Canada's heart attack death rates declined rapidly after 1994

Deaths and hospital admissions from cardiovascular disease dropped almost 30 per cent in the decade after 1994, butslightly more women than men were dying from cardiovascular causes, Canadian researchers say.

Researchers at the Institute for Clinical Evaluative Sciences (ICES) found that deaths from heart disease fell by 30 per cent between 1994 and 2004, from 36 per 10,000 the first year to 25 per 10,000 a decade later.

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The declining death rate meant that about 4,000 fewer Canadians died from a heart attack in 2004 than did so in 1994.

The ICES report deals only with data up to 2004. Earlier this month,however, a reportby theCanadian Institute for Health Information suggested the rate of heart attacks in Canada (i.e. the number of people per 100,000 hospitalized for heart attacks) also dropped 13 per cent between 2003-2004 and 2007-2008, after taking population growth and aging into account.

From 1994 to 2004, ICES researchers found that more men (56 per cent) than women died from a heart attack, but the majority of deaths from heart failure and stroke were in women (60 per cent), principal author Dr. Jack Tu, a senior scientist at ICES in Toronto, and his colleagues reported in Tuesday's issue of the Canadian Medical Association Journal.

The decline in heart attack deaths means more people are living with a damaged heart, which could explain theheart failure fatalities and higher proportion of deaths from the condition among women, Tu said.

By 2004, 50.5 per cent of all deaths from heart disease were in females and 49.5 per cent were in males.

Shirley Devries of Edmonton believes stress contributed to her heart attack five years ago.

"I just don't allow work to get me stressed out," said Devries, who now gardens, takes exercise classes, and eats better. "I don't allow things in life to get me stressed out. And when they do, I use a coping mechanism."

Overall, healthier diets, less smoking and greater use of medications to control risk factors like high blood pressure and cholesterol levels could explain the progress, Tu said.

"It's an ongoing battle from a lifestyle perspective and making sure that people are on the right therapies to maintain these statistics," said Dr. Beth Abramson, a Toronto cardiologist and spokeswoman for the Heart and Stroke Foundation who was not involved in the study.

Looming obesity problem could reverse trend

A related study published in the journal Circulation showed the percentage of patients lowering bad cholesterol to within target levels almost doubled over the last decade in Canada, the United States and seven other countries.

Dr. Blair O'Neill of the University of Alberta Hospital, who was not involved in the study,also sees a looming problem: the need to tackle obesity and sedentary lifestyles.

The CMAJ study concluded the increase in obesity and diabetes are risk factors that could push the number of cardiac deaths in Canada back up.

Cardiovascular disease will likely remain the most common cause of death in Canada and elsewhere given the aging population, public health experts Simon Capewell and Dr. Martin O'Flaherty of Liverpool University said in a CMAJ commentary.

"Prevention, therefore, becomes vital, because over 80 per cent of premature cardiovascular disease is avoidable," the pair wrote.