What’s killing us now has changed

Heart disease has been the No. 1 cause of death in the U.S. for decades, but the type of heart disease deaths is changing. 

A study published in the Journal of the American Heart Association looked at data from the Centers for Disease Control And Prevention’s National Vital Statistics System from 1970 to 2022. 

Here’s the good news: When adjusted by age, heart disease decreased by 66% from 1970 to 2022. 

As well, some of the causes of those deaths also decreased in large numbers: 

• Deaths by heart attack fell by 89%
• Deaths by coronary artery disease by 81%

So, why is heart disease still the No. 1 cause of death? Other heart disease types have taken over:

• Heart failure increased by 146%
• High blood pressure-related disease increased 106%
• Arrhythmias increased 450%

Dr. Joaquin Cigarroa, an interventional cardiologist at Heart Hospital of Austin, explains that 50 years ago, people would have a heart attack and they would die. Mainly because doctors didn’t have good interventions for the patients: “We would put them in a dark room with a warm bottle of water and make sure they are comfortable,” he said. 

Most people didn’t know about CPR, bypass surgeries had just begun and placing stents to keep the arteries open wouldn’t happen in humans for another 16 years. Doctors also didn’t have the medications we have now to control blood pressure and cholesterol — things that lead to heart-related deaths. 

Cigarroa divides heart problems into three types:

• The plumbing, which is blockages in the arteries that don’t allow blood to flow and cause a heart attack. Many of those problems have been solved with stents, bypass and medications.
• The electrical, which causes an abnormal heartbeat. While ablations and pacemakers have helped those electrical problems, abnormal heartbeat problems, including atrial fibrillation, continue to increase.
• Structural problems, which typically are congenital problems. These now can be fixed surgically or in extreme cases with a heart transplant. More people are living longer with structural problems that years ago would have ended in death as a child.

Lifestyle is playing a role in heart failure and arrhythmia problems. About 50% of American adults have prediabetes or diabetes, and 50% have hypertension.

“Hypertension is a silent killer,” Cigarroa said. “It doesn’t care if you feel fine,” but over time, he said, it can lead to heart failure because the heart has had to work too hard. Diabetes damages the blood vessels over time and can make the heart muscle stiffen. 

Age as we are living longer also is playing a role, especially on the electrical system of the heart, Cigarroa said. The heart, he said, “is like  a lamp that has an electrical cable inside it. As time passes, those wires can fray,” he explains. That leads to an irregular heartbeat. 

Also think of the heart muscle as a rubber band that is supposed to be flexible and stretch and contract, but with time that rubber band stiffens and can’t beat as efficiently. Sometimes that stiffening happens on the diostolic, when it can’t relax well, or the sistolic, when it can’t tighten well. (Systolic is the top number in a blood pressure reading and refers to the amount of pressure in arteries while the heart is beating. Diastolic is the bottom number and refers to the amount of pressure in the arteries while the heart is resting in between heartbeats.)

Unlike with a heart attack, heart failure happens gradually. People might have these symptoms:

• Shortness of breath
• Decreased function such as from being able to run 10 miles every day to not being able to run a mile without being winded
• Feeling fatigued
• Swelling in the legs

With atrial fibrillation (often called aFib), people have these symptoms:

• Heart palpitations or fluttering in the heart
• Feeling like the heart is beating fast
• Feeling light-headed
• Shortness of breath

Electrical heart problems unlike plumbing problems can be difficult to diagnose because they come and go. A stress test on a treadmill or using medications or an electrocardiogram (EKG) can show the plumbing problems. An echo cardiogram (an ultrasound of the heart) will show the structural problems. To see the electrical problems, people might need to wear a heart monitor for two weeks if the arrhythmia is not persistent. Those monitors used to be a big box with a belt, but now are a sticker about the size of a driver’s license that transmits results.

• See their primary doctor for regular screenings including diabetes, blood pressure and cholesterol. Those checks should be done at least annually throughout adulthood, even in the 20s.
• Check for inflammation markers in the blood annually. Heart disease, like so many other disorders, is inflammation, Cigarroa said.
• If you know your family history, point out to your doctor if a male in your family has had a heart event before age 55 or before age 65 for a female.
• Get a calcium CT scan of the arteries around the heart at age 40. Typically this is a $99 out-of-pocket scan, but it can identify risk factors.
• Have an annual EKG to identify any abnormalities.
• If you are undergoing chemotherapy, have heart scans during and after treatment. The medication can damage the heart.
• Make lifestyle changes such as improving diet (including reducing sodium), increase exercise and stop smoking. “Quitting smoking does more than any medication I can prescribe you,” Cigarroa said.
• Remember that everything is in moderation. “I like pizza and beer,” Cigarroa said, “Let’s be practical. Moderation is the key to maintaining a healthy lifestyle.”