Obesity driving surge in deadly heart attacks

Younger people, women and nonsmokers now more likely to be victims

A recent Wall Street Journal report noted that one of America’s greatest achievements over much of the past century has been a huge decline in death rates from heart disease and strokes. Anti-smoking campaigns, medications to control blood pressure and cholesterol, and surgical advances have extended millions of lives.

Now, progress has stalled, the newspaper said. The death rate for cardiovascular disease — which includes heart disease and strokes — has fallen just four percent since 2011, after dropping more than 70 percent over six decades, according to mortality statistics from the Centers for Disease Control and Prevention.

Particularly alarming is that the death rate is actually rising for middle-aged Americans. Heart disease was once on course to fall below cancer as the nation’s leading cause of death, a change public-health statisticians most recently predicted would occur by 2020. No longer, Robert Anderson, chief of the CDC’s mortality statistics branch, told the Journal.

OBESITY EPIDEMIC
The obesity epidemic and related rise in the prevalence of Type 2 diabetes are key culprits in the new wave of cardiovascular disease mortality, researchers and cardiologists say. Studies have linked obesity and diabetes to high blood pressure and other conditions that increase the risk of heart attacks, strokes and heart failure.

Nearly 40 percent of U.S. adults age 20 and over are obese, another 32 percent are overweight, and 9.4 percent of U.S. adults 18 and over have diabetes, according to the CDC.

Today’s heart-disease victim is vastly different from the classic patient doctors and the public were trained to recognize a half-century ago: a smoker, usually male, whose LDL, or “bad” cholesterol numbers were sky high. Now, the patients are younger, more obese, much less likely to be smokers and include more women, and many are unaware that they are at risk, according to the Journal article.

BMIS ARE RISING
These days most checkup reports from a doctor visit include not only blood pressure, but the patient’s Body Mass Index, or BMI. Body Mass Index is an indicator of the amount of body fat for most people. It is used as a screening tool to identify whether an adult is at a healthy weight.

A research doctor told the Journal: “I’ve been working in a coronary-care unit for 40 years, and the patient that comes in now looks completely different from the patient when I was starting out,” he said. “It is an absolutely striking difference.”

He calculated the median BMI of patients in the unit one day recently. Obesity is defined as a BMI of 30 or above. The unit’s median was 34, he said. Several patients had BMIs over 40.

“I think obesity is the new smoking in terms of contribution to heart disease,” said a cardiologist at Northwestern University Feinberg School of Medicine. “We’ve made such great progress in coming up with smoking-cessation programs. For physical activity, healthy diet and weight loss we haven’t found the right approach.”

You can calculate your BMI using this formula: 703 times your weight in pounds divided by your height in inches squared. For example, 703 x 185 lbs divided by 70 in. x 70 in. results in a BMI of 26.5, or slightly overweight.

A BMI of 18.5-24.9 indicates that you are at a healthy weight for your height. By maintaining a healthy weight, you lower your risk of developing serious health problems. A BMI of 25-29.9 indicates that you are slightly overweight. You may be advised to lose some weight for health reasons. A BMI of over 30 indicates that you are heavily overweight.

EXCESS WEIGHT AND BLOOD PRESSURE
Being too heavy also raises blood pressure and blood cholesterol and triglyceride levels and lowers HDL (good) cholesterol levels. It can make diabetes more likely to develop, too.

The consequences of obesity are eroding the enormous gains brought about by public-health campaigns against smoking, along with medical innovations such as cholesterol-lowering statin drugs. Statins, which were introduced starting in the late 1980s, have prevented millions of Americans from developing life-threatening blockages in their blood vessels that can cause heart attacks.

A 2018 study in the journal JAMA Cardiology shows the lifetime risk of cardiovascular disease and deaths from it to be higher for overweight and obese adults than for people with a normal Body Mass Index. Cardiovascular-disease death rates rose 1.5% between 2011 and 2017 for 45-to-64-year-olds, according to CDC statistics. That includes increases in the rates of deaths from strokes, hypertensive heart disease and heart failure — all diseases associated with obesity.

Older people still account for most cardiovascular deaths, but the cardiovascular-disease mortality rate for people 75 and older — who had benefited from the treatment advances and smoking cessation — actually fell six percent in the same years.

Obesity and diabetes add to common risk factors such as high blood pressure that already made heart disease and stroke widespread.

About 46 percent of American adults have high blood pressure, or hypertension, under guidelines released in 2017 by the American College of Cardiology and the American Heart Association. Of that group, three-quarters either aren’t being treated with medications or don’t have it under control, according to a study in Circulation, an AHA journal. High blood pressure can be caused by hereditary factors, too much sodium, excess weight and other factors.