Are we failing the cardiovascular epidemic

CVD 1

I recently presented my thoughts at a conference at the Cape Town International Conference Centre in response to an article published in “health24”.

CVD 4

I challenged the concept that the “heart disease theory had failed” and based my conclusions on the following:            

CVD 10Deaths per 100 000 population in the USA for ALL forms of cardiovascular disease have fallen progressively from 1960 to 1997.

CVD 11Interestingly 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).

CVD 19

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”.

CVD 20The simple 7 includes 4 ideal health behaviours:

  1. Not smoking (for a least a year)
  2. Body mass index < 25 kg/m2
  3. Moderate physical activity for 150 minutes/ week
  4. Intake of 4-5 key components of the AHA diet guidelines 

And 3 health characteristics:

  1. Total cholesterol < 5.0
  2. BP < 120/80
  3. 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?

CVD 21

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:

  1. ECG evidence for left ventricular hypertrophy
  2. ECG evidence for left bundle branch block
  3. Presence of micro albuminuria in the urine
  4. Vascular changes on retinal exam with a opthalmoscope
  5. Carotid atherosclerosis as indicated by abnormal Intima-Media and or carotid plaque

CVD 22

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.

CVD 23This is a typical carotid ultrasound of a “healthy” woman with advanced sub clinical carotid atherosclerosis.

CVD 24You 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.

CVD 31

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.

Cardiologydoc

No no

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3 thoughts on “Are we failing the cardiovascular epidemic

  1. I’d like to start off by saying that, speaking from a non – medical viewpoint, the time you have taken to construct clear, readable graphs and pictures has made some of the complex language straight forward, and has enabled me to understand a great deal more about cardiovascular disease.
    I wholeheartedly agree with your dissection of the contributing factors of cardiovascular ignorance, with particular reference to the internet. While I am unable to properly comment in regards to problematic areas arising from Doctors, I have seen firsthand the misleading information that the internet and third party endorsers circulate.
    The process of raising awareness of cardiovascular disease is an incredibly large one, yet, looking at its substantial affect, it is clearly needed.
    I am a 3rd year Media student in Australia, and I have been proposing a University initiative in which Universities around the country incorporate cardiovascular awareness into their assessment guidelines. Different faculties within the Universities (Media, Medicine and social work) will collaborate to develop informative and promotional campaigns to be distributed to each University’s surrounding suburbs. This will provide potentially diverse and innovative campaigns that are cost effective, and incorporate all of the campaigns aspects (from the researching phase, to developing a strategy, to media planning).
    It is important for governmental institutions to target communities from the onset (in schools and universities) so as to contend with the clutter of the internet and third party endorsers, and, whilst this initiative is firmly in a developmental stage and is nothing more than a proposed idea, it provides a possible answer to the contentions of private interest.

    • Dear aheartforaheart

      Your comments and suggestions are refreshing and most welcome. Essentially without the education in prevention of vascular disease the epidemic will continue unabated but somehow we have to teach a balance according to “evidence-base medicine”. The data collected over the past 3 decades (since I was a third year medical student) is enormous with many contradictions over the years hence adding to confusion. I guess this is identified in the number (1/2000) of “healthy” people who are truly free of cardiovascular risk and free of sub clinical vascular disease when they reach mid-life (50’s).

      Blessings Cardiologydoc

      • Dear Cardiologydoc,

        Thank you so much for responding to my comment. It is scary that there is so much contradictory information out there and even more alarming that such a low number of middle aged people are classified as ‘healthy’.

        In an ideal world, perhaps a nation wide campaign aimed at a younger demographic (primary, secondary and high schools) in which awareness and promotion of a broad ‘healthy lifestyle’ (targeting the initial prevention factors) is implemented could potentially reduce these figures.
        However, realistically this will probably never happen, and it is through blogs such as yours that many uninformed people can gain valuable information that can be recirculated, to potentially save many lives.

        I’m a big fan doc, keep up the good work!

        regards,
        Aheartforaheart

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