Progress In Coronary Disease Death Rates Grinds To Near Halt In Young Adults

The worrisome plateau in death rates comes at a time when young Americans are increasingly likely to be obese and suffer from diabetes, high blood pressure and other cardiovascular risk factors.

"Young adults should take stock of their lifestyles," said Earl S. Ford, M.D., M.P.H., a medical officer in the U.S. Public Health Service. "If you're smoking, you should quit. If you're doing less than 30 minutes of physical activity per day, it's time to find ways to be more active. If you need to lose weight, you should burn more calories than you take in."

For the study, Dr. Ford and his colleague, Simon Capewell, M.D., of the University of Liverpool, U.K., analyzed United States vital statistics data between 1980 and 2002 for people aged 35 and older. Overall, the news was good: The death rate from coronary disease fell by 52 percent in men and 49 percent in women.

When considered from a different perspective, the death rate from coronary disease among men declined, on average, by 2.9 percent per year during the 1980s, 2.6 percent per year during the 1990s, and 4.4 percent per year from 2000 to 2002. Among women, the average annual death rate declined by 2.6 percent, 2.4 percent, and 4.4 percent, respectively.

The numbers told a strikingly different story when the researchers reviewed the data by age. Among men aged 35 to 54, the average annual rate of death from coronary disease fell by 6.2 percent in the 1980s, slowed to 2.3 percent in the 1990s, and leveled off with an annual decline of just 0.5 percent between 2000 and 2002.

In women aged 35 to 54, the average annual rate of death from coronary disease fell by 5.4 percent in the 1980s and slowed to 1.2 percent in the 1990s. Between 2000 and 2002, the death rate actually increased by an average of 1.5 percent per year. This increase was not statistically significant. However, in even younger women--those aged 35 to 44--the rate of death from coronary disease increased by an average of 1.3 percent annually between 1997 and 2002, a finding that was statistically significant.

"This should be regarded as a wake-up call for everyone interested in heart disease and heart health," said Philip Greenland, M.D., F.A.C.C., who co-wrote a companion editorial in the same issue of JACC and is the Harry W. Dingman Professor and senior associate dean for clinical and translational research at the Feinberg School of Medicine, Northwestern University, Chicago. "The take-home message is that heart disease has not gone away, continues to be a problem, and could become a greater problem if Americans fail to pay attention to known warning signs like overweight and obesity, and lack of exercise."

Good habits should start early, Dr. Ford said. "Atherosclerotic changes that lead to coronary heart disease occur at an early age. Therefore, it's especially important that children learn to develop appropriate behaviors that minimize their risk for heart disease later in life. Cardiovascular health is a life-long commitment."

The research, conducted at the Centers for Disease Control and Prevention in Atlanta, appears in the November 27, 2007, issue of the Journal of the American College of Cardiology.

Dr. Ford does not report any potential conflicts of interest regarding this topic.