Cardiovascular disease was and still is our killer n. 1. It is a major source of our health care costs and causes disability and related economic losses. At its peak in the 1960s, 1 in 100 of people over 35 died of heart disease every year – more than two thirds more than today.
The decrease in cardiovascular disease prevented 10 million deaths and represented, in a spectacular way, three quarters of the increase in life expectancy in the United States until 2010. The decline in life expectancy in the United States at the plateau up to 2014, decreased by three consecutive years from 2015 to 2017, then restored in 2018.
Why have heart disease declined so rapidly for half a century? Why has the stall diminished? And above all, what can we do to reduce it more? (Much more progress is clearly possible: the death rate from heart disease in the United States is almost 20% higher than in other high-income countries and 75% higher than the rate in France.)
The best estimate is that about half of the reduction in cardiovascular disease comes from public health interventions that have reduced smoking, cholesterol and other risk factors, and the other half from better medical care, particularly better treatment of hypertension is a more effective treatment of people during and after a heart attack.
Why the decrease in heart disease deaths has slowed is less clear. Possible causes are the increase in obesity and the lack of further progress that reduce blood pressure, cholesterol and sodium intake.
There is a bottom line – or, actually, three – one for each of us, our clinicians and the government.
What can you do
We all need to know and control our blood pressure – the lower the better, up to 120/80. For many of us – including me – that means medicine every day for the rest of our lives. People who have had a heart attack or stroke must take a statin. Others at risk are recommended to do so, although there are different opinions on the potential population-level benefit of cholesterol-lowering drugs.
Nobody should smoke cigarettes or inhale other people’s smoke.
We have to walk more – up the stairs, out, to and from work or school, practically wherever we like to walk or can walk comfortably.
We need to find healthy foods that we like – vegetables, fruits, nuts, legumes, fish – and eat more. And we should consume less salt and, when using salt, use low sodium salt and low sodium soy sauce (except for people on a low potassium diet).
What your doctor can do
Healthcare professionals need to measure blood pressure in each adult, put hypertensive patients on effective therapy, and track patient progress through blood pressure control. They must advise all tobacco users to stop, help them do so with drugs and advice, and become strong supporters of tobacco control. And they should not simply advise, but prescribe a healthy diet and regular physical activity.
What governments can do
Governments need to incentivize primary care health systems to improve blood pressure and cholesterol control rates. Controlling blood pressure can save more lives than any other medical intervention among adults, but for over $ 3 trillion a year, the American health care system does it correctly only about half the time.
They also need to increase tobacco taxes (the best way to stop people from smoking); guarantee public spaces and workplaces without smoke; make the image of tobacco use consistent with reality – not fascinating, but disabling and disfiguring; help people quit; and implement other new anti-tobacco policies, including those against children’s use of e-cigarettes.
And governments must make healthy food readily available and accessible and ensure that only healthy food is served, sold or subsidized by the government or on government property.
These deaths can be avoided
These aren’t the only drivers of heart disease. Stress, lead exposure, pollution, alcohol, depression, inadequate sleep, childhood trauma, obesity and others also contribute, although the relative importance of these factors and their interactions are not notes definitively. But that shouldn’t stop us from acting on the main factors we can change to prevent heart attacks and strokes: quitting smoking, eating healthy and controlling high blood pressure.
Every year, cardiovascular disease kills over half a million Americans and disables millions more. The costs of healthcare for the treatment of heart disease and stroke are astronomical and the economic losses from disability and premature death are even higher. Most of these deaths and costs can be avoided. All of us – our families, neighbors, friends, doctors and the government – will benefit if we take these simple steps for a longer and healthier life.
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