American College of Cardiology

A Snapshot of Post-War America
Giving an Ounce of Prevention
Today's Medications— Keeping Problems in Check
What About the Future?

Paul was one of the smart ones.

A 51-year-old Baby Boomer from the western suburbs of Chicago, Paul was a successful radiologist with a wife and two children. He had settled into the comfortable routines of family life.

Paul and his wife had skied when they were first married, and he had run a little in his 30s, but as the kids got older and his stressful hours at the hospital got longer, Paul barely had enough time to sleep, never mind exercise. Still, when his favorite jeans and shirts became a little snug and climbing stairs between floors at the hospital was harder than it used to be, Paul realized he needed to take action. "Time to stop eating out so much," he thought,"and time to haul out my running shoes again."

Paul knew it was wise to have a physical before beginning an exercise program, so he scheduled an appointment with Dr. Burns, his internist. Paul had a family history of coronary artery disease, so Dr. Burns ran him through a battery of tests, including an exercise test. To his surprise, the test suggested a blockage in the coronary arteries supplying Paul’s heart muscle with blood. Dr. Burns promptly consulted with a cardiologist who recommended a cardiac catheterization with a coronary arteriogram to visualize Paul’s heart arteries. This test showed a 95 percent narrowing in the major artery to the front of Paul’s heart.

"You know," Dr. Burns said, "if we hadn’t done these tests, and you had started to work out strenuously, you might have been dead in a week."

Cardiovascular diseases kill some 950,000 Americans every year, but as many as two-thirds of these deaths are preventable. Over the past 50 years, research into the causes of ischemic heart disease (which causes over half the deaths from cardiovascular disease) has shown that many people’s risk of a heart attack can be reduced by making lifestyle changes and taking medication. In addition, treating high blood pressure reduces the risk of stroke and congestive heart failure.

A Snapshot of Post-War America
In 1949, when the American College of Cardiology (ACC) was founded, the United States had just begun to recover its economic footing following the Great Depression and World War II. Returning GIs were heading a mass migration to a new part of the country called "suburbia."

Now that the war was over, diets were rich with lots of meat, eggs, cheese, and fresh whole milk. Soldiers who learned to smoke while fighting overseas continued the habit. In fact, 70 percent of American men identified themselves as smokers at that time. Televisions were just beginning to appear in American living rooms across the country, bringing Milton Berle, George Burns—and a couch-potato lifestyle—into our homes.

Heart Disease, Then and Now
Even the terms used to discuss prevention of heart disease have changed over the past 50 years. The phrase "risk factor," meaning one of several possible precursors for disease, emerged in the 1960s from the ongoing Framingham Heart Study, which had begun about the same time the ACC was being formed. Today, physicians know certain factors put people at risk for heart disease:

• family history,
• high blood pressure,
• high blood cholesterol level,
• cigarette smoking,
• diabetes mellitus,
• sedentary lifestyle,
• obesity,
• advancing age, and
• being male.

But a half-century ago, the level of knowledge about heart disease and the technology available to diagnose it were still primitive. "During the last 50 years, there have been remarkable gains in the diagnosis and treatment of heart disease as well as in the prevention of its development," commented Charles H. Hennekens, MD, Eugene Braunwald Professor of Medicine at Harvard Medical School and chief of the Division of Preventive Medicine at Brigham and Women’s Hospital in Boston.

In 1950, most people visited the doctor only for illness, not for the regular preventive physicals encouraged today. Doctors would give advice on preventing heart disease—drop some pounds, take it easy, and smoke less—only if a patient reported obvious symptoms or if the patient’s mother or father had died early and suddenly from heart problems.

Giving an Ounce of Prevention
Modern medicine, fortunately, has evolved. Today, attentive physicians give first-time patients a battery of tests and monitor returning patients.

A blood pressure measurement is taken on every visit. Recent studies suggest that even people with only slightly elevated blood pressure can benefit from taking measures, such as changing diet and lifestyle or using medication, to lower it.

In addition, a nurse or physician’s assistant will draw blood for blood lipid analyses and to measure blood sugar. If blood levels are found to be abnormal, the doctor might refer the patient to a nutritionist, prescribe drugs to correct high cholesterol levels, or treat the patient for diabetes mellitus.

At-risk patients might also be given an electrocardiographic stress test, which tells how adequate the blood supply to the heart is and how much physical strain it can safely tolerate. Contemporary physicians and exercise physiologists also might help a patient work out a detailed exercise plan, focusing on aerobic activities that increase lung capacity and the heart’s ability to work at higher levels.

Today's Medications— Keeping Problems in Check
High blood pressure, or hypertension, is a silent killer. People who are aware of this danger have checkups and take medication before high blood pressure damages their heart and blood vessels.

Scientists now know that hyperlipidemia, or high levels of cholesterol in the blood, can damage the blood vessels and increase the risk of heart attack and chronic heart failure. Scientists have identified exercise and modest alcohol consumption as two factors that raise levels of the so-called "good" cholesterol and determined that a diet low in animal fats results in lower levels of the "bad." In addition, modern medications dramatically and safely reduce the cholesterol level and keep it in check.

Finally, physicians now know that diabetics suffer heart disease at higher rates and are more rigorous about helping patients control their blood sugar level.

What About the Future?
Because they know that risk of heart disease can begin very early in life, health experts are beginning to focus on assessing children and counseling parents on raising healthier children.

The new-found emphasis on all types of prevention—coupled with improved diagnostic techniques and treatments—have produced impressive results. Mortality from heart disease has dropped from 146 per 100,000 people in 1948 to just 87 per 100,000 in 1996. Americans live an average of five years longer thanks to this reduction in mortality.

Yet, progress may be slowing.

"Heart disease rates have decreased by two percent a year over the past few decades, but that is leveling off and may even be on the rise again," Dr. Hennekens warned. "For the first time, we have a sign of increases in heart disease to come: Today’s adolescents are heavier, smoke more, and exercise less than their parents did at the same age."

When Paul was a kid, people didn't worry much about getting exercise. Americans generally were more active; indeed, a fair portion of the population still worked on the farm. Today, more and more people work in offices or at home, often glued to a computer all day.

Still, Baby Boomers, the oldest of whom are entering their fifth decade after growing up without the benefit of today's prevention advice, are finding it's never to late to change. Evidence shows that even after age 50 and even if heart disease has already developed, healthy lifestyle changes — stopping smoking, eating a healthy diet, exercising sensibly, and lowering cholesterol and blood pressure levels with medication — may improve the odds for a longer, more active life.

For Paul, some changes were definitely in order. An angioplasty successfully cleared up his clogged artery, and Dr. Burns prescribed cholesterol-lowering medications to keep Paul's levels down. Paul then began the long process of getting into shape. He doesn't work the long hours anymore, and although he continues to eat out once in a while, he watches what he eats. Last year, at age 53, Paul completed his first marathon.