Monday, February 20, 2017

U.S Heart Failure Rates on the Rise

The number of American adults with heart failure – in which the heart is too weak to pump blood throughout the body – rose by 800,000 over five years, the American Heart Association (AHA) said in a new report released last week.

The same report also said that heart disease remains the leading cause of death in the United States, even as the death rate from heart disease is heading down.

The number of people with heart failure is expected to rise by 46% by 2030. That means 8 million people will have heart failure by then. Reasons for the rising number of Americans with heart failure include an aging population and a growing number of heart attack survivors, who are at increased risk for heart failure.

Cardiovascular disease includes all types of heart disease, high blood pressure and stroke, the heart association noted in an AHA news release.

Heart disease and stroke are the two top causes of death worldwide. In the United States, heart disease if first and stroke is fifth, according to the AHA’s 2017 Heart Disease and Stroke Statistics Update.

In the United States, more than one-third of adults (92) million) have cardiovascular disease. In 2014, nearly 808,000 Americans died from cardiovascular disease.

However, one bright spot in the update is that deaths from cardiovascular diseases fell more than 25% from 2004 to 2014.

Heart attacks strike about 790,000 people in the United States each year, and kill about 114,000. The update found similar numbers for stroke. In 2014, about 795,000 Americans had a new or repeat stroke, and 133,000 of them died.

The update had one other bit of positive news – physical activity increased more than 7% from 1998 to 2015.

My Take:
This report skirts an important issue. It’s not just heart attack survivors that are more vulnerable to heart failure, but all those patients treated for potential cardiovascular disease with statin drugs.

Statins create cardiac myopathy (heart muscle disease) in up to 10% of patients on prolonged use of these drugs. While statins due reduce the risk of death by cardiovascular disease by 1%, I question the value of placing everyone with a cholesterol level over 200 on these medications.

Every day in my office a patient presents me with lab work showing a total cholesterol between 200 and 240 with an LDL (the ‘bad” cholesterol) between 100 and 130. Their PCP (primary care physician) has recommended statin drugs.

These numbers do not warrant medication. In fact, total cholesterol and LDL levels have no correlation with cardiac risk. To measure cardiac risk, you need to run the CRP, homocysteine, and fibrinogen. These tests evaluate vascular inflammation, the true causes of CVA. This tests are part of my routine lab testing but seldom are such test run by PCPs.

The Bottom Line:
I fear we are just trading cardiovascular disease for heart failure when improved lifestyle could reduce both. A 7% increase in physical activity over the course of 17 years is not very encouraging.

Source: January 26, 2017 National Institutes of Health

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