Heart Disease’s Long Goodbye

As the United States commemorates its latest milestone in the fight against heart disease, a small pill called enlicitide has been approved by the FDA to lower “bad” cholesterol by nearly 60 percent. This achievement is easy to get caught up in, but beneath the headlines lies a more nuanced story: decades of progress that have turned what was once an almost certain death sentence into a manageable condition for millions.

Since 1950, the age-adjusted death rate from cardiovascular disease has fallen by three-quarters. This means a 60-year-old today is roughly four times less likely to die of heart disease than a 60-year-old was when Harry Truman was president. The trajectory is nothing short of remarkable.

However, it’s essential to acknowledge that despite these gains, heart disease still claims nearly one in five deaths worldwide. Its impact is far from vanquished, and its shifting landscape demands a new approach – one that recognizes the limitations of even the most effective treatments.

Enlicitide is just the latest example of how medicine has been quietly making progress against heart disease by mimicking the effects of a rare genetic mutation that allows some individuals to naturally lower their cholesterol levels. These pills offer a more accessible and tolerable alternative to statins, which can’t be taken by everyone. But what happens when the pill is gone? What happens when gene editing becomes tomorrow’s answer?

The truth is, even with enlicitide on the market, heart disease remains a complex condition that defies easy solutions. The war against it won’t be won simply by approving more pills or infusions; it will require an equally sweeping effort to address its root causes – from smoking and high blood pressure to obesity and diabetes.

A Shift in Focus

While heart-attack deaths have plummeted 89 percent since 1970, other conditions such as heart failure, arrhythmias, and hypertensive disease have seen an uptick of 81 percent. This paradoxical rise is both the result of success (people living long enough for their hearts to wear out in other ways) and the challenge that lies ahead: as treatments become more effective, they also create new challenges.

A New Path Forward

The future of heart disease treatment will require a nuanced understanding of its complexities. Enlicitide may be just the beginning – but it’s only one piece of the puzzle. Gene editing holds promise, but so does a recommitment to addressing the root causes of this epidemic. Policymakers and healthcare professionals must rethink their approach: reducing smoking rates and improving access to affordable treatments, developing more effective prevention strategies that target the entire spectrum of heart disease.

A Long Goodbye

The war on heart disease won’t be easy to win – but with continued progress, we’re not far from a future where this condition is no longer the leading cause of death. The road ahead will require incremental gains, hard-won battles, and an unwavering commitment to addressing its complexities. As enlicitide becomes part of the arsenal against heart disease, it’s essential to acknowledge both the progress we’ve made – and the long goodbye that still lies ahead.