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"It is likely that the dual epidemics of obesity and diabetes, which began around 1985, are the major contributors to the deceleration in the decline of cardiovascular disease, heart disease and stroke death rates," said lead researcher Dr. Stephen Sidney. He is director of research clinics at Kaiser Permanente Northern California, in Oakland.
"If these trends continue, important public health goals, such as those set by the American Heart Association to reduce cardiovascular and stroke mortality by 20 percent from 2010 to 2020, may not be reached," he added.
The researchers found the annual death rate dropped nearly 4 percent for heart disease and nearly 5 percent for stroke from 2000 to 2011. However, those rates dropped less than 1 percent from 2011 to 2014. Through this time, the annual rate of decline in cancer deaths remained stable, at nearly 2 percent.
Before 2011, it was anticipated that the death rate from heart disease would become lower than the cancer death rate, and heart disease would no longer be the leading cause of death in the United States for the first time in nearly 100 years, Sidney explained.
But, "because of the deceleration in the decline of heart mortality, it still remains the leading cause of death," Sidney said.
The overall decrease in deaths from heart disease and stroke has been attributed to better medical care and more people having their blood pressure and cholesterol under control, as well as fewer people smoking, the researchers said.
"Efforts from the cardiovascular health care community have had an immense impact on the decline of cardiovascular death rates," said study co-author Dr. Jamal Rana. He is a Kaiser Permanente cardiologist and clinical adjunct researcher at the Kaiser Permanente Division of Research.
"However, given the startling trend pointed out in this study, the cardiovascular community needs to reaffirm its commitment to continue developing innovative ways to improve heart disease prevention at the population level," he added.
Dr. Donald Lloyd-Jones, chair of the department of preventive medicine at Northwestern University in Chicago, pointed out that deaths from heart disease and stroke have shown a steady decline for four decades. "But in the last several years there has been a flattening in these death rates, which is quite concerning," he said.
The previous declines were due to reduced smoking rates, some improvement in diet, better control of cholesterol and blood pressure, and much better care of victims of heart attacks and strokes, he noted.
"Perhaps we have maxed out in our benefits from those things. But it's more likely that these things are still beneficial. The problem is they are being offset by the obesity epidemic," said Lloyd-Jones, who wrote an accompanying editorial.
That trend may continue, and there might be rising deaths due to heart disease as the effect of the obesity epidemic really kicks in, he suggested.
"This is a wake-up call for a need to change national policy," Lloyd-Jones said. "We can't just keep doing more of the same. We have to get serious about preventing overweight and obesity in our kids and adults."
"The major benefit of a walking program for people over 70 is in reducing disability and improving mobility," said lead author Dr. Anne Newman. She is chair of the department of epidemiology at the University of Pittsburgh.
It is possible that exercise needs to be started earlier in life to reduce heart attack and stroke, or that even more exercise is needed, she suggested. "Studies of cardiac rehab do show that recurrent heart attacks are prevented with exercise," Newman said.
Both studies were published online June 29 in the journal JAMA Cardiology.
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