Big Challenges for Canadians’ Heart Health

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By the Health of Canadians, Special for  USDR.

The 2015 Heart and Stroke Foundation Report on the Health of Canadians looks back on 60 years of life-saving, ground-breaking research, revealing astonishing improvements in diagnosis, treatments, and outcomes between then and now. However, these gains will be threatened as our population changes and some risk factors for heart disease are set to rise  sharply.

“We have made incredible progress in improving the heart health of Canadians since the 1950s and 1960s,” says David Sculthorpe, CEO, Heart and Stroke Foundation. “Back then of those who made it to hospital after a heart attack, 30 – 35 per cent did not survive. Today that number is down to five per cent. Or put another way, 95 per cent of Canadians who have a heart attack will now survive – thanks to  research.”

According to a new Heart and Stroke Foundation poll* Canadians are not aware of the progress that has been made – less than one-quarter realize that survival rates are now so promising. And yet, heart disease has an extensive reach across our country. In fact, according to the poll, more than half of Canadians report that someone close to them has had heart  disease.

Decades of  progress

The Foundation interviewed 16 of the country’s leading cardiovascular experts, who agree the greatest accomplishment regarding heart disease has been in survival rates. In 1952, cardiovascular disease (heart disease and stroke) was responsible for almost half (46 per cent) of all deaths in Canada. Today it accounts for just over one quarter (27 per cent) of all deaths. Sixty years ago, fewer than 20 per cent of infants born with complex heart defects reached adulthood, but today, more than 90 per cent  do.

This success is directly related to research advances in prevention, diagnosis, treatment and care  including:

  • Identifying, treating and managing risk factors such as high blood pressure and  cholesterol.
  • Cutting smoking rates by much more than half to 16 per cent today from about 50 per cent in the  1950s.
  • Understanding the physical causation of the disease; for example, identifying the role that clots play in acute myocardial infarctions (heart attacks) led to effective clot-busting  drugs.
  • Developing and continually improving medications to manage risk factors and heart disease such  as:
    • Beta blockers, which protect the heart from subsequent  attacks.
    • ACE inhibitors, which cause blood vessels to relax, leading to lower blood  pressure.
    • Statins, which are used to lower cholesterol and are effective at preventing cardiovascular disease as well as treating those who have  it.
    • Anticoagulants and anti-platelets such as acetylsalicylic acid (ASA, commonly referred to as Aspirin), which can be used to prevent dangerous blood clots from  forming.
  • Producing sophisticated imaging equipment, such as magnetic resonance imaging (MRI) scanners and CT (X-ray) scanners, has made diagnosis faster and more  precise.
  • Discovering and improving new procedures; for example, open-heart surgery has more and more been replaced by less invasive procedures such as angioplasty, a non-surgical  technique.
  • Improving recovery time and quality of life for the 1.6 million Canadians living with the effects of cardiovascular  disease.
  • Collecting and analysing data to measure practices and improve treatments and outcomes for  patients.
  • Translating knowledge to make the most effective use of evidence collected, by sharing it with the right players, and putting it into action. For example, sharing evidence about the harms of second-hand smoke with policy-makers resulted in smoke-free  policies.

Much of the discovery noted above – as well as pacemakers, “blue baby” surgery and clot-busting drugs – are breakthroughs that started with Heart and Stroke Foundation research. Since its inception in 1952, the Foundation has invested more than $1.4 billion in vital heart and stroke research, making it the largest contributor in Canada after the federal government. Last year we invested almost $34 million in research across Canada and we have committed to raise $300 million for research over the next  decade.

New challenges threaten  advances

Despite the amazing accomplishments, we are in danger of losing the gains we have worked so hard  for.

“We cannot underestimate the progress we have made, but we still have an enormous task in front of us,” says Sculthorpe. “Heart disease and stroke continue to be the second leading cause of death in Canada and a leading cause of disability, responsible for 66,000 deaths each year. And we know we are facing a new set of challenges that will require more research and new  solutions.”

While we have made improvements in managing some risk factors, we have also lost incredible ground in other  areas:

  • Diabetes rates in heart attack patients have skyrocketed to 31 per cent from 17 per cent in a matter of  decades.
  • Sixty per cent of adult Canadians are overweight or obese and obesity rates in children have tripled over 30  years.
  • The population is aging and as people get older, their chances of developing cardiovascular disease  increases.
  • Poor diets and lack of physical activity are leading risk  factors.
  • Nine out of 10 Canadians have at least one risk factor for cardiovascular disease, but according to the poll only 12 per cent of Canadians are aware of this  fact.
  • Smoking rates have decreased but 16 per cent of adult Canadians still engage in this behaviour that is the leading cause of preventable disease, disability and death, and the proliferation of e-cigarettes poses new  challenges.

The changing face of heart  disease

The portrait of the typical heart patient has changed dramatically. Dr. Eldon Smith began practicing cardiology in the 1960s and has seen a shift in the typical heart patient over his long  career.

“Back then, 75 per cent of my patients were male. The average age was 55; they were married, employed, smokers, overweight and sedentary. They usually had other risk factors such as high cholesterol and high blood pressure, which may have been diagnosed but were likely not being managed – the drugs were so awful they would not take them,” says Dr.  Smith.

This contrasts with what is seen today. Dr. Smith notes the average patient is substantially older, and still likely to be male – although the numbers of women with heart disease has risen. Patients still tend to be overweight, and while many have high blood pressure and elevated cholesterol, these are most likely diagnosed and well managed. Fewer are smokers, but if anything heart disease patients are even more sedentary than in the  past.

A revolution in  recovery

Comparing the quality of life in heart disease survivors between “then” and “now” also reveals a true transformation, according to Dr. Smith. Fifty years ago if someone survived a heart attack, they were often very sick and lived a life of restriction. They convalesced for months and were sent home and often advised to buy a rocking chair and watch TV; they were told not to return to work and to avoid physical activity, including sex. Their lives never went back to normal. Survivors today are often discharged home within a few days and can be back to work in a few weeks, and many return to a normal  life.

‘I almost regret I don’t have a mark to  show’
Four years ago Tim McEown, 52, was at home when he suffered a heart attack. Tim was rushed to the hospital, had stents inserted in his heart arteries through a three-quarter inch incision in his wrist and felt immediately better. From the time the ambulance arrived to the surgery being completed was less than an hour and a half, and Tim was home three days  later.

“The contrast between my heart attack and my father’s triple bypass more than 20 years ago could not be more profound,” says Tim. “His surgery was invasive and traumatic while my experience, incredible as it may seem, left no more of a mark than having my blood taken. My dad was in hospital for more than a week and he was on the table for several hours. I was out of surgery in less than 70 minutes and home in three days. I almost regret I don’t have a mark to show for my near-death experience whereas Dad had his chest spread wide open and the scars to prove  it.”

Research into a healthier future – we can get there from  here

What Canadians  say:
When asked how important research is to our heart health, 98 per cent of Canadians polled say they feel it is somewhat or very  important.

When asked to identify the top three factors that could improve heart health, a large majority specified healthier lifestyle choices as most important. The other two most popular choices were more information to help manage risk factors, including telephone hotlines and other types of support, and better diagnostic tests and  tools.

Canadians identified the top priorities for heart health research  as:

  • Better individualized assessment and treatment plans based on someone’s medical history, lifestyle and  genetics.
  • Better tools and support to help people make healthy lifestyle  choices.
  • Better understanding of the genetic causes of heart disease and how to address  them.
  • New tests to diagnose heart  disease.

What the experts  say:
The experts interviewed by the Foundation agree. Dr. Paul Dorian points to research as the best hope for identifying how to help Canadians make healthy changes. “We need a better understanding around how to change behaviour across the population. Many of the diseases we treat are in theory preventable and by activities that do not require a  doctor.”

The experts identified a number of exciting research possibilities for the future, which could have a major impact on continuing to improve the heart health of  Canadians:

Restoring function to damaged hearts. Heart failure is on the rise as more people survive heart attacks and other acute heart conditions. As people with damaged hearts are living longer, they become more susceptible to heart failure. Work continues into finding new ways to repair damaged hearts by repairing muscle using stem cells, and other therapies to stop cells from dying or to regenerate new  cells.

Predicting the future. Imagine a world where the chances of developing heart disease can be predicted. Work is being done to identify genetic markers that will reveal which genes predispose a person to cardiovascular disease – information that could help stop the disease before onset or halt its progression. Breaking down the DNA code could help explain why heart disease runs in families, and will help develop the individualized drug treatments of  tomorrow.

Putting knowledge into action. Knowledge translation is an area that holds immense potential of further progress in heart health. It involves sharing information with all the right players, and using information to inform decisions about prevention, care, treatment, rehabilitation, and creating the systems and policies to support this. “Tobacco control is a great example of translating evidence,” says Dr. Scott  Lear.

Promoting recovery. With more Canadians surviving and living with the effects of cardiovascular disease, more research is needed to support them to make the best recoveries possible and improve quality of  life.

Creating healthy public policy. Research is the basis for important policy decisions that affect the population – for example, policies around building neighbourhoods that support physical activity, availability of healthy food and healthy eating through nutrition labelling and smoke-free  policies.

Quick stats –  Canada

  • Every seven minutes in Canada, someone dies from heart disease or  stroke.
  • 1.6 million Canadians live with the effects of cardiovascular  disease.
  • Heart disease and stroke are two of the leading causes of death in  Canada.
  • Heart disease and stroke cost the Canadian economy $20.9 billion every year, and are the biggest driver of prescription drug  use.
  • 500,000 Canadians live with heart  failure.
  • One in 100 babies is born with a congenital heart  defect.
  • More women are dying from cardiovascular disease than  men.

Read the full report here

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