More about heart attacks in the final-quarter

The post about heart attacks generated a high ratio of comments-to-views. I interpret that as the topic being of high interest to part of my readers.

So, I am going to keep flogging that pony.

History of declining heart attack mortality in the US

It is important to start with a discussion on the diffusion of new knowledge.

There is a system of peer review to ensure that the conclusions match the data and that solid protocols were used.

Then the work is replicated.

The fully validated "science" is flowed from the academics to the medical journals. In time, specialists read those papers. Then the general population of doctors. Then the information flows out to the individual on the street.

In the 1960s, this might take five year.

Another consideration is that one of the underlying, causal factors is the accretion of plaque on the insides of the arteries. The build-up is progressive in nature. Thirty-five years of eating French-fries and 1/4 pounders with bacon will not be un-done in the snap of the fingers with a few salads.

The point is that there will be significant lag-times between a "finding" and when it shows up in the mortality curve.

The angioplasty is a different animal than the first three "technologies".

As an individual you can make a life-changing decision in the time it takes to lace on a pair of comfortable shoes for walking. Or you can pass on the fried foods or cut down on  your smoking.

While the lag-times are long before the results hit the mortality curve there are no special equipment or training requirements.

The angioplasty (a balloon is inserted up an artery and "driven" to the arteries in your heart. Then the balloon is inflated to "grade" the constrictions the way a road-grader removes washboard undulations on a gravel road) requires a suite of special equipment (imaging, angioplasty equipment) and specialized training.

While the results are HUGE for those lucky enough to get the procedure, the roll-out is constrained by economics.

To measure is to manage. -Lord Rutherford

It is notable that a 40% reduction in heart attack mortality had been achieved via open-loop methods and the slope suggests that it was still improving.

A boat-load of events happened in 1984.

The clot-buster drugs offered many of the benefits of the angioplasty with a significantly smaller economic drag to its deployment.

Stents increased the durability of the angioplasty results.

Conclusion of the first major statin trial that demonstrated positive longevity with taking statins.

It would be valid to observe that since narrowing of the arteries is progressive (over decades) and clots are "triggered" by some unpredictable event, that projecting area-under-the-curve increased survival will underestimate increased longevity.

The paradox was observed that even though women have fewer heart attacks than men, and even though there is a lower mortality rate for the population, women who have had heart attacks were significantly more likely than men of the same age.

It was determined that symptoms of heart attacks in women are sometimes/often different than the ones that were published and were taught in medical schools. Delayed diagnosis resulted in delayed treatment which resulted in higher death rates.

Base image from HERE

Red lines and text in green text-box are mine.