Deaths from heart attacks halved in last decade

The death rate from heart attack in England has halved in the last decade, claims a research paper published today in the British Medical Journal.

Compared with earlier years, the study found there were fewer heart attacks in the last decade and fewer of these were fatal.

Several studies have already investigated changes in deaths from heart attack in many countries around the world, but reasons for the decline in deaths in England are still not known. Researchers from the University of Oxford set out to identify the possible causes of this reduction.

Using national hospital and mortality data, they looked at 840,175 men and women in England who had suffered from a total of 861,134 heart attacks between 2002 and 2010. Overall, the death rates for heart attacks fell by 50% in men and 53% in women.

The researchers investigated how much of the decline in death rates resulted from a decrease in the occurrence of new heart attacks, and how much was a result of improved survival after heart attack. They concluded that just over half of the decline in total death can be attributed to a decline in the number of new heart attacks, and just under half to a decline in the death rate after heart attack.

The substantial drop in the rate of occurrence of heart attacks reflects the impact of both primary and secondary prevention through beneficial changes in the health of the population with respect to cardiovascular risk factors, say the researchers, while the improvements in death rates following hospital admission are likely to reflect major improvements in NHS care over the recent years.

Most of us know about the factors that raise our risk for heart attack: high blood pressure, bad blood lipids, diabetes, smoking, family history of heart attacks. Either that, or we’ve been living in a cave.

Though a study of more than 500,000 patients just reported in the Journal of the American Medical Assn. doesn’t change any of that, it did find something odd: Among a large group of people admitted to the hospital for their first heart attack, those who had those traditional risk factors were less likely to die of the heart attack than those who arrived at the hospital without any of them.

What could this mean? The authors don’t really know. But they do have several ideas.

One idea is: People who already have risk factors for heart disease are likely to be on medications such as aspirin, statins, beta blockers and so on, so even if they have a heart attack, the attack may be less serious than those experienced by people who were on no meds.

And once they get to the hospital? The study data show that those without the traditional risk factors were less likely to quickly receive the right kind of medications or procedures such as angiograms and bypass surgery within the first 24 hours.

It’s also possible that the kind of heart attack experienced by those who don’t have the traditional risk factors may be biologically somewhat different than those that go along with high blood pressure, bad cholesterol, etc. – and also more deadly. For example, those in the zero-risk-factor group tended to be older.