Canada's Cardiovascular Profile Parallels US

Clyde Yancy tells Canada: Challenges ahead for CVD

Shelley Wood

October 24, 2011

October 24, 2011 (Vancouver, British Columbia) — Canadians who tend to pride themselves on being healthier, generally, than their neighbors south of the border need to take a cold hard look at CVD trends in their own country, according to American cardiologist Dr Clyde Yancy (Northwestern University, Chicago, IL), who was the keynote speaker during the opening ceremony of the Canadian Cardiovascular Congress 2011. Yancy's talk was entitled "Reversing the tide and preventing heart disease by 2020."

Dr. Clyde Yancy

Yancy, discussing his talk with heartwire, said he'd done some digging around into Canadian health statistics: "The first thing you'll see if you review the status of CVD in Canada," he said, "is that the condition exactly parallels the US. As an order of scale, it obviously is less compelling, because the population density is different. But in terms of the percentage of people affected and the likelihood of cardiovascular disease remaining a leading cause of death in Canada, it is exactly the same."

Cross-border comparisons

Yancy's talk reviewed the progress made in the US at reducing CV risk in recent decades, noting a 35.7% reduction in deaths from coronary heart disease and a 32.5% reduction in stroke. On the flip side, the reduction in the number of people not engaged in regular moderate or vigorous activity is only 8%, far short of the target of 25% by 2010. According to the Centers for Disease Control and Prevention (CDC), an estimated 26.8 million noninstitutionalized Americans have diagnosed heart disease and 12% of the American population has undiagnosed disease.

But Canadians, Yancy argued, are not lagging far behind. Alluding to Public Health Agency of Canada numbers, Yancy noted that 1.6 million Canadians have heart disease or stroke, including almost one-quarter of the population over age 25 — a proportion of the overall population that is not too different from that of the US. And while the numbers of deaths due to CVD have declined "dramatically" since 1960, heart-disease death rates in Canada, as in the US, will inevitably rise as a result of an upsurge in obesity and diabetes.

Risk-factor trends similar the world over

Reviewing the key modifiable risk factors for cardiovascular disease, Yancy pointed out that successes in some areas and lackluster results in others follow similar patterns both North and South of the 49th parallel. Citing a story in the Huffington Post last week, Yancy notes that Canada's favorite "comfort foods" include very high-fat, high-sugar, high-sodium treats, including "mac and cheese," maple syrup over pancakes and bacon, and poutine. Yancy's point: the epidemic of obesity, diabetes, and unhealthy eating choices is by no means confined to the US, or even to North America.

"I would make the case that we're in the midst of global pandemic of CVD, and the steps we are advocating in the US and Canada are not only beneficial but necessary, because the aggregate burden of CVD and its impact on developing countries, low- and middle-income countries, will be so profound that it will potentially impact the nature of our global society," Yancy explained. Pointing to the two most populous countries in the world, Yancy noted that China now has more than 200 million people living with CVD and in India, 10% of the country's 800 million people now have diabetes and rates of obesity are "skyrocketing."

"So the things that are going to need to be done in developed countries, hopefully, to stem the tide, really have to be replicated across the board, which means we can't talk about expensive therapeutic actions, waiting for disease to happen then treating it; we really have to take a preemptive approach and talk about preventive strategies," Yancy said.

Prevention pays off

But there is some light on the horizon, Yancy argued, pointing to a Circulation analysis from earlier this year showing the potential cost savings of prevention strategies, ranging from bike paths to reducing sodium and tobacco use.

"The benefit from prevention is substantial enough," Yancy told heartwire," and we can fundamentally alter this burden of disease by doing some simple public-policy steps and by encouraging the populace to develop different lifestyles. Not radical stuff, but being more physically active, following a more heart-healthy diet, tobacco cessation, sodium reduction, controlling the weight, controlling the blood sugar, and particularly controlling the blood pressure. Those things are very important."

Asked if he thought Canadians' perceptions of themselves as healthier and fitter than their American neighbors was part of the problem, Yancy said he wouldn't "take an entire country to task and challenge them with regard to their health, because without question, the US really can't throw stones."

That said, he continued, "I think we all need to be cognizant of the fact that we have allowed ourselves, in both countries, to drift into Western lifestyles that by definition are not healthy."

Pointing to the most recent published statistics, Yancy noted that CVD cost Canadians $22.2 billion dollars in 2000; in 2007, 10% of all visits (almost 25 million) to Canadian physicians were for the management of CVD.

"So these messages are not unique to the United States; they are least pertinent to North America, if not globally," he said. "The challenge is how do we take these messages and make them user-friendly for the wide variety of different continents and countries that are impacted by CVD? That really will be a challenge. . . . But there's no reason why the US and Canada can't be leaders in demonstrating the importance of reducing these risk factors for heart disease."

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