Heart disease: Good news, bad news

By Mario E. Motta, M.D.

The January headline was good news: "U.S. deaths down from heart disease, stroke."

The news story reported a significant drop of nearly 26 percent in deaths from coronary heart disease (and 24 percent from stroke) since 1999. Those statistics from the Centers for Disease Control and Prevention (CDC) indicated that the American Heart Association's (AHA) goals to reduce deaths from heart disease and stroke by 2010 had been met earlier than expected.

The Heart Association attributed the decrease to several factors: better technology and medications; development of evidence-based practice guidelines that improve providers' knowledge of effective treatments; fast transport of patients to the hospital for appropriate and timely treatment, such as angioplasty; patients gaining better control of blood pressure and cholesterol levels; clean air legislation and smoking cessation efforts. While pleased with the reduced mortality data, the AHA also issued a strong caution: All of the risk factors are still too high, the organization said, and if the trend continues, death rates could begin to rise again.

With that caution lingering, the February headline was not so good: "Only 1 in 4 knows heart attack warning signs."

This story reported the results of a CDC study of residents in 13 states and the nation's capitol, showing that public awareness of the signs of heart attack and the critical nature of calling for emergency assistance were "alarmingly low," in the words of Dr. Jing Fang, lead author of the CDC's report. Further, the survey indicated that such knowledge had declined since the last survey in 2001, when inquiries revealed that one in three were informed. Dr. Fang suggested more public education is needed one reason for what you're reading right now.

While the drop in deaths is good news, the high risk factors remaining and the lack of knowledge about warning signs are troubling. Heart disease remains the nation's number one cause of death. And it ranks first in medical expenditures for treatment at some $76.5 billion annually, according to the Agency for Healthcare Research and Quality.

Some trends are positive: patients are paying more attention to their blood pressure and cholesterol levels; fewer people are smoking; and life-saving tools such as defibrillators are becoming more common. Other trends are ominous: Too many people remain sedentary (the rate of physical inactivity has only declined by 2.5 percent according to the AHA), and the prevalence of obesity and diabetes is not only rising dramatically, but also appearing at earlier ages than ever before.

The CDC estimates that some 920,000 Americans suffer a heart attack each year, and of those who die, about half perish within an hour of the first symptoms before ever getting to the hospital. So it's vitally important to know the five warning signs: (1) shortness of breath; (2) chest pain or discomfort that comes and goes or lasts more than a few minutes; (3) discomfort in the arms or shoulders; (4) feeling of weakness or lightheadedness; and (5) discomfort in the jaw, neck or back. The most common symptom for women, like men, is chest pain. But women are more likely than men to experience other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.

And it's critical to act quickly, even if you're unsure about what's happening. Don't drive to the hospital or wait for the pain to subside. Call 9-1-1 immediately. It's the fastest way to get to the emergency department for treatment, and the emergency medical staff on ambulances can start treatment as soon as they're on the scene and continue treatment on the way to the hospital.

Any talk of heart disease, of course, wouldn't be complete without mentioning preventive measures. Good nutrition, daily physical activity, keeping blood pressure and cholesterol below recommended levels, and eliminating tobacco all contribute to reducing your risk for coronary heart disease.

Engaging in preventive measures as well as knowing the warning signs and what to do if someone does have an attack will keep driving those numbers down. Most important, such behavior will save lives. For detailed information on heart disease and what you can do for prevention and control, visit the American Heart Association at www.americanheart.org.

Mario E. Motta, M.D., a cardiologist with North Shore Cardiovascular Associates in Salem, is Vice President of the Massachusetts Medical Society. Physician Focus is provided as a public service by the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult with their physician for treatment. Comments to PhysicianFocus@mms.org.