Saturday May 25, 2019

Deaths Rising in U.S. Due To Heart Failure, Especially in Younger Adults

Between 1999 and 2012, annual heart failure death rates dropped from 78.7 per 100,000 people to 53.7 per 100,000, the researchers found. But then mortality rates started to climb, reaching 59.3 fatalities for every 100,000 people by the end of the study period.

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Two women converse in New York, June 26, 2012. The nation's obesity epidemic continues to grow, led by an alarming increase among women. Obesity is one of the risk factors of heart failure. VOA

More U.S. adults are dying from heart failure today than a decade ago, and the sharpest rise in mortality is happening among middle-aged and younger adults, a new study suggests.

Researchers examined data from the U.S. Centers for Disease Control and Prevention (CDC) on deaths from heart failure between 1999 and 2017 among adults 35 to 84 years old.

Between 1999 and 2012, annual heart failure death rates dropped from 78.7 per 100,000 people to 53.7 per 100,000, the researchers found. But then mortality rates started to climb, reaching 59.3 fatalities for every 100,000 people by the end of the study period.

“Up until 2012, we saw decline in cardiovascular deaths in patients with heart failure and this was likely due to advances in medical and surgical treatments for heart failure,” said senior study author Dr. Sadiya Khan of Northwestern University Feinberg School of Medicine in Chicago.

“However, this study demonstrates for the first time that the cardiovascular death rate is now increasing in patients with heart failure and this increase is especially concerning for premature death in people under 65,” Khan said by email.

A person receives a test for diabetes during Care Harbor L.A. free medical clinic in Los Angeles, Sept. 11, 2014.
A person receives a test for diabetes during Care Harbor L.A. free medical clinic in Los Angeles, Sept. 11, 2014.

Heart failure by the numbers

About 5.7 million American adults have heart failure, according to the CDC, and about half of the people who develop this condition die within five years of diagnosis. Heart failure happens when the heart can’t pump enough blood and oxygen to supply vital organs.

In the study, African Americans were more likely to die of heart failure than whites, and this disparity was especially pronounced among younger adults, researchers report in the Journal of the American College of Cardiology.

Compared to white men, black men had a 1.16-fold higher risk of death from heart failure in 1999 but a 1.43-fold higher mortality risk by 2017, the study found.

And, compared to white women, black women started out with a 1.35-fold higher risk of death from heart failure and had a 1.54-fold greater risk by the end of the study period.

When researchers looked just at adults 35 to 64 years old, the racial disparity was even starker: by 2017 black men had a 2.60-fold higher risk of death from heart failure and black women had a 2.97 fold higher risk of death.

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“Heart failure is preventable and treatable,” Fonarow said. “There is an urgent need … to eliminate the healthcare policy that has been associated with the increase in heart failure deaths. Pixabay

“More than 50 percent of black adults have hypertension and have high rates of obesity and diabetes, and this may explain a portion of the disparities in heart failure mortality,” Khan said.

Risk factors, access to care

“Beyond differences in risk factor prevalence, disparities in access to care unfortunately contribute to both inadequate prevention and diagnosis,” Khan added. “We need to do better in terms of access to care for all Americans.”

The study used data from the CDC that includes the underlying and contributing cause of death from all death certificates in the U.S. between 1999 to 2017, for a total of more than 47.7 million people.

The study wasn’t designed to determine what might be causing the rise in heart failure deaths.

“Some have speculated this mortality increase has to do with increased prevalence of heart failure risk factors of diabetes and obesity,” said Dr. Gregg Fonarow, a cardiologist and researcher at the University of California, Los Angeles, who wasn’t involved in the study.

However, it’s also possible that a recent shift in Medicare payment rules designed to curb repeat hospitalizations may have “also contributed to the increases in mortality by restricting necessary care, particularly in the most vulnerable heart failure patients,” Fonarow said by email.

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While black men are more likely to develop heart failure at younger ages, and less likely to receive recommended treatments, they’re also more likely to be treated at hospitals that are disproportionately impacted by Medicare efforts to curb repeat hospitalizations, or readmissions, Fonarow said.

“Heart failure is preventable and treatable,” Fonarow said. “There is an urgent need … to eliminate the healthcare policy that has been associated with the increase in heart failure deaths.” (VOA)

Next Story

Obesity Increasing More Quickly in Rural Areas than in Cities Worldwide: Study

City-dwelling women and men, however, put on 38 and 24 percent less, respectively, than their rural counterparts over the same period, according to the findings, published in Nature

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FILE - A man crosses a main road as pedestrians carrying food walk along the footpath in central Sydney, Australia. VOA

Obesity worldwide is increasing more quickly in rural areas than in cities, a study reported Wednesday, challenging a long-held assumption that the global epidemic of excess weight is mainly an urban problem.

Data covering 200 countries and territories compiled by more than 1,000 researchers showed an average gain of roughly five to six kilos per woman and man living in the countryside from 1985 to 2017.

City-dwelling women and men, however, put on 38 and 24 percent less, respectively, than their rural counterparts over the same period, according to the findings, published in Nature. “The results of this massive global study overturn commonly held perceptions that more people living in cities is the main cause of the global rise in obesity,” said senior author Majid Ezzati, a professor at Imperial College London’s School of Public Health.

“This means that we need to rethink how we tackle this global health problem.” The main exception to the trend was sub-Saharan Africa, where women gained weight more rapidly in cities. Obesity has emerged as a global health epidemic, driving rising rates of heart disease, stroke, diabetes and a host of cancers.

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Two women converse in New York, June 26, 2012. The nation’s obesity epidemic continues to grow, led by an alarming increase among women. Obesity is one of the risk factors of heart failure. VOA

The annual cost of treating related health impacts could top a trillion dollars by 2025, the World Obesity Federation estimated in 2017. To date, most national and international policies to curb excess body weight have focused on cities, including public messaging, the redesign of urban spaces to encourage walking, and subsidized sports facilities.

Body-mass index

To factor health status into the comparison across nations, the researchers used a standard measure known as the “body-mass index”, or BMI, based on height and weight. A person with a BMI of 25 or more is considered overweight, while 30 or higher is obese. A healthy BMI ranges from 18.5 to 24.9.

Approximately two billion adults in the world are overweight, nearly a third of them obese. The number of obese people has tripled since 1975. The study revealed important differences between countries depending on income level.

In high-income nations, for example, the study found that rural BMI were generally already higher in 1985, especially for women. Lower income and education levels, the high cost and limited availability of healthy foods, dependence on vehicles, the phasing out of manual labour — all of these factors likely contributed to progressive weight gain.

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The populations — both men and women — in small South Pacific island nations have among the highest BMI levels in the world, often well above 30. Pixabay

Conversely, urban areas “provide a wealth of opportunities for better nutrition, more physical exercise and recreation, and overall improved health,” Ezzati said. Around 55 percent of the world’s population live in cities or satellite communities, with that figure set to rise to 68 percent by mid-century, according to the United Nations.

‘Ultra-processed foods’

The most urbanized regions in the world are North America (82 percent), Latin America and the Caribbean (81 percent) and Europe (74 percent). More recently, the proportion of overweight and obese adults in the rural parts of many low- and middle-income countries is also rising more quickly than in cites.

“Rural areas in these countries have begun to resemble urban areas,” Barry Popkin, an expert on global public health at the University of North Carolina, said in a comment, also in Nature. “Modern food supply is now available in combination with cheap mechanized devices for farming and transport,” he added. “Ultra-processed foods are also becoming part of the diets of poor people.”

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“The NDC Risk Factor Collaboration challenges us to create programmes and policies that are rurally focused to prevent weight gain”, Popkin said. VOA

At a country level, several findings stand out. Some of the largest BMI increases from 1985 to 2017 among men were in China, the United States, Bahrain, Peru and the Dominican Republic, adding an average of 8-9 kilos per adult.

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Women in Egypt and Honduras added — on average, across urban and rural areas — even more. Rural women in Bangladesh, and men living in rural Ethiopia, had the lowest average BMI in 1985, at 17.7 and 18.4 respectively, just under the threshold of healthy weight. Both cohorts were well above that threshold by 2017.

The populations — both men and women — in small South Pacific island nations have among the highest BMI levels in the world, often well above 30. “The NDC Risk Factor Collaboration challenges us to create programmes and policies that are rurally focused to prevent weight gain”, Popkin said. (VOA)