Treatment, lifestyle help cut heart deaths

By Gene Emery

BOSTON (Reuters) - Lifestyle changes, new drugs and treatment advances were equally responsible for a dramatic drop in U.S. heart disease deaths during the 1980s and 1990s, U.S. and British researchers reported on Wednesday.

But increasing levels of diabetes and obesity are bucking that trend now, the team from the U.S. Centers for Disease Control and Prevention and Britain's University of Liverpool and Newcastle University said.

They calculated that nearly 342,000 early heart deaths were prevented between 1980 and 2000, although heart disease remains the No. 1 killer of Americans.

Surgery and other interventions prevented 47 percent of the early deaths, while 44 percent were prevented by a combination of lower smoking rates and risk factors such as cholesterol and blood pressure being cut by drugs, exercise or better diet.

"However, the prevalence of both obesity and diabetes has increased alarmingly," the team, led by the CDC's Dr. Earl Ford, wrote in their report published in the New England Journal of Medicine.

"These two decades saw rapid growth in costly medical technology and pharmaceutical treatments for coronary heart disease, as well as substantial public health efforts to reduce the prevalence of major cardiovascular risk factors."

The exceptions were increases in weight, which accounted for about 26,000 additional deaths in 2000, and diabetes, which killed about 33,500 people.

Before factoring in the negative effects of excessive weight and diabetes, Ford and his colleagues said lower smoking rates accounted for nearly 12 percent of the decline in the death rate.

Better treatment for high blood pressure was responsible for a 20 percent drop and improved cholesterol control was the biggest contributor, lowering the rate by 24 percent. Increased physical activity shaved the death rate by 5 percent.

No single drug or treatment revolutionized care during those two decades. The use of aspirin, statins, beta blockers, ACE inhibitors and treatments to directly dissolve clots all contributed.

Most lives were saved by direct intervention after patients had heart attacks, such as bypass surgery, the researchers said.

Angioplasty -- a procedure in which a balloon is threaded to the site of a blocked artery so it can be expanded, allowing blood to flow again -- accounted for only about 2 percent of the deaths prevented or postponed during those two decades. Statin drugs accounted for about 8.5 percent.

Darwin Labarthe, director of the CDC's division for health disease and stroke prevention, said the key lesson was that people should get out and walk, cut back on their alcohol consumption and improve their diet.

"We're underinvested in prevention," he said in a telephone interview.