The biggest cause of death in the region often follows a circuitry of life choices and genetics, with the final kill switch thrown by the victims themselves.
That conclusion was drawn through analysis of national health data, the observations of state and region health experts and the experiences of family members who have lost loved ones to heart ailments.
Nearly 24,000 people across Lake, Porter and LaPorte counties died of heart-related causes between 1999 and 2010, a Times’ computer-assisted analysis of U.S. Centers for Disease Control and Prevention data shows.
The greatest number of deaths in this category resulted from life decisions the victims made, according to the data, and state and region health officials.
Atherosclerotic heart disease – or hardening of the arteries – claimed at least 9,496 lives in the region in the 12-year period, the CDC cause-of-death records show. The disease accounted for nearly 40 percent of all heart-related region deaths.
It’s a condition often hastened by fatty, artery-clogging diets that over time restrict blood flow to the heart and throughout the body.
How we live and die in the region often is a factor of what we put on our plates and how often we exercise, region health officials said, but their message isn’t one the region as a whole has heeded through the years.
In Lake County, 34 percent of adults are obese, according to Robert Wood Johnson Foundation health rankings. About a third of Lake County's population is physically inactive, according to the foundation.
Diabetes – and more specifically diabetics who fail to follow prescribed health regimens and proper diets – also contributes to the figures, state and region health officials said.
Economics, convenience and access to health care and insurance remain some of the region’s biggest stumbling blocks to improving this stark region body count, health officials said.
But the biggest challenge can be convincing the populations most at risk to change their lifestyles.
Gone too soon
Amelia Kowalisyn, 32, of Valparaiso, wishes that message had resonated more with her brother, Michael Back.
Back, a longtime Hobart resident who moved to Chicago in adulthood, died of a heart attack in July 2005.
He was 35.
It was far too soon for Kowalisyn and the rest of Back’s family to lose him. He was a fun-loving computer whiz who loved his family and had a blast with his friends.
He also suffered from Type 2 diabetes, which he was diagnosed with at 18. Back checked his insulin levels twice a day and took insulin injections to keep his blood sugar levels balanced.
But certain behaviors attack the health of diabetics at an amplified rate, including poor diets, smoking and lack of exercise.
Back liked his pizza, beer and cigarettes, Kowalisyn said. Heart disease also runs in the family, but she wasn't sure if it was a factor in her brother's death, she said.
“It’s frustrating trying to talk to family members when they’re not willing to take care of themselves,” she said. “He was 35 when he died. This is not a normal occurrence for someone that young. People really need to take their health more seriously.”
Diabetes cases alone were listed as the primary cause of death in at least 2,965 deaths in the region between 1999 and 2000, the CDC data show.
Region health experts estimate diabetes was a factor in far more of the 23,841 heart-related deaths – including heart disease, heart attacks and other ailments – than the data specifically reveal.
Though heart conditions also remain the leading cause of death nationwide, the rate of such deaths in the three-county region is outpacing the nation. While heart ailments accounted for nearly 38 percent of deaths across Lake, Porter and LaPorte counties, the same category claimed 27 percent nationwide in the same time period.
"It's doubly compounded when diabetes crops up," said Champ Thomaskutty, Indiana State Department of Health director of chronic disease epidemiology.
And as in Back's case, the dying are getting younger, Thomaskutty and CDC data conclude.
"This is no longer only a condition restricted to our seniors," Thomaskutty said of heart disease and other heart-related fatalities. "It's an issue that's hitting more and more people under 65, under 55 and people in their 30s and 40s."
Of the region people who died of heart-related deaths between 1999 and 2010, 5,060, or about one in five, were 64 or younger, The Times' analysis of CDC data found.
Heart disease alone claimed 2,283 people before age 65, the data show.
More than eight years after her brother's death, Kowalisyn still struggles with whether Back's premature death could have been prevented.
"It's so important that people take this story and really understand that your body can only take so much," she said. "It's so important to take care of yourself -- not just for you but for your family and friends."
Dr. Alexander Stemer, president of Munster-based Medical Specialists, agrees that even when genetics is a factor, many premature heart-related deaths are preventable.
"The problem is more manageable than it used to be if people take advantage of the tools out there," said Stemer, whose 60-physician medical practice includes doctors and dietitians who work with diabetic and heart disease patients.
"If you know you have a family history of heart disease or other serious heart conditions, have your lipids checked regularly," Stemer said. Lipids, or fat levels including cholesterol, can be checked through a blood test with your physician.
If you're at risk, reasonably cheap medications and daily doses of baby aspirin -- after consulting with a physician -- can be preventive measures for heart disease that can cost only pennies per day, Stemer said.
Those with a family history of heart ailments should seek screenings with their physicians by their 40s or 50s, Stemer said.
Economics and portion sizes
One of the biggest battles medical professionals fight revolves around economics and portion sizes, Stemer said.
Heart disease, obesity and other heart-related ailments tend to escalate in more financially strapped populations, Stemer said.
Cheaper food, such as dollar-menu items at fast food restaurants, is eaten more by people of lower economic means or those on tight budgets, he acknowledged.
Meanhwhile, more healthful foods, such as fresh produce and vegetables, tend to be more expensive.
"In Indiana as a whole, there is an increased percentage of people who don't consume a healthy level of fruits and vegetables," Thomaskutty said. "That leads to obesity, which leads to the bigger risk factors for heart disease and cancer."
But even those choosing cheaper, less healthful foods can improve their health by managing the amount they eat at each meal and staying active, Stemer said.
"It's really helpful for people to meet with dietitians and see what a recommended portion size looks like," Stemer said. "Maybe you're really tight on a budget. So maybe you go to McDonald's with your spouse and split a meal, with each eating half a hamburger and a few fries."
Changing a person's mindset can be the steepest obstacle to encouraging heart health, Munster-based dietitian Lucy Cole said.
"Yes it is tough to fight against the dollar menu," Cole said. "However, it costs a lot to be ill. Besides the cost of medications, there is the emotional cost -- and not just for the person who is ill."
Cole noted that family members often serve as caregivers to those suffering from chronic and sometimes fatal heart conditions.
And then there is the toll such conditions take on the family of those who lose loved ones at young ages. These days, Kowalisyn channels her grief over her 35-year-old brother's death into walks and fundraising efforts for the American Diabetes Association, anything to give meaning to the loss.
"He could have ended up getting married and having kids," Kowalisyn said. "He will never get a chance at those experiences.
"It applies to everyone. You have to take care of yourself and your health."