Among the many noteworthy achievements in modern medicine over the past few decades is the reduction in heart attack risk, alongside reduced rates of many other aspects of cardiovascular disease. The data I'll point out here is but one example in a much broader trend. This is the higher end of what can be achieved through compensatory medicine for age-related disease, a set of increasingly sophisticated efforts to patch over the consequences of dysfunctional tissues, but without actually repairing the molecular damage that causes that dysfunction. Keeping a damaged machine functioning without repairing it is expensive and challenging. To go beyond the incremental improvements produced by medical science in the recent past, it will be necessary to change the high level strategy, and start to address the root causes of aging and age-related disease rather than merely papering over the problem.
Heart attack rates among an ethnically diverse population of more than 3.8 million Kaiser Permanente members in Northern California fell 23 percent from 2008 to 2014. Researchers studied rates of heart attacks by severity, age, gender, and diabetes status. While the incidence of heart attacks was highest in men, older age groups, and people with diabetes, similar declines in heart attack rates were seen across all subgroups - including those most at risk and with the highest rates, as well as among lower-risk patients, such as younger patients and women. The findings of this latest study build on research published in 2010 that demonstrated a 24 percent decline in heart attacks between 1999 and 2008.
A key difference in the two time periods studied was the type of heart attack that accounted for the majority of the declines. More severe but less common heart attacks, known as ST-elevation myocardial infarction or STEMI, which typically require an immediate procedure to open a blocked artery, fell by 62 percent from 1999 to 2008. The number of these heart attacks fell by an additional 10 percent from 2008 to 2014, resulting in a total reduction of 72 percent in these severe heart attacks from 1999 to 2014. The more common but less severe heart attacks, known as non-ST-elevation myocardial infarction or NSTEMI, showed the greatest decline from 2008 to 2014. These types of heart attacks peaked in 2004 and have fallen 33 percent through 2014. When taken together, there was a 40 percent reduction in all types of heart attacks across Kaiser Permanente in Northern California from the peak in 2000 through 2014, the most recently studied year. "While the decline in severe heart attacks across our population has been astonishing, we now see consistent declines in all types of heart attacks. Reductions in less severe heart attacks, which are nearly four times as common as the severe heart attacks, drove the bulk of the recent decline. But what is most heartening is that these reductions were consistent across every demographic and risk group we examined."