Ill Omen on Heart Disease

A little-reported study that appeared in this week's Archives of Internal Medicine revealed a disturbing trend: heart disease among pre-retirement adults may be on the rise again after declining for more than 20 years through the late 1990s.

The study was based on a review of autopsies of 425 16- to 64-year-olds in the county surrounding the Mayo Clinic in Rochester, Minn. All had died of unnatural causes (murder, suicide, accidents) between 1981 to 2004. The reviewers found that over the entire period 8.2 percent of the victims had serious coronary blockages, and 83 percent had some evidence of heart disease.

But when looked at over time, the autopsies revealed that heart disease declined fairly steadily through 1995, but then began an upward tick -- coincident with the rise in obesity and diabetes in the area. It should also be pointed out that the rise was coincident with the introduction and widespread use of medications to reduce serum cholesterol, a risk factor for building up plaque in arteries.

The disturbing implication of a rise in the rate of heart disease is that the heart disease death rate, which has declined fairly steadily for decades, will soon follow. "The reversal in trends in young adults could precede that in older individuals in the future," University of Illinois demographers Jay Olshansky and Victoria Persky wrote in an accompanying editorial.

A recent study estimated that the decline in heart disease death rates in the last quarter of the 20th century should be equally attributed to better treatment and reduction in risk factors like smoking, obesity and diabetes. If it begins rising again, it won't be because treatment has gotten worse. That fact has clear implications for where attention should be paid over the next decade on the prevention-treatment spectrum of intervention opportunities.