are either obese and/or who have type 2 diabetes — two major risk factors for heart disease and stroke.
“Despite significant improvements in heart health over the past century, the increase in these chronic health conditions in epidemic proportions may be driving the recent slowdown,” said Dr. Jamal Rana, one of the study’s co-authors, in a released statement.
And those epidemics do not appear to be abating. In June, researchers reported that 35 percent of men, 40 percent of women and 17 percent of children and adolescents are now obese in the U.S. And more than 9 percent of Americans — 29 million people — have diabetes, primarily type 2 diabetes, which is closely linked with being overweight or obese.
We appear to be “reaping what we have sown in the obesity epidemic over the last several decades,” writes Dr. Donald M. Lloyd, head of preventive medicine at Northwestern University’s Feinberg School of Medicine, in an editorial accompanying the new study. “This bitter harvest can still be largely avoided if patients, physicians, public health officials, and politicians can finally create meaningful policies and pathways to enable a culture that prioritizes health and promotes prevention.”
“The time is now,” he stresses, “if not already past for some.”