As the U.S. population ages, a “silver tsunami” of deaths from heart disease is now afflicting the U.S., according to a report from Kaiser Permanente’s Northern California Division of Research.
A “dangerous wave” of heart disease that began eight years ago reversed a half-century decline in the rate of heart disease deaths in the general population. The situation is expected to get worse, Kaiser researchers said.
Americans experienced 657,457 deaths from heart disease in 2017, nearly 61,000 more than the 56-year low of 596,577 in 2011, according to the researchers.
“Unfortunately, this overall picture is forecast to worsen” because the population most prone to heart disease, those 65 and older, is projected to grow from about 51 million today to about 73 million in 2030, the researchers wrote in a report for the National Forum for Heart Disease and Stroke Prevention.
The 65-and-older group, sometimes called the Medicare population, experiences about 80% of heart disease deaths and an even higher proportion – more than 90% — of deaths from the fastest increasing type of heart disease: heart failure.
Heart failure is a specific diagnosis related to the inability of the heart to pump efficiently. The American Heart Association describes it as a condition in which the heart “cannot keep up with its workload.”
If considered on its own rather than as a subcategory of heart disease, heart failure today would be the eighth leading cause of death, behind diabetes, the researchers said.
Demographic and technological changes as well as lifestyle trends have produced conflicting currents in the cardiovascular health picture.
Improvements in medical diagnosis and care, and reductions in smoking have tended to reduce the number of deaths from heart disease, while the rise of obesity, a sedentary lifestyle and associated risk factors like high blood pressure tended to increase mortality.
The overall U.S. population is growing, but the heart-vulnerable Medicare group is growing faster. At the most general level, the number of heart deaths is increasing because of a ballooning elderly population, while the rate at which they occur is decreasing in the ever-larger general population.
The Kaiser study has shown that the dangers of aging are dominant.
A Kaiser study recently published in JAMA Cardiology found that the age-adjusted death rate from heart failure increased by 20 percent from 2011 to 2017. The death rate increase among people 65 and older was nearly double that at 38 percent, according to the study.
To Steve Sidney, a Kaiser physician, senior scientist and lead author of the JAMA Cardiology paper, the aging trend is “a really big deal. There are an estimated 6-plus million people living with heart failure today, a number that is estimated to go up, because of the population dynamic, to about 8 million by 2030.”
Sidney said there are economic consequences to the problem as well. Heart failure is one of the more expensive conditions to treat because of the cost of repeat hospitalizations. Heart failure patients “tend to be in and out of hospitals a lot.”
The heart failure study appeared shortly before a gloomy report issued by the U.S. Centers for Disease Control and Prevention indicating that U.S. life expectancy in 2017 had declined compared to the year before.
It was the third consecutive year in which a drop in U.S. life expectancy was observed.
Sidney noted that while the Kaiser study focused particularly on older people, it also found a nearly 60% increase in heart failure deaths among people younger than age 65 during the study period, 2011 to 2017.
The numbers are much smaller for the healthier, younger group than in the over-65 age group – 2,727 heart failure deaths in 2011 rising to 4,327 in 2017. Nevertheless, he said, heart disease is the leading killer in America, and seeing such a sharp increase in younger adults is “scary.”
Asked what he would advise people to do, armed with knowledge of the Kaiser findings about rising rates of death from heart failure, he said that “prevention should be taking place a lot earlier.”
He said that high blood pressure is a key risk factor -- perhaps the key risk factor – to be aware of and to treat starting at an early age. “We know how to treat it and to control it,” he said.
High blood pressure is a problem because it forces the heart to work harder to pump blood, eventually risking damage to the heart muscle.
He also mentioned obesity, diabetes and lack of physical activity as risk factors. These often accompany one another and “are not trivial to manage. They are very difficult.”
Nevertheless, they are important for health in later life.