27/09/2020

Middle-aged people are increasingly dying from heart disease in cities across the country—including exercise-mad Colorado

COLORADO SPRINGS, Colo.Colorado is ranked as one of the nations healthiest states. It often doesnt feel that way to David Rosenbaum.The Colorado Springs cardiologist regularly sees men and women in their 30s and 40s with heart problems, such as high blood pressure, an irregular heart rhythm, heart attacks. A visit from a young patient was rare when he started practicing there 17 years ago. Not anymore.People say, oh, Colorado, were so healthy, said Dr. Rosenbaum, who works for UCHealth, a not-for-profit health-care system. Not so much.
Americans are dying of heart disease and strokes at a rising rate in middle age, normally considered the prime years of life. An analysis of U.S. mortality statistics by The Wall Street Journal shows the problem is geographically widespread. Death rates from cardiovascular disease among people between the ages of 45 and 64 are rising in cities all across the country, including in some of the most unlikely places.
In the Journals analysis, three metro areas east of Colorados Rocky MountainsColorado Springs, Fort Collins and Greeleyrecorded some of the biggest increases. Death rates in each rose almost 25%. The three cities boast robust access to exercise and health care. There are bike trails, good heart-disease treatment-and-prevention programs and nearby skiing and hiking.
Deaths in middle age from cardiovascular disease are highest in the South. But rates are rising across the U.S., including in Colorado, which often ranks as the healthiest state.
Deaths from cardiovascular disease for ages 45-64 in major metro areas
Change from 2010-11 to 2015-16 in the rate per 100,000 people
300
decrease
0-5%
5.1-10%
10.1-15%
15.1-20%
Over 20%
100
Colorado
Columbus, Ga.
Rate: 336 in
2015-16 (highest)
Metro areas with the largest rate increases
Increases by area type
27.9%
24.1
1. Lexington, Ky.
2. Atlantic City, N.J.
3. Corpus Christi, Texas
4. Lincoln, Neb.
5. Fort Collins, Colo.
6. Beaumont, Texas
7. Fort Wayne, Ind.
8. Greeley, Colo.
9. Colo. Springs, Colo.
10. Kennewick, Wash.
Major metros
Midsize metros
Small metros
Rural areas
U.S. total
2.9%
25.7
23.9
8.1
25.7
23.5
9.9
25.1
23.3
9.3
24.4
22.5
4.3
Deaths from cardiovascular disease for ages 45-64 in major metro areas
Change from 2010-11 to 2015-16 in the rate per 100,000 people
300
decrease
0-5%
5.1-10%
10.1-15%
15.1-20%
Over 20%
100
Colorado
Columbus, Ga.
Rate: 336 in
2015-16 (highest)
Metro areas with the largest rate increases
Increases by area type
Major metros
Midsize metros
Small metros
Rural areas
U.S. total
27.9%
24.1
1. Lexington, Ky.
2. Atlantic City, N.J.
3. Corpus Christi, Texas
4. Lincoln, Neb.
5. Fort Collins, Colo.
6. Beaumont, Texas
7. Fort Wayne, Ind.
8. Greeley, Colo.
9. Colo. Springs, Colo.
10. Kennewick, Wash.
2.9%
25.7
23.9
8.1
25.7
23.5
9.9
25.1
23.3
9.3
24.4
22.5
4.3
Deaths from cardiovascular disease for ages 45-64 in major metro areas
Change from 2010-11 to
2015-16 in the rate per
100,000 people
Over 20%
15.1-20%
10.1-15%
5.1-10%
0-5%
300
decrease
100
Colo.
Metro areas with the largest rate increases
1. Lexington, Ky.
2. Atlantic City, N.J.
3. Corpus Christi, Texas
4. Lincoln, Neb.
5. Fort Collins, Colo.
6. Beaumont, Texas
7. Fort Wayne, Ind.
8. Greeley, Colo.
9. Colo. Springs, Colo.
10. Kennewick, Wash.
27.9%
25.7
25.7
25.1
24.4
24.1
23.9
23.5
23.3
22.5
Increases by area type
Major metros
Midsize metros
Small metros
Rural areas
U.S. total
2.9%
8.1
9.9
9.3
4.3
Sources: Centers for Disease Control and Prevention (death rates); Census Bureau (population)
They are also part of a booming urban corridor where new subdivisions, shopping centers and big-box stores are pushing into former ranch land and once open roads are becoming clogged with traffic as new residents move in. Like much of America, the region is undergoing changes that foster more stress and sedentary lifestyles.
Other metro areas that ranked in the top 10 for death rate increases include Lexington-Fayette, Ky., with the biggest increase; Atlantic City-Hammonton, N.J.; and Kennewick-Richland, Wash. Large cities such as Denver are farther down the list.
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(The Journal ranked the change in the cardiovascular-disease death rate among middle-aged people in metro areas with populations of 100,000 or more, representing 85% of the U.S. population. The analysis compared the change in that death rate between 2010-11 and 2015-16, the most recent years for which data are available.)
The findings suggest that the underlying causes of cardiovascular disease are universal and difficult to address, public-health officials and doctors say. While the South and some other parts of the nation have perpetually high rates of death from heart disease and strokes, middle-aged cardiovascular death rates are rising even in places where those rates have been historically low.
Its everywhere, said Judy Hannan, senior adviser at the Centers for Disease Control and Prevention to Million Hearts, a federal initiative to prevent heart attacks and strokes.
Health officials cite a number of factors threatening to rob Colorado of its historically healthy status. The states adult obesity and diabetes rates, though still the lowest in the nation, have risen over the past several years. High blood pressure, drug and alcohol use, stress and a lack of physical activityeven in an exercise-mad statealso play a role, they say. These factors also increase risk for people who are genetically disposed to heart disease, doctors say.
Were experiencing the same phenomena that the rest of the country is experiencing, said Kirk Bol, manager of the vital statistics program at the states Department of Public Health & Environment.
Michael Wailes, the 46-year-old owner of a digital marketing agency, grew up on a farm near Greeley, Colo., where his grandfather raised cattle. Back then, the farm was surrounded by open plains.
Mr. Wailes was a skinny kid, he said. He ran track, and would go hiking and rock climbing in the mountains.
Rather than farming, Mr. Wailes went into advertising and marketing. He was a smoker and developed a love of fast food. My favorite thing in the world was to go to McDonalds and get two Double Quarter Pounders with cheese, and nuggets and fries, he said.
Mr. Wailes felt chest pain one day in 2015 when he was at the gym, after having had two heart attacks in the prior half decade. Unable to reach his wife by phone, he got into his car and drove to the hospitala practice doctors discourage. He walked into a waiting room and collapsed.
He came out of a medically induced coma three days later and learned he had had another heart attack, one that nearly killed him.
At 6 feet 1, Mr. Wailes weighed about 275 pounds. Now, he has lost more than 60 pounds. He changed his diet, jumps rope every day and quit smoking years ago. I would love to be able to live to 80, he said. That is when his father, who had heart disease, died.
Thousands of people move to Colorado every year, but a 2018 analysis by the state public-health department found newer residents have lower rates of overweight and obesity than existing state residents. Researchers used drivers license data to identify new residents, who traded in out-of-state drivers licenses for Colorado ones.
Some of our homegrown Coloradans are the ones experiencing the disparities, said Joan Brucha, healthy-eating, active-living manager for the states health department. Theres a whole proportion of our population that has never been to the mountains.
One of Gov. Jared Poliss priorities is to reduce obesity rates, Ms. Brucha said.
Even the fit, athletic residents the state is known for are at risk. Paul Thompson collapsed on a mountain-biking trail in July 2017 while on an intense ride with a friend. The 55-year-old, who grew up in Colorado, had a pain in his back for about 10 days. But he attributed it to exercise-induced asthma and thought he would work through the pain, according to his wife, Colette Thompson. A part of him thought he was Superman, she said.
The friend riding with him called paramedics and administered CPR until they came. It was too late. An autopsy found Mr. Thompson, of Fort Collins, had arterial blockages, and that he had also had a previous heart attacklikely a silent one, with few or no symptoms.
At his funeral, Ms. Thompson urged attendees to pay attention to symptoms and family history, she said. Several have gone to get checked out, she said, and 11 have received stents or other therapy as a result. Six of the 11 were friends Mr. Thompson played hockey with, said Ms. Thompson.
Even if you think youre in good shape, if you have this unusual chest or back pain, you need to take it seriously, said Ms. Thompson, 60, who is a director for community health improvement for UCHealth. She said she stresses cardiovascular screening and intervention more than she did before in programs she oversees.
In Fort Collins, a public agency offers frequent low-cost or free screening programs at workplaces and other venues. Nurses measure blood pressure, cholesterol and glucose levels and advise in one-on-one meetings on changes clients can make. The agency, called the Health District of Northern Larimer County, is funded primarily by local property tax dollars.
At one recent screening, Cheri Nichols went over test results with Sally Purath and calculated the 66-year-old retired teachers risk of heart disease on an app. It showed an intermediate risk.
Ms. Nichols, the nurse who manages the screening, urged her to eat more fiber, talk with her doctor about her high blood pressure, and exercise more. Youre going to get a lot of benefit from those lifestyle behaviors, she said.
In some rapidly growing parts of Colorado, changing lifestyles and greater prevalence of important risk factors have boosted the death rate due to cardiovascular disease in middle age.
Population of 3 Colorado metros
Percentage of Colorado adults…
1.5 million
25%
Neb.
Fort Collins
Greeley
20
…with high
blood pressure
Greeley
1.0
Denver
15
…who are obese
10
0.5
COLORADO
5
…with diabetes
0
0
N.M.
2000
2010
2018
2000
10
17
2000
10
17
2001
10
17
Percentage of Colorado adults…
Population of 3 Colorado metros
1.5 million
25%
Neb.
Fort Collins
Greeley
20
Greeley
…with high
blood
pressure
1.0
Denver
15
10
0.5
COLORADO
5
0
0
N.M.
2000
2010
2018
2000
10
17
2000
10
17
2001
10
17
Population of 3 Colorado metros
1.5 million
Neb.
Fort Collins
Greeley
Greeley
1.0
Denver
0.5
COLORADO
0
N.M.
2000
2010
2018
Percentage of Colorado adults…
25%
20
…with high
blood
pressure
15
10
5
0
2000
10
17
2000
10
17
2001
10
17
Source: Colorado Department of Public Health & Environment
Ms. Purath, who likes to snowshoe, said the regular screenings are a helpful reality check. It helps me get off my duff, she said.
Researchers in northern Colorado are expanding a cardiovascular-disease screening and education program called Healthy Hearts for school-age children and families. The idea is to teach healthy lifestyles and detect risk factors early, said Gary Luckasen, medical director of cardiovascular research at UCHealth in northern Colorado, who started the program in 1992.
More than a quarter of elementary-school children screened in the 2018-19 school year were overweight or obese, and 19.2% had borderline or high cholesterol, according to program data.
In Colorado Springs, Dr. Rosenbaum, 51, sees an increasing number of young patients. When a lot of people youre taking care of are younger than you, thats a bit unnerving, he said.
More needs to be done to emphasize heart-disease prevention, he said. Sure, Grandpa had it, Mom and Dad had it, but Im too youngI think thats a feeling a lot of people have, he said.
He counsels patients regularly about lifestyle changes and managing risk factors. He follows a mostly plant-based diet and extols others to eat healthierincluding his colleagues. He once stuck his business card in a biscuit-and-cheese casserole in a hospital doctors lounge with the message, If having chest pain, please call and a circle around his office phone number.
Colorado Springs is called Olympic City USA, home to the headquarters of the U.S. Olympic & Paralympic Committee. Olympic athletes train there and active residents hike up Pikes Peak. In 2017, though, Matt Baranowski could barely walk around a downtown block.
The prevalence of several cardiovascular disease risk factors is higher in the U.S. for 35-64 year-olds than for older adults.
Heart disease management by age group
Age 35-64
Age 65 and older
Percentage with high blood pressure
under control
52.9%
45.9
Percentage who smoke tobacco
24.6%
10.4
Percentage taking cholesterol drugs
48.1%
63.5
Percentage who are physically inactive
28.4%
41.2
Average sodium intake (mg/day)
3,591
2,947
Source: National Center for Health Statistics, Centers for Disease Control and Prevention
The Colorado Springs resident, now 37, was working in IT at the city newspaper. At 6 feet 2 and 450 pounds, he would get winded walking from the parking garage to the office.
He wanted to turn his life around. Doctors had diagnosed him with atrial fibrillation, a heart-rhythm problem associated with obesity. He had two scary trips to the emergency room in recent years. He was on a blood thinner and beta blocker and was also prediabetic.
He cut back on playing videogames. He started getting out once during the day to walk around the block. Then twice around the block, and more.
In 2018, after another scare when doctors discovered blood clots in his feet, Mr. Baranowski began intermittent fasting and adopted a ketogenic diet.
Now, he works for the U.S. Olympic & Paralympic Committee as an IT systems engineer. He has lost 215 pounds and is seeing a nutritionist to develop sustainable healthy eating patterns. The heart palpitations are much less frequent and dont last long. Now I feel like a completely different person, he said.
The environment has helped encourage him. He works out regularly at a gym at his employers training center.
On a recent day, he lifted weights next to Tyler Carter, a two-time Paralympian in Alpine skiing. Its a big motivator, Mr. Baranowski said.
Write to Betsy McKay at betsy.mckay@wsj.com
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