Heart Disease Can Kill At Any Age

[NOTE: A fair number of links are included in this post: AHA links to the American Heart Association, NIH links to the National Heart, Lung, & Blood Institute, OTH links to Other Websites]

Many people are surprised to learn that heart disease doesn't kill just older people, heart disease is one of the "Top 10 Causes of Death" in the U.S. at every age from newborns to those age to age 65 and over (see data above).

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From birth through age 14, the number of deaths due to heart disease is relatively low (there was a total of 761 deaths in the US in 2005 for this age range and most of those occurred during the first year of life). Also, the kinds of heart diseases that kill infants and children are quite different from those that kill people age 15 and older - e.g. congenital heart disease AHA NIH and infections that damage the heart AHA, OTH, etc.

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From age 15 to 24, kids grow into adults. They also start to develop and die from adult heart diseases - - not very many at first - - here are the statistics. In 2005, there were 1,119 heart disease deaths of individuals age 15-24 (all races, both sexes): 71 due to heart attacks, 41 due to high blood pressure, 122 due to chronic heart disease including heart failure, and 885 due to other diseases involving heart valves, the muscle of the heart, the pacemaker and conduction system of the heart, etc. By the way, it's this last type of heart disease that causes the sudden deaths you may have heard about when high school, college, or even professional athletes die unexpectedly during some sporting event. [I'll talk more about this in another post, "High School Sports Physicals Can Be A Joke".]

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Let's take a closer look at these deaths.

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NOTE: this post is still a work in progress

Advice, Faith, and Facts - part 2

How to find facts you can trust - - -

Start by being cautious of the broadcast media.

--------------Ever wondered how they come up with
--------------the headlines for the evening news?

Dr. Kimberly Thompson, who is on the adjunct faculty of the Harvard School of Public Health, has written a very useful 8-page Consumer's Guide to Taking Charge of Health Information which is freely available to anyone interested in making sense of the barrage of health information reported by the popular media every day. I won't repeat what she says in this very readable guide - READ IT FOR YOURSELF; but, I will add a few personal observations on the topics covered:

Is the reporting reliable? - The guide discusses of how "spin", "bias", and "coverage" can influence how a story is reported. Another important topic, however, isn't mentioned - i.e. the education/experience of the reporter. Does the reporter covering the story understand what the story is about? Naive reporters can over simplify and/or confuse the facts. And, this can be a significant problem especially in news organizations where, for example, a reporter doing celebrity gossip one day may be assigned to cover a health news story the next.

Is the information reported reliable? - This is probably the most useful section in the guide - i.e. what are "more reliable" vs. "less reliable" sources of information. There are two comments I would add:. 1) apparently, it's human nature to trust what people say more than what scientific research says - hence all the personal testimonials in TV ads. People need to resist the tempation to go with their "gut instincts" when reliable evidence is available -and- 2) not surprisingly, many reporters like to go to medical meetings so they can scoop the competition and report on the latest research. BUT, much of the research reported there hasn't been published yet, so it hasn't been subjected to peer review. Thus, research reported at meetings falls in the "less reliable" category.

What do the numbers mean? -and- Do I need to worry? - On one hand, reporters love to include statistics in their stories because it lends an air of authority to their reporting. On the other hand, it's rare for researchers to have absolute confidence in their numerical results so they are typically reported along with a "P Value" that indicates how confident the scientists are in their numbers and sometimes the results reported may NOT be strongly supported by the data. Reporters often neglect to mention this in their stories either because they don't understand it or they don't want to ruin what would otherwise be a good story (reporters who are any good with numbers usually report the business news).

Reporters are also often clueless about "risk factors". If a particular factor increases the risk of death by 100%, many reporters would lead you to believe you are doomed if you don't avoid whatever risk they're writing about. BUT, if 1 person in a thousand is dying from something and some factor increases the risk of death by 100%, that only means 2 people per thousand are likely die. Don't let some news report by a reporter of unknown qualifications panic you - especially if you don't understand statistics. Talk to someone more knowledgeable than yourself - like your doctor - then you can panic if warranted.

Does the information "matter"? - That depends on the relevance of the information - i.e. how likely it is to directly/immediately impact you or those you love. For example, if you come from a family with a history of breast cancer, a news article reporting a cure for breast cancer -- in mice, while interesting, doesn't "matter" right now (though the research may lead to a cure in humans someday).

It also depends on whether the information is "actionable" or not - i.e. how likely it is you will be able use that information to develop an action plan. A news article that reports the risk of diabetes is higher for African-Americans or Hispanic-Americans, for example, is certainly of interest if you have friends in those ethnic groups; but, until people can change their ethnicity, there isn't much anyone can do - the article doesn't "matter". However, if a news article reports the risk of diabetes is higher in people who are overweight and you have family members or good friends who are overweight African or Hispanic-Americans - the article does "matter" (if you care enough to tell them about it).

One other thing to keep in mind is: things that "matter" aren't always in the news, and things that are in the news don't always "matter". So, don't get carried away by media hype like what happened in the past with bird flu and mad cow disease. So far, they haven't killed ANYBODY in the US. However, you should worry about plain flu and pneumonia which kills over 50,000 people and cow meat that contributes to over 750,000 heart attack and stroke deaths every year.

I've found some reliable news that "matters", what next? - The Consumer's Guide does a good job on this topic and addresses ways to develop action plans (including "trade-offs" - i.e. developing action plans that you can live with), what to do when you don't have enough information to decide what needs to go into your action plan, and general guidance on places to go to find that information. To facilitate that process, I've posted links to a number of reliable news sources and information resources in the sidebar on the left side of this blog. Look at it from time to time because I intend to keep adding to the lists.

Some time in the not too distant future, I plan to post the specific guidelines I use for "Finding Reliable Health News Online" and for knowing "Where NOT To Get Health News Online".

Advice, Faith, and Facts – part 1

More years ago than I care to admit, I taught at a Christian, liberal arts college back east. During a Week of Prayer service there one year, the guest speaker said something that I’ve never forgotten:

When it comes to advice, there are really only two kinds –

Advice that is based on facts (currently referred to as “evidence-based” advice in the medical world) – Fact-Based Advice requires you to have faith in the facts

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Advice that is NOT based on facts (i.e.- commonly referred to as “opinion”) – Non-Fact-Based Advice requires you to have faith in / belief in / trust in the people who offer such advice.

Faith in people is essential in many areas of life – religion, politics, love, etc. (even buying insurance and used cars). Everyone needs to have faith – at least in some people and some human institutions like churches, government, marriage, healthcare organizations, etc. or you can become paralyzed by insecurities to the point of becoming ineffectual.

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- - - - - - - - - - - - - - - - - - - - - HOWEVER

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Your health is NOT an area where you should put your faith in other people’s opinions or subscribe to widely held beliefs. For example, many people fervently believe “natural” and “organic” foods are best. In parts of the real world where people have no choice but to grow food naturally (they can't afford fertilizers, pesticides, or much else), starvation and infectious diseases are rampant and life expectancy is dismal. Further, two rigorous studies recently done in Germany and Denmark failed to demonstrate any differences between crops grown using organic and modern farming methods. Health decisions need to be based on evidence, not on modern myths and folklore.

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[NOTE: Some studies have shown biochemical differences between plants grown with and without pesticides; however, no one has demonstrated, to the best of my knowledge, that pesticide-free plants are more nutritious. In fact, the opposite may be true for pests who eat such plants - i.e. some of the biochemical differences noted are the plant's response to the pests trying to eat them.]

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Go to a typical megamall “health & nutrition center” and all the friendly, helpful people who work there will tell you the great new supplement that they just got in from New Zealand made from some newly discovered tropical berry can cure everything from high cholesterol to stress to insomnia to memory loss to constipation to erectile dysfunction.

Why should you believe them? What evidence do they offer to back their claims (the ad copy on the box?)? Can they profit if you take their advice?

I am a firm believer in evidence-based healthcare. I don’t expect the readers of this blog to blindly take my word for anything. It’s only my opinion (though I try to make my opinions evidence-based). To that end, I try in include links to the sources of information I use when I write this blog. Check out the evidence yourself. Form your own evidence-based opinions. Only then you can become confident in the decisions that you make about your health.

In my next post, “Advice, Faith, and Facts – part 2”, I’ll tell you “How To Find Facts You Can Trust”.

Mortality - what Americans are dying of

[NOTE: 2006 data above was reported 06-11-08, 2002 data alluded to was reported as I started teaching health classes three years ago]

When you die - as everyone does sooner or later,

there is a 76% chance you will die of one of the

"Top 10 Causes of Death"

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I started teaching community college health classes 3 years ago. While preparing my lectures, I decided organize my course using a "Top 10 Countdown" theme featuring the most important causes of death reported by the CDC - i.e. how they kill you, warning signs, things that can increase your risk, and practical ways to decrease your risk of disease and premature death.

While nearly all my students were familiar with heart disease and cancer as the #1 and #2 causes of death (see table above), many were less familiar with the rest of the diseases on the list as causes of death and they were totally ignorant of mortality trends (see Page 8 of this report).

Heart disease has been the #1 cause of death in the US since the end of the influenza pandemic of 1918; however, that is about to change. Advances over the years in diagnosis, treatment, and prevention have dramatically reduced heart disease deaths; in fact, reported heart disease deaths have decreased 9.7% since I started teaching health classes just 3 years ago (see table above). Heart disease will soon drop to #2. There has been an even more marked decrease in the number of deaths due to stroke - #3 on the list [note: similar processes are involved in most heart attack deaths and stroke deaths].

Cancer, on the other hand, is different story. Cancer death rates are essentially unchanged from 50 years ago despite the fact that the US government declared war on cancer in 1971 and the National Cancer Institute has spent over $73 billion on cancer research since that war was declared. In its defense, research done by the NCI has extended the life of cancer victims, dramatically in some types of cancer, though "a cure" has yet to be found. Cancer will soon be #1 as the heart disease death rate drops below the cancer death rate.

Many people are surprised to learn that lung diseases other than lung cancer - e.g. chronic bronchitis and emphysema both of which are smoking-related - are the #4 cause of death. Others are equally surprised to see accidents are the #5 cause of death and that accidental deaths are up (even seat belts and airbags don't help when people drive too fast or are under the influence). Not surprisingly, accidents are the #1 cause of death for people age 1-39.

There is usually little change in the rankings of the various causes of death in the annual CDC mortality reports with one recent, notable exception - Alzheimer's disease. As recently as 1998, it didn't make the list (it was #12). In just 8 years it has moved up to #6; and since I started teaching 3 years ago, there has been a 23.9% increase in Alzheimer's deaths. With heart disease and stroke deaths down and cancer victims living longer, more people are living long enough to develop Alzheimer's disease.

Just one or two more observations on what Americans are dying of before I close. Many people don't take diabetes seriously, but it "officially" killed over 72,000 people in 2006 and undoubtedly "unofficially" killed many more as diabetes markedly increases the risk of heart attacks and stroke.

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Finally, many people don't take flu and pneumonia seriously either despite the fact that they killed over 56,000 people last year. How many of those deaths could have been prevented by a simple flu shot or pneumonia immunization?

How long do U.S. citizens live? . . . . . . . . . . . . . . . Not as long as they should.

How long do you have to live before you die?

Find out at The Internet Death Clock

The Centers for Medicare and Medicaid Services at HHS estimates the US will spend $2.39 Trillion for health care in 2008. As I write this, the US Census Bureau estimates US Population is a little over 305 million. After doing the math, it appears per capita expenditures for health care in 2008 will be $7.850.16 for every man, woman, and child in the US.

Historically, the US spends more money per capita than any other country in the world on its citizen’s health. Based on the most recent, reliable information I could find (i.e.- figures for the 30 most developed nations in the world) the US spent 48% more per capita than country #2 on the list (i.e.- Norway), and 147% more than the average for all 30 nations on health care [comparing Gross Domestic Products, the US spent 15.0% of its GDP versus the average of 8.4%].

With the huge amount spent, you’d think US citizens would be healthier and live longer than anyone else in the world. Yes Americans are living longer. A CDC press release June 11, 2008, trumpeted “US Mortality Drops Sharply in 2006” in announcing a record high average life expectancy at birth of 78.1 years. HOWEVER, if you check the CIA World Factbook (a US Government publication) you will discover the US is #46 on the world life expectancy at birth list. At the top of this list, citizens of Macau can expect to live to 84.3 years – over 6 years longer! Other countries ahead of the US on the list include Jordan, Bosnia, and Cyprus. Why?

Simply, the vaunted “American Way Of Life” is NOT the best way to live. Americans need to learn how to keep from killing themselves. Beginning with my next posts I’ll talk about “Mortality” (what diseases Americans are dying from) followed in subsequent posts by “Morbidity” (what diseases Americans are suffering from) and what I call “Toxic Lifestyle Choices” (what is really killing Americans).

Welcome to my blog -

A few years ago, Dr. A.H. Mokdad et al. wrote a seminal article about how Americans are killing them-selves (see - J.A.M.A. 2004;291:1238-1245). The general gist of the article was about half of all Americans who die, die prematurely, before their time, years earlier than they would have otherwise, because of the poor choices they made in the way they lived their lives.

Yes, heart disease is currently the #1 one killer of Americans, BUT some Americans have fatal heart attacks at age 75 while other have fatal heart attacks at age 45 - or earlier. Similar things can be said about cancer (the #2 cause of death), stroke (the #3 cause of death), lung disease (the #4 cause of death), etc. etc. etc.

Why do some people die young and others don't. No one has a set time to die. Even people with a family history of early-onset heart disease, for example, can do things to "delay the inevitable", to "cheat the grim reaper", to "live long and prosper", TO KEEP FROM KILLING THEMSELVES -- hence the name of this blog. Similar things can be said about cancer, stroke, lung disease, Alzheimer's disese, diabetes, etc.

This blogger keeps up with the latest health news and information for the health classes I teach at a community college in Southern California. And, through this blog, it is my intent to share this information on PRACTICAL ways to make better choices in your everyday life so that you can live healthier, happier, and longer lives - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - i.e. so you know "How To Keep From Killing Yourself".