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Victory, but much yet to be done

A 30-per-cent decline in deaths from cardiovascular disease over 10 years is worth celebrating, though perhaps with a long walk or a game of tennis, rather than a slab of cake and a case of beer. Alas, there are killjoys who are saying that the improvements in heart health will not last, largely because of rising obesity and diabetes rates. And the killjoys may be right.

A little celebration, first. Prevention works. Two-thirds of the improvement came from changes in behaviour - smoking became uncool, eating habits improved - while just one-third came from medical advances, according to a study published in the Canadian Medical Association Journal this week. That ratio tells an important story, as Canada tries to contain the endlessly rising costs of medical care. The period studied, 1994 to 2004, was one in which governments invested heavily in both prevention and treatment of cardiovascular disease. More than 80 per cent of cases in middle-aged people are preventable. People can and do change.

This is part of the payoff from the drop in the proportion of smokers. That drop was astounding - to 20 per cent in 2004 from 25 per cent just five years earlier. It has meant not only a longer life but a healthier life. Heart disease now starts later in life, and affects a shorter period. Once considered a disease of middle-aged men, it is increasingly associated with elderly women (women made up 50.5 per cent of cardiovascular deaths in 2004, up from 49.3 in 1994). Public-health campaigns in Canada and the United States are now alerting women on how to lower their risks.

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"Is the party over?" ask Simon Capewell and Martin O'Flaherty of the University of Liverpool's public-health division. Death rates from heart disease have stopped declining in the United States, Britain and Australia. In light of improvements in treatment, the lack of progress on death rates is concerning. "An iceberg of hidden cardiovascular disease" will become apparent soon, mostly affecting the elderly. Their prescription: eliminate trans fats, cut in half the intake of saturated fats and salt, make fruit and vegetables cheaper, increase physical activity, and make cigarettes too expensive for mass consumption.

A continued decline in cardiovascular disease may depend on progress on obesity. But hectoring people about being couch potatoes hasn't worked; nor has lecturing children. More than 50 per cent of adult Canadians say they have no regular physical activity in their lives. Young people did not stop smoking till adults did.

Maybe the answer lies not in overemphasizing obesity, but in finding ways to live healthier, more active lives at any weight.

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