Harvard Heart Letter

Ask the doctor: Why aren't prevention efforts stopping an increase in heart disease?

Q. Why is heart disease still on the rise despite the incredible increase in the number of people taking cholesterol-lowering drugs and the more than 30 years of "low-fat" propaganda?

A. The situation you describe — the ever-growing number of people with heart disease despite major advances in cardiovascular medicine and a growing emphasis on prevention — sounds like a paradox. But it can be explained by several trends. These include the aging of the population and the linked epidemics of obesity and diabetes.

Although heart disease can appear at any age, it becomes common after age 55 in men and after age 65 in women. As baby boomers swell the ranks of older Americans, the number of people with heart disease is sure to follow. In less-developed countries, the gradual control of infectious diseases is preventing early deaths, allowing more people to live long enough to develop cardiovascular diseases and cancer. The alarming increase in obesity and diabetes seen in this country and many others adds to the problem, since both of these conditions promote cardiovascular disease.

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