麻豆传媒

Heart disease still leads among causes of death in the U.S. according to just-released final data by the Centers for Disease Control and Prevention for 2014, but a separate analysis suggested that progress in prevention is slowing.

The National Center for Health Statistics' annual report based on death certificates from all 50 states and the District of Columbia showed that , down from 23.5% in 2013, followed closely by cancer at 22.5% both years.

No differences in the rank order of the top 10 causes of death from 2013 to 2014 emerged in the full data released Thursday, although the total age-adjusted mortality rate was the lowest ever recorded, as reported in December from the initial data.

Despite the good news on overall mortality rates, analysis of trends in those top causes of death held some cause for concern, , of Kaiser Permanente Northern California in Oakland, and colleagues reported online in JAMA Cardiology.

"During the first decade of the 21st century, heart disease mortality declined at a much greater rate than cancer mortality, and it appeared that cancer would overtake heart disease as the leading cause of death," they wrote.

However, their analysis of the CDC's Wide-Ranging Online Data for Epidemiologic Research data system showed that the , whereas the rate for cancer remained fairly stable.

The annual rate of decline for all cardiovascular disease dropped from 3.79% in 2000-2011 to 0.65% in 2011-2014. For heart disease, the change was from 3.69% to 0.76%; whereas for cancer, the change was from 1.49% to 1.55%.

"If this trend continues, strategic goals for lowering the burden of cardiovascular disease set by the American Heart Association and the Million Hearts Initiative may not be reached," Sidney's group cautioned.

An accompanying by , of Northwestern University in Chicago, who has been heavily involved with the AHA and its prevention guidelines, agreed that target might be missed and explained the changing trends this way:

"Indeed, the inflection point in cardiovascular disease mortality rates in the U.S., when increases observed for the entire 20th century suddenly flipped to sustained declines, occurred in 1968, shortly after the U.S. Surgeon General's first report on tobacco and coincident with the introduction of coronary care units for patients with acute myocardial infarction.

"However, while we celebrated these successes and appeared to be poised for victory, the seeds of our undoing were being planted. The largest population-wide epidemic of chronic disease in human history began to be evident in 1985. Since that time, we have seen relentless increases in the prevalence of obesity and trailing, but alarming, increases in the prevalence of diabetes affecting all ages and segments of the population. And right on schedule, about 25 years into the obesity epidemic, there appears to have been a sudden slowing in the progress of declining cardiovascular mortality rates, with now almost stagnant changes in age-adjusted cardiovascular disease mortality and actual increases in crude mortality rates and total cardiovascular deaths over the last few years as a result of population growth."

To turn things around, society needs to get serious about primordial prevention from in utero well into middle age, Lloyd-Jones argued.

"For now, it appears we will be reaping what we have sown in the obesity epidemic over the last several decades. This bitter harvest can still be largely avoided if patients, physicians, public health officials, and politicians can finally create meaningful policies and pathways to enable a culture that prioritizes health and promotes prevention."