Heart Patients Now Less Likely to Die of Heart Disease

By

Researchers at the Mayo Clinic in Rochester MN were pleasantly surprised to find that more people who have known coronary heart disease die from other causes — such as cancer, and lung and neurological diseases — than heart disease, compared with 20 years ago. The study was published online on February 10^th 2014 in Circulation, an American Heart Association journal.  

A release from the clinic reports that the team evaluated the trends in cause-specific, long-term mortality from 1991 to 2008 in patients at the Mayo Clinic who underwent percutaneous coronary intervention, a procedure used to open clogged heart arteries. The investigators broke the study population into three eras: 1991 to 1996, 1997 to 2002, and 2003 to 2008. Cardiac deaths predominated in the first era and were about equal with non-cardiac deaths in the middle era. In the final era, non-cardiac deaths dominated.

Approximately 20,000 patients were studied. Of those, nearly 7,000 patients died within the study time frame. Among that group, only 37 percent of deaths in the modern era, 2003-2008, were cardiac-related.

The release quotes senior author Rajiv Gulati, M.D., Ph.D. as saying, "We found that patients with established heart disease undergoing angioplasty and stenting in the modern era have about a 1 in 3 chance of dying from their heart disease, and a 2 in 3 chance of dying from non-cardiac diseases in the long term."  

These welcome results were unexpected patients undergoing angioplasty in the modern era have gotten older, with more complex coronary disease and more risk factors compared with years ago. Consequently, the authors assumed that the patients cardiac death rates would have increased. "In addition, in randomized clinical trials of PCI, deaths from cardiac disease still predominate," Dr. Gulati said. The authors believe the sharp decline in long-term cardiac deaths in these patients may result from improved cardiac therapies. For example, more patients today with established heart disease take medications to lower cholesterol, prevent heart failure, and decrease blood pressure, and technologies used in catheterization laboratories — where PCI is performed — have improved. Of the cardiac-specific deaths, deaths from heart attack and sudden heart rhythm disturbances declined steeply, but there was no decline in deaths from heart failure.

"These results show that we have an opportunity to focus on the non-cardiac diseases in these patients — to treat the patient holistically," Dr. Gulati says. "But it also gives us the opportunity to identify and target those patients who are at risk of dying from heart disease."