In developed nations such as the United States, the leading causes of death look very different from those of the late 1700s when you were most likely to die from dysentery, influenza, and pneumonia as a colonist. Modern Americans tend to fall victim to chronic diseases rather than acute infections. In fact, the conditions that kill us now were practically non-existent in the past since you didn't live long enough to suffer from them or have enough food to cause complications. But times have changed... let's talk about it.
#1 KILLER - HEART DISEASE:
As you can see, the number one killer of Americans is heart disease. About 695,000 people in the United States died from heart disease in 2021, which is roughly 1 in every 5 deaths. That may or may not surprise you. Public health has spent countless hours and dollars focusing on cancer since 1971 with the passing of the National Cancer Act, thus kicking off Nixon's "war on cancer". That effort had mixed results, but that's a topic for another day. The same can be said for the Trump and Biden administrations during the early days of the COVID-19 pandemic, which at the time came in at #3 according to the CDC (note, that data is controversial given potential differences/interpretations of dying "with" vs "from" COVID-19). Regardless of the public's focus, the real killer hides in the shadows, slowly taking hold of Americans earlier and earlier in life as it tears through tax dollars, decimates quality of life, and claims more lives than kidney disease, liver disease, diabetes, Alzheimer's, chronic lung disease, and stroke combined.
Heart disease is a broad term that refers to several conditions, most notably that of coronary artery disease (CAD), which is the most common phenotype of heart disease in the United States. CAD occurs when the major blood vessels that supply the heart (the so-called coronary arteries) struggle to send enough blood, oxygen, and nutrients to the heart muscles. However, heart disease can present itself through many symptoms such as heart failure and arrhythmias. One of the most common presentations of heart disease is sudden cardiac death. That tends to happen due to myocardial infarction (heart attack), which is actually the most common way of finding out that a patient has (or had) heart disease. That's a tragic outcome, and the cause is heart disease's ability to very quietly cause problems, which is why you'll hear many people refer to it as the "silent killer". It doesn't help that heart attacks are fatal roughly 1/3 of the time.
Outside of environmental factors like smoking tobacco products, the causes of heart disease don't tend to have any obvious signs until it's too late. The best examples of this are hypertension (high blood pressure) and hypercholesterolemia (high cholesterol), which is more of a surrogate biomarker for apoB-containing particles. For a deeper dive into these particles and an explanation for why there's not really "good cholesterol" or "bad cholesterol", please check out our previous post on what causes a heart attack. Neither hypercholesterolemia nor hypertension tends to have any symptoms that are detectable by the patients themselves. Rather, these conditions have to be diagnosed using blood draws and blood pressure cuffs, and the results often surprise patients.
Physicians such as Peter Attia, MD have been quite outspoken about heart disease and claim that it really shouldn't be in the top 10, let alone #1. He shares this view with many other longevity and cardiac experts, particularly because heart disease can be largely prevented with life change and proper medication management. He claims, and I tend to agree, that intervening earlier in life and taking a prophylactic approach to heart disease through lifestyle interventions would prevent most heart disease in the United States. A prophylactic approach would also meaningfully delay it in even the highest-risk patients.
Medication management of apoB-containing particles such as LDL-P (the "container" for LDL-cholesterol), hypertension, and hypertriglyceridemia can go a long way. However, exercise is likely the most potent drug of all for extending life and preventing heart disease. What kind of exercise? Any type of exercise is better than nothing, but Zone 2 training would be a great place to start! This not only targets the heart muscles, but also enhances metabolic flexibility, thus focusing on one of the biggest risk factors for heart disease.
Regardless of whether you have a family history of heart disease, which many of us do, I encourage you to learn about it and do everything you can to prevent it. It's literally the most dangerous thing our society faces today. Although a heart attack can feel "sudden", the reality is that things have been going wrong for years before an event ever occurred. This disease lurks in the shadows before it strikes, so arm yourself with a flashlight. Go to your doctor's office, see how things are going, and if need be, make some changes. It's about time we remove heart disease from the top 10.