Heart Disease Kills Fewer in N.C.: Cancer is Now the Top Killer As Doctors Make Hearts Last Longer

By Jean P. Fisher, The News & Observer, Raleigh, N.C.

Nov. 20–For the first time in nearly 90 years, heart disease is no longer the No. 1 killer of North Carolinians — a historic upset in a state widely known as a hot spot for heart attack.

Instead, cancer has become the leading killer, even as rates for both cancer and heart disease are falling, according to numbers released Monday by the state Division of Public Health. Death rates from heart disease declined more radically, fueled by improvements for controlling high blood cholesterol and opening blocked arteries.

The difference in the number of deaths is not large. Cancer killed just a few dozen more North Carolinians, with 17,267 deaths last year, while heart disease took 17,189 lives.

But the heart disease death rate in North Carolina has dropped 30 percent since 1990, when it was about 279 per 100,000 residents. Last year, it was 194 per 100,000 residents.

Cancer deaths have declined only about 2 percent since 1990, falling to about 195 per 100,000 residents last year.

“If you think about it, 30 years ago we didn’t have angioplasty, we didn’t have any cholesterol-lowering agents, we didn’t routinely use aspirin — it was a very different world, ” said Dr. Pamela Douglas, a Duke University cardiologist and immediate past president of the American Heart Association.

Lynda Redner of Willow Spring, 60, has benefited from the full array of breakthroughs. After she visited a doctor for chest pains in 2004, she had an emergency heart catheterization at WakeMed. Redner’s cardiologist found three blocked arteries, which he cleared and propped open with stents.

She went on medicine to reduce her cholesterol but was back at WakeMed in 2005 to have four more blockages treated with quadruple bypass surgery. Just last month, Redner had yet another blockage, which was treated with angioplasty and another stent.

“I feel very fortunate to be here,” Redner said.

Other prevention efforts, such as getting more smokers to kick tobacco, have also helped, said Dr. Marcus Plescia, head of the state Division of Public Health’s chronic disease branch. Tobacco use causes damage to the circulatory system and greatly increases the chance of death from heart attack.

Heart disease is still the No. 1 killer nationally. North Carolina is the first state in the Southeast to see heart disease deaths dip below cancer deaths, according to state public health officials. Several other states, including Alaska, Colorado, Maine, Minnesota, Montana, Oregon and Washington now count cancer as their top killer.

“The numbers have been converging for quite some time,” Plescia said.

Cancer is in many ways a harder disease to control, said Dr. Shelley Earp, an oncologist at UNC-Chapel Hill and director of UNC’s Lineberger Comprehensive Cancer Center. What is commonly called cancer is really a group of dozens of different diseases, each with its own cause and treatment.

By contrast, heart disease is essentially the same in most patients. It’s caused by the same things and responds well to the same few treatments. Patients who have high cholesterol — a major risk factor for heart disease and heart attack — generally get a drug such as Lipitor that gets their blood levels in line, Earp notes.

“We unfortunately don’t have a silver bullet in cancer in quite the same way,” he said.

Age and cancer

Now, people who once would have succumbed to heart attack or heart failure are living long enough to develop cancer.

“The incidence of cancer goes up almost tenfold once you reach age 65,” Earp said. “All of those men who would have died of heart attack in the 1950s and ’60s are instead surviving to an age where cancer is a lot more prevalent.”

And while the rate of death from heart disease is down overall, it remains the No. 1 killer of women, ending the lives of 8,286 last year in North Carolina. Cancers killed 8,140 women.

Plescia added that the gains for heart disease are accompanied by a growing concern about the state’s children, who are increasingly overweight and sedentary — lifestyle factors that lead to heart disease. He said the state’s progress could easily be reversed.

“I think we’re going to see this bottom out and go right back up again if we don’t do something about childhood obesity,” he said.

jean.fisher@newsobserver.com or (919) 829-4753

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