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Heart attack and stroke death rate decline good news, but…

Deaths from heart disease and stroke have fallen significantly and ahead of schedule, according to the American Heart Association (AHA). This is particularly good news in Mississippi, which has some of the highest rates for heart disease and stroke in the country.

The good news nationally about heart attack and stroke death rates declining is being spread by the current national president of the AHA, Dr. Daniel Jones, who is vice chancellor for health affairs and dean of the School of Medicine at the University of Mississippi Medical Center.

In a recent press release, the AHA heralded the new mortality data from the Centers for Disease Control and Prevention (CDC) that shows since 1999 coronary heart disease and stroke age-adjusted death rates are down by 25.8% and 24.4%, respectively.

“This means that the American Heart Association’s 2010 strategic goal for reducing deaths from coronary heart disease has been achieved, and for stroke nearly achieved — ahead of time,” Jones said. “However, potential problems loom for the future, as all of the major risk factors for these leading causes of death are still too high and several are actually on the rise. If this trend continues, death rates could begin to rise again in years ahead.”

In 1999, the American Heart Association set a strategic goal of reducing the death rates from coronary heart disease and stroke, and reducing the risk factors for these diseases by 25% by 2010. The new CDC data notes early success in meeting the goals. But there is still much work to be done.

“This progress in the reduction of death rates is a landmark achievement, and has come about as a result of tremendous efforts from many partners in research, healthcare, government, business and communities,” Jones said. “As encouraging as it is, heart disease and stroke remain the number one and number three causes of death in the United States.”

The reduction in the death rates for coronary heart disease and stroke equates to approximately 160,000 lives saved in 2005 (the most recent year for which data is available) compared to the 1999 baseline data. If the current mortality trends hold (which will not be the case if the current trends in risk factors are not improved and current quality of care improvements do not continue), the AHA projects that there may be a 36% decline in the age-adjusted coronary heart disease death rate and a 34% decline in the age-adjusted stroke death rate when the 2008 data are released in a few years (in comparison with the 1999 data). The population size in 2008 will also be larger, so it is projected that the estimated lives saved in 2008 will be approximately 240,000.

Mississippi has also seen declines in heart disease and stroke mortality since 1999, but not as large a decrease as seen nationally.

According to the 2005 numbers from the CDC, 8,637 people in Mississippi died of cardiovascular disease at a rate of 295.7 and an age adjusted rate of 306.8. The numbers for stroke are that 1,622 people in Mississippi died of stroke at a rate of 55.5 and an age-adjusted rate of 58.

Jones said there are challenges to reducing heart disease and stroke incidence in Mississippi. The state’s low per capita income means many people can’t afford care. And there are fewer healthcare providers per capita than in other states.

What has been behind the success in reducing death rates? Jones said there is no question that statin drugs, which help lower cholesterol, have been a big part of that. There have also been great strides in people being aware of what they need to do to lower their risk of heart attacks and stroke.

“We are doing better with education, but we still have a long way to go,” Jones said. “Some of the areas where there is lots of reason for improvement are that too many people are smoking. The dangers of smoking should be a message that is out there strong, yet many people in Mississippi chose to smoke.

“A really important issue in our state and the county is the issue of obesity. We know we should exercise more and eat less, and yet that is not implemented very well in our state. Workplace wellness is a good investment. Healthier employees are more productive employees and reduce healthcare costs eventually. We need physical education and health education in our schools. There has been rapid increase in rates of childhood obesity. This is going to be a terrific problem for our country if we don’t get a handle on it.”

Jones said other factors behind the decline in rates are improvements in medical treatment including angioplasty and clot-busting drugs. The development of evidence-based practice guidelines has helped healthcare providers know what is effective both for the treatment and prevention of heart attacks and strokes.

Some of the advances are complex and others are quite simple, though important.

“We know that getting patients to the hospital quickly for the appropriate treatment is crucial to saving lives,” Jones said. “We know that timely angioplasty to open blocked coronary arteries, or thrombolysis when primary angioplasty is not available or appropriate, is making a difference. The development of more hospitals into primary stroke centers and providing more rapid and better care for stroke victims have all made positive impacts.

“Improving the quality of care through the dissemination of evidence-based clinical guidelines can help patients benefit from the research that we and others have supported, helping them live longer and reducing their risk of a second heart attack or stroke. The American Heart Association’s Get With The Guidelines hospital-based quality improvement program initiative, which now includes more than a million patient records, is just one way we continue to translate scientific knowledge into day-to-day practice.”

Research shows that while there is progress on some of these risk factors, others are not being reduced nearly enough. The number of people with high blood pressure has fallen by 16% since 1999. The number of people with elevated blood cholesterol is down 19.2% and tobacco use is down 15.4%. But the rate of physical inactivity has only declined by 2.5% and the prevalence rates for obesity and type II diabetes are actually increasing, and are appearing at earlier ages than ever before.

“We’re working on this, but much more needs to be done,” Jones said. “If we don’t make a concerted effort to reduce these risks, we will lose the momentum we celebrate today. We will see our children developing heart disease earlier, experiencing early deaths or needing major medical care sooner. The financial and, more importantly, the emotional toll is too great.”

Mississippi State Medical Association president Dr. Dwalia S. South, a family medicine specialist at the Family Medical Center, Ripley, was surprised by the good news about heart disease and stroke mortality. But she wasn’t surprised to hear Mississippi saw less progress than the rest of the country.

“In November, a report came out that put us on top of the list, number one in the country for deaths from heart disease and strokes,” South said. “We are the stroke and heart disease capitol of America.”

On the positive side of the equation, South believes that public education has had a major impact. People are more aware of what they need to do to stay healthy. Even commercials on television advertising blood pressure medicines have had a beneficial impact.

“This is one place where I think drug advertising has not been a bad thing,” South said. “Some advertisements are cute and informative. There has been a national educational process going on, even through our television. Thirty years ago, no one knew what cholesterol was. We didn’t know what it did. It was something no one ever considered.”

It takes time for national trends to trickle down to Mississippi. South is optimistic improvements are on the way. She particularly is supportive of efforts to improve health education and physical activity in the schools.

“Where we have really missed the boat and where we have failed our children is by not teaching healthy eating and the value of exercise,” South said. “When you go into schools now and see how many children are overweight, it is alarming. They are getting too much food and not enough exercise. Schools are keyed in about making good test scores, and children are so unhealthy it is pathetic. They aren’t going to gym anymore. It is pitiful. We really have to put our money where our mouths are and where our hearts are and start making changes with school kids.”

South said the federal No Child Left Behind program really pushed the administration and teachers in the direction of working to improve test scores.

“But what good is all that book learning if the children are not going to be healthy enough to survive into adulthood?” South said. “It is too late for a lot of us, people whose habits are already set. We’ve developed all these bad habits that have been generational. If we can do anything now to leave behind a legacy, it is with our school kids.”

For more information about heart disease and stroke, see the Web site www.americanheart.org.

Contact MBJ contributing writer Becky Gillette at 4becky@cox.net.

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