Thursday 28 February 2008

Heart disease: we need medicine
not moralism

Fear of rising heart deaths is unfounded. And if we’re serious about lowering the death rate even further, we need better treatment not lifestyle lectures.

This week, a number of news headlines have highlighted the deadly threat of heart disease in Britain: ‘Bank crises “increase rate of heart attacks”’, warned the UK Guardian on Tuesday. The day before, The Times (London) cautioned that ‘Young adults’ inactivity puts them at risk of heart attack’.

The Guardian report is based on research from the University of Cambridge. Data from the World Bank and World Health Organisation over a 40-year period was analysed at Cambridge, where the researchers concluded that between 1,280 and 5,130 Brits ‘could die from heart attacks if there was a widespread repeat of the Northern Rock banking crisis’ (1). Lead researcher David Stuckler said: ‘To put this effect in perspective, this is more than 10 times the number of British troops who have died in Iraq.’ The researchers found that ‘cardiac deaths surge briefly and regularly every time there is a systemic bank failure’ and it is the elderly that are at greatest risk.

But those of us aged 35 to 54 had better not be too complacent, we’re told, because our lives may be cut short by our ‘live-now’ lifestyles. Simon Capewell, professor of clinical epidemiology at the University of Liverpool, said: ‘The flattening trends in mortality rates among young adults suggest that the cardiovascular disease epidemic is not being controlled.’ He warned: ‘The party is over and complacency runs a high risk.’

Having recently lost both my mother and my uncle to heart disease, I am not about to advocate complacency. It is estimated that in the European Union, cardiovascular disease kills over two million people every year. Still, a little perspective would not go amiss. The fact is that despite the impression given by various newspaper headlines, heart disease is not on the rise. Instead, the concern voiced by some experts, and blown out of all proportion by others, is that the dramatic decrease in deaths from heart disease over the last few decades has started to flatten out.

In my view, the experts should be concerned. They should be continually trying to reduce deaths from heart disease. Clearly, a hell of lot more can be done to improve medical intervention: my mother died from a massive heart attack several months after being put on a waiting list for heart surgery. If she had been given the treatment she needed earlier she may still have been alive today. If the medical establishment could spend a little more time putting its own house in order and a little less time lecturing us about our ‘live-now’ lifestyles, we may all be better off.

The warning that up to 5,000 people could lose their lives if we faced a massive banking crisis may be shocking. But these figures were arrived at using not-entirely-reliable computer models comparing associations between banking crises and cardiovascular disease deaths. Also, when we consider the Cambridge study’s figures alongside the fact that there were 68,230 fewer deaths from heart disease in 2000 than there were in 1981 in England and Wales, the potential effect of a financial crisis no longer seems so shocking.

There was a 62 per cent reduction in deaths from heart disease among men and a 45 per cent reduction among women over two decades from 1981. Various factors have contributed to this dramatic decrease. A large-scale study in 2004 by Capewell indicates that 58 per cent of this decrease is due to a reduction in certain risk factors, such as smoking, and 42 per cent is due to the availability of more advanced medical and surgical treatments - although this study, too, was the product of a computer model (2). Today’s heart scare is the result of scaremongers twisting what is actually a good news story: the dramatic decline in deaths from heart disease over the past 20 years. That this decline seems to be levelling off should be investigated, of course, but it should also be seen in the context of an overall successful war against death from heart disease.

We all know smoking is bad for us and don’t need to be lectured any more about that. The effect of obesity and diet on our health and our hearts is much more uncertain and, to the extent that there is a problem, there is as yet no simple solution like there is with smoking - we can’t exactly quit food. So, rather than telling us how to live, physicians should now concentrate on reducing mortality rates further by improving the availability and efficacy of medical intervention.

First published by spiked