The number of Americans who have a low risk-factor burden for cardiovascular disease (CVD) has decreased in recent years, because of increases in obesity, diabetes, and hypertension, a new study has found [1].
The results indicate a reversal of the progress made in fighting CVD during the 1970s and 1980s, say the researchers. "We were at increasing levels of favorable risk profiles as a nation; we were making progress," lead author Dr Earl S Ford (Centers for Disease Control and Prevention, Atlanta, GA) told heartwire. But, "the trends have unfortunately turned in the wrong direction since the early 1990s, so we are kind of regressing." Ford and colleagues report their paper online September 14, 2009 in Circulation.
In an accompanying editorial [2], Drs Rob M van Dam (Harvard School of Public Health, Boston, MA) and Walter C Willett (Harvard Medical School, Boston, MA) say: "The disturbing trends in cardiovascular disease seem difficult to reconcile with the tremendous progress in medical knowledge and technologies and the fact that Americans spend >15% of their gross domestic product on healthcare."
This study provides "an important signal that the health of Americans is at a crossroad. The current path leads toward increasing adiposity, diabetes mellitus, cardiovascular disease, and disability, and an unfit, socially isolated population stuffed with pills and subjected to frequent palliative procedures," they continue. However, "an alternative scenario is possible" if every opportunity is taken to support optimal nutrition and physical activities of children and to "create an environment that encourages healthy options throughout life. Physicians can contribute to this effort" in many ways, they observe.
Huge potential for prevention that remains to be realized
For their study, Ford et al created an index of "low risk," defined as being a never or former smoker, having a BP of <120/80 mm Hg without medications, a total cholesterol of <5.17 mmol/L (<200 mg/dL) without medications, a body-mass index of <25 kg/m2, and no diagnosis of diabetes mellitus. Using data from four national surveys in adults 25 to 74 years of age, they found the age-adjusted prevalence of low risk increased from 4.4% in 1971-1975 to 10.5% in 1988-1994 before decreasing to 7.5% in 1999-2004 (p<0.001 for nonlinear trend). The patterns were similar for men and women; whites had a significantly higher prevalence of low-risk-factor burden than blacks during each survey, except 1976-1980. And a larger percentage of whites had a low-risk-factor burden than Mexican Americans in 1988-1994 (p<0.001) and 1999-2004 (p=0.001).
The results emphasize "the huge potential for preventing cardiovascular disease that remains to be realized. Primordial prevention holds enormous promise in decreasing the burden of cardiovascular disease," say Ford et al. The findings "argue for vigorous population-based approaches to reverse the unhealthy shift in the distributions of blood pressure and body-mass index and to sustain or accelerate the improvement in the distribution of total cholesterol," they add.
Will this trend translate to increased morbidity or mortality?
Ford told heartwire that "one of the main factors driving the analysis is excessive weight, including its adverse effects on blood pressure and on driving diabetes in a major way. If you look at the trends in smoking, they are still in a favorable direction. The trends in cholesterol are a little bit ambivalent; they are not as good as they used to be." Ford said it is not entirely clear what the exact outcomes of these findings will be. "The implication is that there could be an increase in incidence of coronary heart disease down the road, and then the next question is: Does it affect mortality? It could be that we have a lot more people developing coronary heart disease, but because of modern treatments, good drugs, and interventions, they may not necessarily die, so we might see a lot more morbidity but not necessarily a lot more mortality. That's something we are just going to have to follow to see how it plays out."
In the meantime, "there's a lot of work to be done," he said. "Physicians played a big role in helping decrease the percentage of the population that smokes and, clearly, it's challenging to get people to maintain recommended weights, but they need to work together with their patients as best they can to try to get them to adopt as many healthy behaviors as they are able to." A lot of other sectors of society have roles to play, he said, "from schools to workplaces to maybe churches. There are a lot of opportunities to drive things in the right direction."
Van Dam and Willett agree wholeheartedly. "Healthcare providers should have adequate resources, time, and reimbursement to engage in the prevention of cardiovascular disease in individuals. Such efforts by clinicians need to be complemented by efforts by state and national agencies that have the responsibility to develop effective public-health interventions," they state in their editorial.
Source: www.theheart.org
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