published Saturday, September 21st, 2013

Thousands of deaths could be prevented each year with simple changes in personal habits

CLOSER TO HOME

Heard disease and stroke deaths in 2010 that were considered avoidable:

Alabama -- 3,998

Georgia -- 6,480

Tennessee --6,311

Source: Centers for Disease Control and Prevention

BY THE NUMBERS

* 30 percent: Hamilton County residents who are overweight or obese

* 27 percent: Residents who say they don't engage in physical activity

* 73 percent: Who don't eat enough fruits and vegetables

* 18 percent: Smoke

* 11 percent: Drink excessively

* 15 percent: Lack health insurance

Source: 2013 Ochs Center for Metropolitan Studies

HELPFUL TOOLS

Check your risk

Dr. Steven Austin encourages people to check what's called a "Framingham risk score," which calculates their risk of developing heart disease by taking into account their age, gender, blood pressure reading and cholesterol levels.

It is free online: http://cvdrisk.nhlbi.nih.gov/calculator.asp

Don't lose time

Remember to act "FAST" at signs of a stroke, says Dr. Biggya Sapkota.

F -- Facial droop

A -- Arm weakness

S -- Speech slurred

T -- Time cannot be wasted if you see these symptoms. Head to your nearest hospital or stroke center.

Counselors say it's generally not a good idea to dwell on "what if "questions after a person dies. It can become unhealthy.

But when hundreds of thousands of Americans die each year from diseases considered preventable, the "what ifs" become unavoidable for doctors and researchers trying to stem the tide.

And the questions they ask aren't complicated: What if more people had decided against second helpings of dinner? What if they had chosen to leave those cigarettes unlit? What if they had taken more time for after-dinner walks, or made a bigger deal out of taking their blood pressure medicine?

What if more people could have afforded to see a doctor in the first place?

A new study paints a stark picture of just how much Americans' everyday health habits are linked to their mortality.

In 2010, more than 200,000 Americans under age 75 died of strokes and heart disease that could have been avoided if people had sought treatment earlier or changed their habits, the study by the Centers for Disease Control and Prevention found.

Cardiovascular disease is the leading cause of death in America, killing about 800,000 people each year. But researchers say one in four of those deaths could have been averted through screening and treatments for high blood pressure, high cholesterol, smoking and obesity.

"We're talking about deaths that don't have to happen," CDC Director Dr. Tom Frieden said.

Men are more than twice as likely as women -- and blacks twice as likely as whites -- to die from such diseases, the report showed.

And there are many such deaths in this region. Avoidable-death rates were highest in the Southern Appalachian region, the CDC study found -- including Tennessee.

Tennesseans rank at or near the top of the national scale for obesity, diabetes, heart disease and smoking. Overall, Georgians are slightly better, and Alabamians are slightly worse.

"This is a population that needs help," said Chattanooga cardiologist Dr. Steven Austin. "This is an area where you stay very busy. ... It's certainly true that a big number of the deaths we see are preventable. A family history of heart disease you can't change. But there are things you can [do to lessen risk]."

In Hamilton County, 30 percent of residents are overweight or obese, and the county's mortality rates are higher than the U.S. average -- especially for stroke and diabetes

Thousands of locals also lack access to basic screenings and treatment. As of 2012, about 43,800 Hamilton County residents lacked any kind of health coverage, according to statistics released Thursday by the U.S. Census Bureau.

On average, someone in the United States dies from a stroke every four minutes. But it is even worse here in the "stroke belt" of the Southeast, said Dr. Biggya Sapkota, a neurologist with Erlanger's Southeast Regional Stroke Center.

"We live in an area where there's more strokes, more severe strokes, and where more people don't survive strokes," he said. "Compared to the rest of the country, the mortality from the stroke is 20 percent higher."

And stroke rates will only continue to climb as the national population ages, Sapkota said.

Eighty percent of strokes, he said, are due to risk factors that can be changed. If patients were serious about controlling their blood pressure, he said, that could prevent "all kinds of other issues."

"These days almost everyone has hypertension once they reach a particular age," lamented Sapkota. "We're all eating processed food, loaded with salt."

The most high-risk population, said Chattanooga cardiologist Dr. Robert McKoy, is people over age 60 who are diabetic, sedentary, obese, or have a history of heart disease.

But doctors are seeing more patients with these problems at younger ages. They say more people -- especially those with a family history of problems -- need to be screened earlier.

"We are seeing more and more strokes with younger people these days, largely due to early-onset diabetes ... and the impacts of higher child obesity rates," said Sapkota.

The heart and stroke specialists mainly work with patients who already have had a cardiac or stroke event.

At that point, the doctors pinpoint harmful factors and prescribe a medication regimen -- though pills won't solve the problems if people won't change their habits.

But it can be hard for doctors to communicate how urgently a patient needs to change. The advice to "eat a healthy diet" and "exercise more" are so well-worn and predictable that many people may just brush them off. On the other hand, being too extreme with warnings also can backfire.

"People will run away from you if you're talking about death," said McKoy. "You have to individualize your message about how these things are deadly. But you also want to avoid beating around the bush."

But even people well aware of their risk levels can have a tough time breaking established habits.

"You have people who've had a heart attack and a stroke and they're still smoking," said Austin. "You almost want to ask, 'Why are you even coming to me if you're still smoking? That is your biggest barrier.' It has to be a real commitment on the part of the patient."

A verbal contract between doctors and patients -- like an agreement to quit smoking by a certain date -- can often help move the dial from dismissible advice to more concrete goal-setting, Austin said.

Peer support, such as a weight-loss group or help lines to quit smoking, is vital for behavioral change, he said.

McKoy says he tries to hammer home the risks to people at church and social gatherings -- every chance he gets.

"Sometimes it hits home, sometimes it doesn't," he said. "But you've got to keep pushing."

Contact staff writer Kate Harrison at kharrison@timesfreepress.com or 423-757-6673.

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