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Heart attack deaths drop over past two decades
- clircle 3y agoHow do i square this finding with the supposed increasing obesity epidemic in America?
- mbg721 3y agoThe article points out that they're not sure if it's due to better prevention of heart attacks or better treatment that prevents death once an attack occurs. It could be that obese Americans used to ignore symptoms but no longer do, for example.
- dangwhy 3y agoarticle says decline of smoking is one of the big factors.
- ggm 3y agoThere would be a shittonne of confounding factors. I don't doubt smoking is part of it saying that, but over the last 20 years diet has gone from "fat is bad" to "this fat is less bad" to "fat isn't bad its sugar, stupid". Hydrogenated margerine was just heading out the door 20 years ago. The cohort who lived off it probably had their heart attacks by now. (I don't think "i can't believe its not butter" caused the heart attacks, I just point out there's been wider societal changes than just smoking: Exercise is trendy again, and TV has got crap so people do less couch time than they used to) I'm sure the real science here is good. If they say it's smoking, and they ran the numbers, I'd believe them. You know, it says "smoking" in a sentence which says "and other factors" to me. The truly interesting thing is the variance in survival rates between POC and white America has reduced. Thats really good. Because survival is about improved treatment and detection. It may mean a POC harming bias in social/medical services and access to quality healthcare has improved, or that their income levels have aligned more with mainstream america and so the health improvement is about lifestyle lift.
- riffraff 3y ago> Exercise is trendy again Is it a last 20 year development? I remember people going to the gym in the '90s. Step aerobics anyone?
- ggm 3y agothe cohort who died of heart attacks were not young. If you were gym young in the 90s, you formed the body of people who didn't die over the next 30 years, and helped moved the dial. If you were gym old in the 90s, and lived on tater tots smothered in lard, chain smoked and drank sprite out of a bucket, you were the cohort who did die over the next 30 years. Mr Kurtz, he dead. (Marlon Brando wouldn't have known a Gym after the waterfront)
- HlessClaudesman 3y agoYeah, remember we are talking about effects in the aggregate, was the 1980s / 90s fitness trend actually widespread in different cohorts or just more visible in your cohort? I dont know, but today we do see quite a few men of prime heart attack age in their 50s who are absolutely Jeff Bezos jacked. Increased fitness and decreased smoking in most groups seems to explain the results.
- sokoloff 3y ago> TV has got crap so people do less couch time than they used to Do they do less couch time? I’d have guessed that streaming/on-demand services and mobile phone usage at home have well more than made up for what traditional TV has lost.
- dangwhy 3y ago> Exercise is trendy again, and TV has got crap so people do less couch time than they used to This is not true at all. Sedentary time increased to all time highs to 12hrs/day and 3/4 of population is obese.
- ggm 3y agoA problem which will solve itself in mortality stats in the future. An economist minded colleague said if you want to reduce end of life costs in healthcare then encourage smokers over 45 to puff more not less and remove the problem faster.
- paulpauper 3y agobut increased fatness should offset this, i would assume
- xupybd 3y agoA decline in deaths from one cause can signal another cause is killing people before the other cause gets a chance.
- carlmr 3y agoFamous example: motorcyclists get less cancer.
- Paul-Craft 3y agoIt works the other way around, too. Currently, the top 5 causes of death in the US are, in descending order, heart disease, cancer, COVID, accident, and stroke. If you could wave a magic wand and make it so that nobody ever died of heart disease anymore, those people would still die eventually of something else. So, curing 100% of all heart disease would actually cause more people to die of cancer, COVID, accident, stroke, etc.
- flakeoil 3y agoCOVID is probably just a short term anomaly and not a major cause of death going forward. COVID was probably also a cause of death that decreased some of the other death causes.
- smt88 3y agoThe opioid crisis has killed relatively young people in huge numbers. Suicide has risen too.
- yieldcrv 3y agoYeah if someone under 50 dies randomly and the family isn't specifying then I automatically assume accidental fentanyl A lot of people dont want their idols to be associated “with drugs” but thats just childish at this point
- xupybd 3y agoWhile the absolute numbers are not a huge percentage of the population they are tragically high. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates#:~:text=More%20than%20106%2C000%20persons%20in,drugs%20from%201999%20to%202021 https://nida.nih.gov/research-topics/trends-statistics/overd....
- dclowd9901 3y agoI wonder if any of that movement can be attributed to many companies moving away from saturated fats, as an actual selling point for their food products. Not long ago it was basically a dirty word when it came to food. Doesn’t mean that people consumed fewer carbohydrates.
- spirit557 3y agoLook at this graph comparing saturated fat consumption and rate of heart disease: https://www.cureamd.org/wp-content/uploads/2018/10/Saturated-Fat-and-Vegetable-Oils-Versus-Heart-Disease-USA.jpg https://www.cureamd.org/wp-content/uploads/2018/10/Saturated... This data comes from a book by Chris Knobbe, MD studying consumption of different fats. It is supposed to be released this month not sure if it has yet. Blaming saturated fats has basically been a complete lie IMO.
- dclowd9901 3y agoWow, great callout. Is this an issue with Vegetable oil specifically? If one uses olive or avocado oil, are issues of heart disease correlated?
- spirit557 3y agoIf you still see this I doubt they would be compared to seed oils. Avocados and olives were consumed for thosuands of years before 1900. Seed oil extraction is a modern, heavily processed invention and was introduced into the food supply by industry looking to get rid of its waste product after 1900
- RC_ITR 3y agoA meaningful driver of heart attacks was older people working manual jobs that stressed their cardiovascular system. Now those same types of people sit in F-150s and use laptops to control heavy machinery. Fitness is worse, but risk for a single catastrophic event is less.
- xyst 3y agoThis article means that identifying and treating heart attacks has improved tremendously. People shouldn’t correlate it with the general health of the population though.
- laratied 3y agoNo doubt. My father would be dead if not for the advances in treatment. He also practically changed no bad habits after the heart attack. We have got better when the heart attack happens and better at keeping people alive who want to eat pizza and drink beer all the time.
- inglor_cz 3y agoQuite well. Smokers who quit tend to gain weight.
- poorbutdebtfree 3y agoThe same way you square "food insecurity."
- dvasdekis 3y agoI personally wonder if some heart attacks have been reclassified as cardiac arrests or other outcomes as our understanding of heart health has advanced? It's just a thought, I don't have any data to support this. Not sure if anyone has any insight.
- mr_toad 3y agoSeems unlikely, we’ve known the difference for a long time, and the diagnosis versus say cardiogenic shock is pretty straightforward. The classifications are not mutually exclusive. You can have one without the other, or both together. Given that most cardiac arrests are caused by MCI I’d expect the rates of deaths due to cardiac arrest declining as well.
- hprotagonist 3y agoi guess AEDs work
- hdt9771 3y agoCardiologist here, can confirm. We’ve long been seeing these promising trends, in the US, Europe, and elsewhere. I would say the greatest reason for this are 1- advances in percutaneous interventions (which is as much about having new tools to fix acute MIs, such as more effective stents, as much as logistically making these tools + the skilled physicians to operate them widely available in any place at any time), 2- relatively cheap & highly effective cardiac medications, & 3- the hugely successful anti-smoking campaign. Diet/exercise changes of course may be some contributors but they’re clearly not being widely followed. Here’s the original article in JACC fyi— https://www.jacc.org/doi/10.1016/S0735-1097%2823%2901585-1 https://www.jacc.org/doi/10.1016/S0735-1097%2823%2901585-1
- bagels 3y agoMI = myocardial infarction, percutaneous ~= stents/angioplasty
- graeme 3y agoNoticed any change in the past couple of years? There have been reports of increases in heart attacks following Covid infection, especially in younger people. However data moves pretty slowly. The article linked above for example cuts off in 2020. Whereas most people only got infected in 2022. https://www.cedars-sinai.org/newsroom/today-young-people-are-more-likely-to-die-of-heart-attacks-post-covid-study-finds-but-why/ https://www.cedars-sinai.org/newsroom/today-young-people-are...
- Aldipower 3y agoStudies not taking the vaccination status into account are not serious. This study even does not talk about vaccination status.. I am not saying COVID isn't cause heart attacks. But this study is just embarrassing.
- defrost 3y agoIt's literally an observational summary of all filed provisional death certificates between between April 1, 2012, and March 31, 2022 limited to those that specifically mention "heart attacks" (AMI - acute myocardial infarctions) [0]. As those death certificates don't mention measles, rubella, flu, or COVID vaccinations, etc. they don't feature in a pure numerical grouping and summary. If you feel that vaccination status play a part worthy of notice then you are free to pull the data yourself [1] and cross reference those deaths against vaccination status data. Very few published studies are the be all to end all, they are each at best parts of a greater picture, what this study does highlight is that AMI's trended downwards for almost a decade and then rose as COVID spread. Clearly there is more work to be down here - as this study signposts. [0] https://onlinelibrary.wiley.com/doi/10.1002/jmv.28187 https://onlinelibrary.wiley.com/doi/10.1002/jmv.28187 [1] https://wonder.cdc.gov/mcd-icd10-provisional.html https://wonder.cdc.gov/mcd-icd10-provisional.html
- phendrenad2 3y agoSmoking is probably the big factor here.
- xutopia 3y agoI was thinking that and trans fats... they've decreased by over 30% between 1980 and 2009. source: https://www.reuters.com/article/us-health-diet-trans-fat-idUSKCN0IB2GH20141022# https://www.reuters.com/article/us-health-diet-trans-fat-idU...
- BlackFly 3y agoIt is good news, but these things always make me wonder: what kind of death increased? I see there was a two year increase in the expected life span in the USA over the last two decades, so probably people are indeed living longer but death finds us all. Did cancer death rates go up?
- AstralStorm 3y agoChildbirth deaths have increased in the USA in particular. It is a very troubling trend.
- api 3y agoIs there a relationship to natural and home birth trends? Don’t know but it’s something to ask.
- achates 3y agoI would bet that it's more related to older mothers and higher obesity rates.
- AstralStorm 3y agoIt's correlated with racial makeup of the area in which hospital operates - a combination of funding and racism.
- paulpauper 3y agothis is sorta unexpected given the high prevenlance of obesity , 75 percent of Americans being at least overweight, but life expectancy is stable or rising, and disease keeps falling. Even with better treatments and prevention, we would not expect this. we would expect incidences to go way up, same for mortality.
- kqr 3y agoThink of it the other way around and it becomes less surprising. We should expect people to become less healthy when healthcare improves. Thanks to the improvements in healthcare more people have the opportunity to become overweight and stay that way for a longer time.
- FollowingTheDao 3y agoAll the study is saying is that we’re doing better at keeping fat people with heart disease alive. It’s not saying anything about lowering the rate of heart disease. And I think this is the crime of the medical system. It’s not healthcare, it’s sickcare.
- nervousvarun 3y agoPrivate healthcare is for-profit and directly incentivized by an unhealthy population. Public healthcare is non-profit and directly incentivized by a healthy population. Is this true? Because to my American eyes it has always seemed true. The obesity epidemic seems like a good case study. Private health care looks to prescription drugs to fix it (subscription model) whereas public conceivably would push community awareness campaigns promoting exercise/diet (no profit stream).
- FollowingTheDao 3y agoI have experience this problem in my own healthcare. When I tell the doctors, I want to focus on diet and metabolics and not medication they do not want to help me. So even the doctors are trained to exist in the for-profit system. And I know I’m in the early stages of ankylosing spondylitis yet since I don’t have any bone deformation yet they just don’t care about my pain.
- hackernewds 3y ago> also a reduction in racial disparities for heart attack deaths This can be mean TWO things. Not just ONE as the line suggests.
- YellOh 3y agohttps://www.cdc.gov/nchs/hus/spotlight/HeartDiseaseSpotlight_2019_0404.pdf https://www.cdc.gov/nchs/hus/spotlight/HeartDiseaseSpotlight... Pretty sure it means that while all groups decreased in deaths from heart attacks, the highest risk groups (white and black Americans) saw a larger decrease in deaths than the groups that had lower risk of death (Hispanic and Asian Americans). Therefore the gaps between racial groups' deaths are lower than they were at the start.
- dmkirwan 3y agoIn many parts of Europe, a heart attack used to go like this: 1: 112 call to an ambulance 2: Ambulance arrives, takes an ECG and gives aspirin and GTN 3: Paramedics drive to the emergency department 4: ER doctor identifies the patient is having a heart attack, and pages cardio 5: Cardio decide the patient needs a stent and they bring them to an OR to have it fitted. In each of these steps, the patient could go into cardiac arrest and likely will not survive. Today it looks more like this: 1: 112 call happens, the call taker follows a protocol that asks the caller to administer aspirin if appropriate while the ambulance is on the way 2: Ambulance arrives, takes an ECG, identifies a heart attack and transmits the ECG to a cardiologist, all while treating the patient 3: Cardiologist thinks the patient would benefit from a stent, so the paramedic begins transporting the patient and administers whatever pre-operation drugs the cardiologist wants (this would normally happen at step 5 in the previous example) 4: Patient is brought direct to the OR (or PPCI as they're specifically called here) where the cardiac team are waiting around the table for the patient It's so efficient. I'm not up to date with the latest research on this but just the time savings alone must have saved so many lives. Treatment starts far sooner and all unnecessary steps are removed.
- AnimalMuppet 3y agoI've posted this before, but: Here's what to look out for. A heart attack doesn't always look like a crushing pain in your chest. (It can - don't ignore it if that happens!) Sometimes it looks like "I used to be able to do that two weeks ago, and now I can't". I play ultimate frisbee. At one point, I noticed that I was getting winded more easily, and taking longer to recover. Now, that happens as you get older, but it happens over the course of decades. When it happens in a month, that's not just aging. So I went to a cardiologist, and they had me do a stress echo test. They did an ultrasound of my heart while resting, then put me on a treadmill and ran me until I dropped, then did another ultrasound. They said that there was "abnormal motion of my heart wall under stress". Translation: when the load got high enough, parts of the heart muscle weren't getting enough oxygen (blood) to keep up. So they scheduled me for a catheterization (I forget whether that's the right term). They ran a catheter in my right wrist, threaded it through my arteries to the arteries that feed the heart, and went looking around. They found an artery that was blocked 90% and one that was blocked 80%, and they put stents in them. They found another that was blocked 60%, which is called the "widow maker", and they didn't put a stent there, because it was only 60% blocked. I found this kind of weird at the time, but after thinking about it, I suspect that if they put a stent there, then they can't later come back and put a stent at any point downstream of it, so the options would be to either do nothing or cut my chest open, and they'd rather leave their options open and monitor. They put me on a heavy statin dose. (I'd been on statins for decades, but the cardiologist looked at my previous dose and said "that's like a placebo". There's doses that a GP thinks are useful, and there's doses that a cardiologist thinks are useful, and those are quite different.) I get to have a stress echo every three years for the rest of my life. But I can still be as active as I was, with no restrictions or caution needed. TL;DR: Watch out for an abrupt decline in your ability to sustain physical exertion. In order to see it, you need to regularly be physically active. If you do see it, take action now - don't wait for the crushing chest pain.
- abhayhegde 3y agoThanks for sharing this. Hope you're better now. What do you think about the side effects of statins?