Is a Global Decline in Deaths from Heart Disease Ending?
A new trend, anticipated by many, seems to be gaining momentum. For decades, deaths due to heart disease have declined in wealthy countries. But now, that decline is slowing. In fact, it’s going in the opposite direction now for several countries – including the U.S.
These observations come from a new study in the International Journal of Epidemiology. Moreover, they line up with other data we’ve previously noted.
Most Notable in Younger Age Groups
Alan Lopez and Tim Adair analyzed vital statistics for 23 high-income countries from the World Health Organization. They looked at deaths from heart disease for all ages and for people 35 to 75 years of age. In most of those countries, they found a considerable slowing in the decline of such deaths. In seven of them, they found the deaths rising for males or females.
This observation is most robust in the age group between 35 and 75 years. In other words, it’s hitting hardest the age groups that were younger as obesity prevalence began growing rapidly in the 1980s. Lopez and Adair explain:
The recent moderation of CVD-mortality trends in these countries suggests that obesity, or at least poor diet, might well have offset the risk reductions attributable to their low levels of smoking, given the clear increase in CVD-mortality risks with increasing obesity. For the USA, at least, this claim is consistent with recent findings on the impact of obesity on reducing life expectancy.
50 Years of Progress at Risk
Heart disease remains the leading cause of death globally. The last 50 years has brought down the rate of such deaths. That’s been a major public health achievement. It came from reducing smoking rates and from efforts to reduce the impact of high blood pressure and cholesterol.
Now that progress is at risk. Rising obesity might not explain all of what we’re seeing, but it’s a big part of the picture. And clearly, despite lots of talk, we have not been as successful in dealing with obesity as we were in dealing with smoking, hypertension, and cholesterol.
Objectively, it’s now clear that many assumptions guiding efforts to prevent and reduce obesity have been false. We need more objectivity and curiosity to find better solutions. More of the same old answers – which have not worked – will put global health at risk for years to come. Assumptions are not good enough. We must pursue real answers.
Click here for the study and here for further perspective from the authors. For more data from the U.S., click here.
Heart Attack? photograph © Thomas Hawk / flickr
Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.
August 12, 2019
August 12, 2019 at 10:53 pm, David Brown said:
An important cause of heart disease, excessive arachidonic acid intake, is being ignored. Excerpts:
“Derivatives of arachidonic acid may be involved in atherosclerosis and its clinical complications. There is much interest in pharmacologically manipulating the arachidonic acid cascade as a means of preventing cardiovascular disease.” https://www.ncbi.nlm.nih.gov/pubmed/3297623
“Many health effects of oils rich in oleic acid (18:1 n9) seem to be opposite those of arachidonic acid (20:4 n6), i.e. concerning cardiovascular risk.” https://lipidworld.biomedcentral.com/articles/10.1186/1476-511X-12-106
“A number of studies have found a positive correlation between the amount of arachidonic acid (AA)3 in adipose tissue and the risk of ischemic heart disease (IHD).” https://academic.oup.com/jn/article/135/9/2271/4664062
The amount of linoleic acid in adipose tissue, but also in platelets, is additionally positively associated with coronary artery disease (CAD), whereas long-chain omega-3 (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)) levels in platelets are inversely related to CAD. https://openheart.bmj.com/content/5/2/e000898
Arachidonic acid (AA) is an ―essential‖ fatty acid. It belongs to the ω-6 series of polyunsaturated fatty acids (PUFAs). AA is an immediate biochemical precursor of all the major physiologically active eicosanoids. It is normally present in very small quantities in the human diet but can be synthesized, in the body, from linoleic acid (LA). LA cannot be synthesized in the human body and other mammals but it is provided via
LA or dietary intake. Scientists are concerned about the high intake of LA or AA in diet because of the adverse effects associated with AA metabolites (thromboxane, leukotrienes and prostaglandins), which are potent inflammatory mediators. http://www.novapublishers.org/catalog/product_info.php?products_id=39419
Eicosapentaenoic acid (EPA) is a key anti-inflammatory/anti-aggregatory long-chain polyunsaturated omega-3 fatty acid. Conversely, the omega-6 fatty acid, arachidonic acid (AA) is a precursor to a number of pro-inflammatory/pro-aggregatory mediators. EPA acts competitively with AA for the key cyclooxygenase and lipoxygenase enzymes to form less inflammatory products. As a result, the EPA:AA ratio may be a marker of chronic inflammation, with a lower ratio corresponding to higher levels of inflammation. It is now well established that inflammation plays an important role in cardiovascular disease. https://www.tandfonline.com/doi/full/10.1080/00325481.2019.1607414
This is a small sampling from a vast body of arachidonic acid research. Here is the problem: “Eicosanoids are major players in the pathogenesis of several common diseases, with either overproduction or imbalance (e.g. between thromboxanes and prostacyclins) often leading to worsening of disease symptoms. Both the total rate of eicosanoid production and the balance between eicosanoids with opposite effects are strongly dependent on dietary factors, such as the daily intakes of various eicosanoid precursor fatty acids, and also on the intakes of several antioxidant nutrients including selenium and sulphur amino acids. Even though the underlying biochemical mechanisms have been thoroughly studied for more than 30 years, neither the agricultural sector nor medical practitioners have shown much interest in making practical use of the abundant high-quality research data now available.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3031257/
Abba Eban quote: “History teaches us that men and nations behave wisely once they have exhausted all other alternatives.”
Regarding the chronic inflammatory diseases, preventing the cause would be the wise choice. Unfortunately, the chief aim of medical science is to develop treatments for symptoms.