Professor of medicine at Harvard Medical School discusses how much progress has been made in the fight against cardiovascular disease.
Few names have been as well-known among the cardiology community in recent years as Deepak Bhatt, MD, MPH.
Bhatt, executive director of Interventional Cardiovascular Programs at Brigham and Women's Hospital and professor of medicine at Harvard Medical School, has authored more than 300 articles and is well-known for his role in the REDUCE-IT trials examining icosapent ethyl.
As a researcher, professor, and clinician, very few have as well-rounded of a view on the current state of cardiovascular health now and moving forward. Recently, Bhatt sat down with MD Magazine® to discuss just how far physicians have come in the ongoing fight against cardiovascular disease.
MD Mag: How much progress has been made in the ongoing fight against cardiovascular disease?
Bhatt: I think it is a story that can be told in a number of ways and I think the most honest way is to say we've tremendous progress in the United States with respect to cardiovascular disease. If you compare to a couple of decades ago or certainly several decades ago, immense progress in things like hypercholesterolemia, hypertension risk factors for cardiovascular disease, and actual cardiovascular disease — rates of myocardial infarction ischemic stroke have dropped dramatically throughout the United States. So, I think we have a lot to be happy about in that regard.
Now globally, the situation is quite different. There are epidemics of cardiovascular disease in China, in India, in parts of Latin America, and Eastern Europe. So, if one looks globally there's just a raging cardiovascular epidemic, but in the US —at least with respect to MI and ischemic stroke — a lot of progress that's been made. Now, having said that it's actually not all good news even in the US because still if you look at cardiovascular disease as a whole it's the leading killer in the United States, still more so than cancer and sometimes different organizations or specialists get into an argument of you know my disease is worse than your disease and you know I think that's silly. I think you know we want to prevent all sorts of disease and it turns out a lot of cardiovascular risk factors and cancer risk factors are shared in terms of diet and lifestyle things that can be done to reduce the risk of both.
What's also concerning is that in the last couple of years it seems what had been a downward inflection in rates of cardiovascular disease in the United States have, at a minimum, stabilized and some sources show even an uptick in rates again — not turning the clock back by decades, but still compared with recent years where it looked like CV disease was just going down and down it looks like it might be going up again and some have said is that because of more diabetes? Is it more obesity? You know, is it other sorts of factors?
If you look around the Appalachian region, for example, rates of mortality going up there even among middle-aged males some of that's the opioid epidemic, some of that suicide, and other things but it does appear that mixed in with all those other things there there's probably also a real signal of increasing cardiovascular disease. More reports of rates of cardiovascular disease, both in younger men and women, seeming to go up.
Is that better detection? Maybe. It's hard to say but from a bottom-line perspective, I think it's important not to rest on our laurels and say you know "The battles over we've won in cardiovascular disease. Let's move on to something else," but rather to realize yes there's a lot of progress that's been made, but there's still a lot of work to do. So, on the one hand we should be very happy and proud as a scientific community and as a physician community and that was involved in public health a lot of progress but just by the same token what do not go overboard and just say oh you know it's over and we're done. There's still a lot of work to be done in the US and globally to reduce the burden of cardiovascular disease.