THE END OF HEART ATTACKS? We hope it’s true, we fear it’s not

The main headline in the London Times the other day must rank as one of the more extraordinary ever printed. ‘End of heart attacks’, it proclaimed (in its tabloid version), even doing without the cautionary question mark.

The basis of the claim was the drop in mortality rates among the under-65s. Since 1990, the numbers who have died from coronary heart disease have halved ‘as a result of improved treatments and lifestyle changes’. More than 90 men under 65 years per 100,000 of population died of heart disease in 1990 compared with just 50 in 2000. Roger Boyle, the UK’s National Director for Heart Disease, said the rate could fall almost to zero by 2013.

But recent correspondence among heart specialists that’s been published in the Journal of the American Medical Association suggests that we still don’t really know what causes heart disease. Recent studies have suggested that 80 per cent of those with heart disease had at least one of the four recognized risk factors – cigarette-smoking, diabetes, high cholesterol and high blood pressure. This is certainly better than earlier estimates that just half of heart patients had one of the risk factors, but this still means that 20 per cent didn’t have any of these risk factors.

These are people who may have lived healthy lives, exercised and followed a good diet – and still got heart disease.

Does this mean we need to revise the risk factors? Could it be that there’s no direct association between them and heart disease, or perhaps just with one or two of them? Until these questions are answered, it seems hard to see how government officials can talk with such certainty that heart disease is all but eradicated.

(Sources: The Times, March 25, 2004; Journal of the American Medical Association, 2004; 291: 299-301).

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