Passage 1 More Americans at Higher Risk of Heart Disease
美国人离心脏病渐行渐近 《时代周刊》

[00:02]More Americans at Higher Risk of Heart Disease
[00:07]Heart Alarm
[00:09]Epidemiologists love to count and process numbers - and Americans,
[00:14]on the whole, love to ignore them.
[00:18]Even the most health-conscious among us soon grow numb to
[00:22]the storm of statistics warning us about rising levels of obesity
[00:28]or falling levels of exercise or all the other numerical indicators
[00:33]that tell us how unwell we're getting. But on Sept. 14,
[00:39]a team of researchers released a new finding that should cause
[00:43]even the most data-weary folks alarm.
[00:47]According to a paper published Monday in Circulation,
[00:51]a journal of the American Heart Association,
[00:55]fewer than 8% of all Americans can now be considered at low risk
[01:02]for heart disease. No one needs a statistician's help to know
[01:07]that that means more than 92% of people are not as healthy as they could be,
[01:13]and that's worth paying attention to.
[01:16]Subjects and results
[01:19]The study was actually the latest in a series of studies,
[01:23]all of which have been part of a program known as the National Health
[01:29]and Nutrition Examination Surveys (NHANES).
[01:35]Administered by the Centers for Disease Control and Prevention (CDC),
[01:41]the program is a four-decade attempt to evaluate the country's health
[01:46]by conducting surveys and physical exams with a rotating sample group of
[01:52]about 10,000 Americans. The first NHANES study was conducted from 1971 to 1975,
[02:03]the second from 1976 to 1980, the next from 1988 to 1994, and the most recent
[02:13]from which the heart-disease findings are only now being released
[02:19]from 1999 to 2004.
[02:23]For that portion of the survey,
[02:25]the investigators focused on people in the 25-to-74 age group
[02:31]and evaluated five different risk factors for cardiovascular disease:
[02:38]blood pressure, cholesterol, smoking history, obesity and diabetes.
[02:44]To be considered at low risk, subjects had to have a blood pressure
[02:50]reading of 120/80 mm Hg or lower without the aid of medication
[02:58]and a cholesterol level below 200 mg/dL, also without drugs.
[03:07]They had to be nonsmokers or at least former smokers,
[03:11]not be overweight or obese, and never have been diagnosed with diabetes.
[03:18]"From a prevention point of view,
[03:20]it's important that Americans achieve as many of these goals as possible,"
[03:25]says the CDC's Dr. Earl S. Ford, the lead author of the study.
[03:32]In the latest NHANES,
[03:35]just 7.5% of adults were considered low risk in all five areas.
[03:42]That's a significant reduction from the 10.5% in the 1988-1994 survey
[03:51]which was already a decidedly poor score. Within the adult population,
[03:57]there is no particular demographic slice that's doing particularly well,
[04:02]but some are clearly better than others. Among women in the current study,
[04:08]10.5% were considered low risk (a decrease from 15.5% in the previous study),
[04:16]compared to just 4.8% of men (down from 5.7%). In the 25-to-44 age group,
[04:26]12.1% came in at low risk, compared to 3.5% of 45-to-64-year-olds
[04:35]and just 0.8% in the 65-to-74 demographic. Whites,
[04:42]among whom 8.2% were at low risk of heart disease,
[04:47]did better than Mexican Americans (5.3%),
[04:52]and both did better than African Americans (4.6%).
[04:58]The racial gaps have much to do with socioeconomic disparities
[05:04]and unequal access to health care, but there are also genetic factors at play,
[05:10]with certain groups having a higher sensitivity to certain conditions.
[05:15]Bad as the current numbers are, they are actually not historic lows.
[05:21]In the 1971-1975 survey, just 4.4% of the entire sample group
[05:28]was considered low risk; that percentage climbed to 5.7% in the next survey
[05:36]before peaking in the third one. The trend was reversed this time around.
[05:42]"Until the 1990s, we were headed in a positive direction," says Ford.
[05:48]"But then it took a turn."
[05:51]Surprisingly - and encouragingly - rising heart-disease risk
[05:56]does not necessarily translate to rising heart-disease deaths.
[06:01]Last year, the American Heart Association announced that since 1999,
[06:08]deaths from heart disease fell a remarkable 25.8%.
[06:14]There are a lot of reasons for that happy development,
[06:18]but the leading ones are better drugs and technology,
[06:21]closer adherence to evidence-based practice guidelines
[06:25]and the simple precaution of getting patients to the hospital fast.
[06:31]Prevention
[06:33]All the same, the best way not to need the hospital at all is not to get sick,
[06:40]and even the greatest advances in treatment will amount to little
[06:45]if people can't bring the risk factors under control.
[06:49]The most important factors to attack, the Circulation paper explains,
[06:54]are not cholesterol or tobacco use. Both continue to drop,
[06:59]and with recent federal action to boost cigarette taxes
[07:04]and allow the Food and Drug Administration to regulate tobacco
[07:09]for the first time, the decline in smoking may actually accelerate.
[07:14](Indeed, last year, the share of Americans who use tobacco fell below 20%
[07:22]for the first time in modern memory.)
[07:25]The real problems are blood pressure, obesity and diabetes,
[07:30]all of which are relentlessly on the rise.
[07:34]The answer to much of this - as is so often the case - is better diet,
[07:39]more exercise and early detection.
[07:43]Such preventive measures form one of the cornerstones of
[07:47]the ongoing health-care debate one of the few points
[07:51]on which nearly all sides can agree.
[07:54]The authors of the new study call for physicians to be paid for
[07:59]heart-disease-prevention measures like working with their patients
[08:04]to develop weight-loss and smoking-cessation plans
[08:08]and to be allowed enough breathing room in their schedules
[08:12]to let them do good assessments. Schools and workplaces, the paper argues,
[08:19]should also be in on the prevention game.
[08:22]Since both are places where large numbers of people congregate,
[08:27]they are also places where simple measures like blood-pressure tests
[08:32]could do the most good.
[08:35]"Much potential exists to reverse threatening trends in cardiovascular health,"
[08:40]the authors write,
[08:42]"but this is unlikely to occur without making prevention of overweight
[08:47]and obesity a national priority." There's no way of knowing
[08:52]when Americans who have heard this repeat again and again will take notice
[08:58]and take action - but when 92% of people are affected,
[09:03]now it seems like a very good time.