Coronary artery deaths drop, but new threats emerge

Improved treatment and better preventive care significantly cut the annual and actual death rate of coronary heart disease--down 36.4 percent and 21.9 percent, respectively, in the United States from 1996 to 2006, according to the American Heart Association. Also thanks to broadened use of cholesterol- and blood pressure-reducing drugs, similar success has been seen in Canada, where the death rate from coronary heart disease in the province of Ontario fell by 35 percent from 1994 to 2005, according to a study in the May 12 issue of the Journal of the American Medical Association.

However, researchers caution, the increasing prevalence of obesity and diabetes in the countries threatens to undermine the positive trends. Just a 1 percent increase in diabetes correlates to a 6 percent increase in mortality, notes study author Dr. Harindra C. Wijeysundera, a cardiologist at the Sunnybrook Health Sciences Centre Schulich Heart Centre in Toronto.

And although life-saving preventive therapies are being used more than they once were, the authors contend that significant numbers of candidates for the drugs still aren't taking them. In the Canadian study, use of statins by people with stable coronary artery disease increased from 8 percent in 1994 to 78 percent in 2005, but that left nearly a quarter of potential users uncovered. Use of blood-pressure-lowering drugs increased from 28 percent of those who needed them in the mid-1990s to 46 percent in recent years--"an improvement, but not ideal," Wijeysundera said.

To keep chronic diseases at bay, experts urge physicians to focus on preventive therapies in addition well-established lifestyle risk factors. "The worry we have now is that the continued steady decline in coronary artery deaths will slacken off because people are acquiring risk factors for heart disease," said Dr. Timothy J. Gardner, medical director of the Heart Center at the Christiana Health Care System in Bloomington, Del., and a past president of the American Heart Association. "Attention must be paid to measures such as weight reduction and exercise and control of diabetes."

To learn more:
- read this MedPage Today piece
- check out this HealthDay News article
- read study's abstract in JAMA

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