One primary reason that longevity in the United States has grown for decades is more effective treatments for cardiovascular disease. That has, among other things, lowered the number of deaths from heart disease and stroke. The period of progress may have ended though, according to a new study.

Researchers at the University of Melbourne reviewed trends in cardiovascular deaths from 23 high-income nations, beginning in 2000. The study results were published in the International Journal of Epidemiology, according to the science news site EurekAlert!, which is operated by the American Association for the Advancement of Science.

The study’s key findings were that “cardiovascular disease mortality rates for people aged 35 to 74-years-old are now barely declining, or are increasing, in 12 of the 23 countries.” The results from certain parts of the populations in Australia, Canada, New Zealand, the United Kingdom and the United States were particularly alarming. One scientist who worked on the study pointed to growing obesity in many developed nations as the reason. The effects of this go back for years as the populations in those nations have become increasingly obese.

Public health initiatives are no longer deterring deaths from heart disease and stroke, another major factor in the end to improving outcomes. University of Melbourne researcher and co-author Tim Adair commented on the importance of the trend: “In order to combat this, significant investment in preventive health measures is needed, particularly those aimed at increasing physical activity, improving diet and reducing obesity.”

The United States is an example of a place where research and public policy have helped improve the mortality rates from heart disease and stroke. The Centers for Disease Control and Prevention (CDC) recently reported that its work, combined with work at the state and local levels, has lowered cardiovascular disease: “These efforts have helped lower death rates from heart disease and stroke, which are the first and fifth leading causes of death in the United States.” One in every four deaths in the United States is caused by heart disease, and the  rate of heart varies significantly by state. These are the states with the most heart disease.

However, the American Heart Association supports the opinion that the progress in the United States has slowed considerably. It said progress had hit a plateau. The rate of death from heart disease in 2016 was 165.5 per 100,000 people. That dropped to only 165.0 in 2017. Among the primary reasons given was, once again, higher obesity rates. A rise in diabetes is also to blame. That rise is often associated with obesity and poor diet.

Taken as a whole, new data about heart disease and stroke are not encouraging, and without lifestyle changes across much of the population, they may not improve. This already varies based on healthy habits and by geography. Weight and exercise appear to be major factors. They have long been associated with an increased risk of heart problems, but other factors are not as familiar. Here are at least 28 dangerous things doctors link to heart disease.

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