Increase in diabetes, obesity could offset progress in cardiovascular health

Rising rates of diabetes and obesity in the U.S. could soon stall -- or possibly reverse -- the progress that has been made in improving the nation's cardiovascular health, some cardiologists say.

For that reason, primary care physicians should focus on educating patients about what they can do to reduce their risk of developing cardiovascular disease or stroke, said Tracy Stevens, MD, a spokeswoman for the American Heart Assn. She also is a cardiologist at St. Luke's Mid America Heart Institute in Kansas City, Mo.

"Americans think cardiovascular disease is somebody else's responsibility. Until Americans take ownership for their health we're not going to continue to have favorable statistics to report," Dr. Stevens said.

She recommends that primary care physicians talk to patients about lifestyle modifications they need to make to reduce their risk of cardiovascular disease and how they can make those changes. Dr. Stevens also encourages doctors to provide patients with a list of local resources, such as nearby gyms, that could help motivate them to lead a healthier lifestyle.

Her suggestions follow the release of the American Heart Assn.'s annual statistical update on heart disease and stroke, which was published online Dec. 15, 2011, in Circulation: Journal of the American Heart Association (link).

The AHA worked with the Centers for Disease Control and Prevention, the National Institutes of Health and other government agencies to gather the most recent data on heart disease, stroke and other vascular diseases.

The report shows that while deaths due to cardiovascular disease and stroke have fallen during the past decade, the prevalence of diabetes and obesity continues to rise. From 1998 to 2008, the rate of cardiovascular disease-related deaths declined by about 31%, and the rate of stroke deaths fell 35%, according to the report.

Despite the improvement, cardiovascular disease kills a significant number of people each year, indicating that more needs to be done to improve American's heart health. Cardiovascular disease accounted for one in every three deaths in the U.S. in 2008, the AHA said. About one in 18 deaths were related to stroke that year.

"We've enjoyed great success" in reducing deaths due to these conditions, said retired cardiologist William Oetgen, MD, senior vice president for science and quality of the American College of Cardiology. "But because obesity and diabetes are on the rise, we're soon going to see a blunting of these good results. It's a very troublesome trend."

Thirty-four percent of adults 20 and older are obese compared with about 23% between 1988 and 1994, according to age-adjusted estimates by the CDC. A similar trend is occurring among youths age 6 to 11, 20% of whom were considered obese in 2007-08, the AHA report shows. The figure was 4% between 1971 and 1974.

Diabetes also is on the rise, according to the association. An estimated 18 million adults 20 and older have been diagnosed with the disease, up from 9 million in 1997, data show.

Although cigarette smoking has decreased -- 19% of adults 18 and older smoke compared with 24% in 1998 -- the prevalence of many other risk factors, including physical inactivity and hypertension, have worsened during the past decade, the AHA said.

The association's goal is to improve by 2020 the nation's cardiovascular health by 20% and reduce deaths from cardiovascular diseases and stroke by 20%. To attain these goals, the AHA said every segment of the population, including physicians, needs to focus on adopting a healthy lifestyle.

"Primary care physicians need to keep doing all they can," Dr. Oetgen said. "They're fighting a valiant fight."