Coronary mortality peaked in 1968, when it was not unusual for Americans to die of a heart attack in their 50s or 60s. At the time, about 40 percent of adults smoked, doctors deemed a cholesterol level of 240 milligrams per deciliter to be “normal,” and nearly half of young adults had blood pressure readings now considered high.
Had the coronary death rate continued its meteoric rise, today more than 1.7 million Americans would succumb to heart disease each year. Instead, there’s been a significant decline, to some 425,000 deaths a year, with a commensurate increase in longevity of 8.7 years between 1970 and 2010. More than 70 percent of the rise in life expectancy is attributable to fewer deaths from cardiovascular disease, primarily heart attacks and strokes.
The countless millions who have escaped a premature cardiovascular death can thank in part a half-century of public health measures and other preventive medicine initiatives that are now threatened by proposed cuts in the nation’s budget.
The fall in cigarette smoking alone had a major impact, having declined to about 15 percent of adults. (Alas, teenagers, whose smoking rates were once well below those of adults, have all but caught up.) Smoking by itself increases the risk of heart disease; it raises blood pressure, diminishes exercise tolerance, decreases protective HDL cholesterol, and increases the blood’s tendency to clot.
But when smoking is combined with other coronary risk factors, like high blood pressure, high cholesterol, obesity or Type 2 diabetes, the risks of a heart attack, stroke and an early coronary death are greatly increased.
A decline in average blood levels of cholesterol also played an important role in the drop in coronary deaths. Today only about 12 percent of American adults have high total cholesterol levels — 240 milligrams or greater, although nearly a third still have elevated levels — 130 milligrams or more — of…