I recently presented my thoughts at a conference at the Cape Town International Conference Centre in response to an article published in “health24”.
I challenged the concept that the “heart disease theory had failed” and based my conclusions on the following:
Deaths per 100 000 population in the USA for ALL forms of cardiovascular disease have fallen progressively from 1960 to 1997.
Interestingly death from CVD per 100 000 population has fallen in MEN from 1979 to 2008 whist in WOMEN the success in palliating CVD has only occurred since 2000. I believe this is due in part to the previous perception by women that they were immune to heart disease and their skeptical ethos to manage cardiovascular risk factors aggressively.
I see this every day in clinical practise that women in general do not take care of their cardiac risk factors. This is supported by a wonderful study published recently in CIRCULATION (one of the most respected cardiology journals).
This study set out to assess “ideal cardiovascular health” in 1933 men and women average age 57 years who were “healthy” and seemingly free of heart disease. Ideal cardiovascular heath is defined by the American Heart Association (AHA) as the “simple 7”.
The simple 7 includes 4 ideal health behaviours:
- Not smoking (for a least a year)
- Body mass index < 25 kg/m2
- Moderate physical activity for 150 minutes/ week
- Intake of 4-5 key components of the AHA diet guidelines
And 3 health characteristics:
- Total cholesterol < 5.0
- BP < 120/80
- Fasting glucose < 6.0
So out of the cohort of “healthy” 57 yr men and women what percentage do you think could tick ALL 7 boxes?
The graphic is taken directly from the publication and shows a staggering 0.05% of the cohort fulfilled the criteria for “ideal CV health”. Contrary to popular opinion women are just a bad (unhealthy) as men.
In a second study again published in CIRCULATION the authors studied a cohort of “healthy” men and women for the presence of SUB CLINICAL cardiovascular disease. Sub clinical disease is “hidden” disease in otherwise healthy asymptomatic individuals and comprises:
- ECG evidence for left ventricular hypertrophy
- ECG evidence for left bundle branch block
- Presence of micro albuminuria in the urine
- Vascular changes on retinal exam with a opthalmoscope
- Carotid atherosclerosis as indicated by abnormal Intima-Media and or carotid plaque
Sub clinical cardiovascular disease (target organ damage) was assessed in healthy normal weight; overweight and obese individuals and men and women with normal waist circumference (< 88 cm for women and < 102 cm for men) and those with waist circumference > 88 cm and 102 cm respectively.
This is a typical carotid ultrasound of a “healthy” woman with advanced sub clinical carotid atherosclerosis.
You can see the very high prevalence of sub clinical disease in normal weight, heathy individuals, increasing to ~ 50% of obese men and women with and without increased waist measurements.
In other words “so-called” healthy people have neither “ideal cardiovascular health” nor are they free of sub clinical disease. This therefore begs the question I posed previously as to why middle age men and women are extremely POOR in keeping themselves truly healthy and FREE of sub clinical disease. Remember those individuals with sub clinical disease are on a continuum time scale representing pathological ageing. In other words their biological age (age inside) is way older than their chronological age.
I’m therefore not surprised with the publication I posted in my last BLOG. “Based on 2009 death-rate data, more than 2000 Americans die of cardiovascular disease every day, or approximately one death every 40 seconds. Every 25 seconds, one American will have a coronary event, and every minute one American will die from one. Coronary heart disease accounted for one in six deaths in the US in 2009, while stroke accounted for one in every 19 deaths. Every 40 seconds, somebody in the US has a stroke”.
But can we understand some of the reasons as to why “ideal cardiovascular health” and freedom from sub clinical disease is so elusive when we have a really good understanding of the pathogenesis of cardiac disease?
In my next blog I will try to address these issues.