A Personal Experience with Heart Health
Just before my 47th birthday last month, I hopped on the subway to Manhattan’s Upper East Side for a coronary artery calcium scan, or CAC.
If you’re not familiar with it, a CAC is a specialized CT scan that detects calcium buildup in the heart and arteries. Now, unlike calcium in your bones, deposits in your coronary arteries are usually a bad sign. They indicate plaque formation, which is a mix of cholesterol, fat, and other substances. The higher your calcium score, the more plaque you’ve got, and, unfortunately, that correlates with a higher risk of heart disease and heart attacks.
A few hours after my test, I got a notification on my phone. My score was 7—a small amount of calcified plaque. It indicated a “low but non-zero cardiovascular risk.” If you break it down, that means I have about a 2.1 percent chance of experiencing a major cardiovascular event in the next decade.
Now, 2.1 percent might not seem alarmingly high. It’s slightly more than the odds of drawing an ace of spades from a deck of cards—but when we’re talking major heart issues, 2.1 percent feels a lot higher than I’d prefer. So, here I am, joining the ranks of millions of Americans on statins to lower my LDL cholesterol, which is often labeled the “bad” cholesterol.
Honestly, I wasn’t eager to celebrate my birthday with such a stark reminder of my mortality. But everything from the advanced technology of the scan to the prescription for statins clearly demonstrates the significant progress the U.S. has made in combating heart disease and related events such as heart attacks.
A Dramatic Decline in Heart Attack Mortality
Heart attacks have historically been seen as near-death sentences. Back in 1963, the death rate from coronary heart disease reached a peak in the U.S., hitting 290 deaths per 100,000 individuals. If you look back to 1970, a man over 65 who experienced a heart attack while hospitalized had only a 60 percent chance of surviving.
The sudden loss of a loved one due to a heart attack was something that truly terrified everyone. It was as if you lost someone without warning, almost like a tragic accident.
However, the statistics today are reassuring. A recent study shows that between 1970 and 2022, the percentage of deaths from heart attacks dropped by almost 90 percent. Heart disease, as a cause of adult deaths in the U.S., fell from 41 percent to 24 percent. Nowadays, if a man over 65 is hospitalized for a heart attack, he has a remarkable 90 percent chance of survival.
It’s estimated that the advances in both prevention and treatment over these 50 years have saved millions of lives. But how did we achieve this?
In 1964, not long after the peak of heart disease deaths, the U.S. surgeon general published a groundbreaking report on the dangers of smoking, initiating a long-term public health campaign aimed at one of the primary contributors to cardiovascular issues.
This campaign has proven greatly effective. In 1970, about 40 percent of Americans smoked, but by 2019, that number had dropped to 14 percent—and it continues to decline.
The reduction in smoking has certainly contributed to fewer Americans facing heart attack risks. Additionally, during the 1980s, statins emerged as a game-changer for cholesterol management, helping to prevent heart disease. Some estimates suggest up to 2 million lives are saved worldwide each year due to statins.
When heart attacks do occur, the widespread knowledge of CPR and the introduction of portable defibrillators—becoming more common in the late 1960s—have assured that more people can survive long enough to reach medical attention. Once they arrive at the hospital, tools like specialized coronary care units and procedures such as balloon angioplasty and stents have significantly improved patient outcomes during acute cardiac events.
Shifting Patterns of Heart Health
Despite these advances in preventing heart attacks, approximately 700,000 Americans still succumb to heart disease each year, equating to 1 in 5 deaths overall.
This situation partly arises from our successes; as more people survive heart attacks and life expectancy increases, more individuals live long enough to face chronic heart conditions like heart failure and pulmonary diseases. So, while we’ve made strides in reducing one significant risk factor, many Americans today are, in a few ways, less healthy than they were half a century ago. Rise in obesity, diabetes, hypertension, and sedentary lifestyles all contribute to a greater chance of experiencing heart disease later in life.
New treatments like GLP-1 inhibitors, such as Ozempic, show promise in lessening the impact of heart disease. Studies indicate that overweight patients using these inhibitors for over three years had a 20 percent lower risk of heart attack, stroke, or death related to cardiovascular issues. While statins have already saved countless lives, it’s clear that millions more could benefit—particularly women, minorities, and those living in rural areas.
Moreover, the number of Americans who could benefit from advanced screening like mine is strikingly low. Only about 1.5 million underwent a CAC test in 2017, while clinical guidelines suggest that over 30 million people could gain from such tests.
Addressing heart disease early is crucial for maintaining health. It’s impressive that heart attack mortality has dropped so dramatically over the past five decades. However, the goal should be to prevent more individuals from even approaching that dangerous brink.
