Fewer Americans are dying each year from heart disease, but the number of people suffering first heart attacks has held steady or even increased since 1987, a study found.
Researchers said the reason is that treatment is outstripping prevention.
Heart disease is the No. 1 cause of death in the United States, killing 481,458 people in 1994, according to the government.
The study in Thursday's New England Journal of Medicine found deaths fell 28 percent among men and 31 percent among women from 1987 to 1994.
Over the same period, however, the number of black women hospitalized with first heart attacks rose 7 percent per year. The numbers stayed stable among black men and whites.
Dr. Valentin Fuster, president of the American Heart Association, said he is not discouraged because the trend is toward overall improvement.
More people are taking drugs to control their cholesterol or blood pressure, and more patients recognize the early warning signs of heart attacks and get to hospitals, he said.
"Patients don't die in the street as they did before," Valentin said. "I think this is very positive altogether."
The study's lead author, University of North Carolina epidemiologist Wayne Rosamond, attributed the decrease in deaths mostly to better treatment for people once they have had a heart attack, not better prevention.
He said the unbudging number of first heart attacks and the high number of deaths that occur without warning outside the hospital suggest that efforts to recognize heart disease early and to get people to adopt healthier habits are falling short.
"What we're seeing is that improvement is slowing and there are still pockets of the population we need to get our prevention message to," Rosamond said.
The study looked at hospital admissions for heart attacks and deaths from heart disease among people age 35 to 75 living in Forsyth County, N.C.; Jackson, Miss.; eight Minneapolis suburbs; and Washington County, Md.
Gregory Heath, chief of heart health at the national Centers for Disease Control and Prevention in Atlanta, said Americans don't get enough exercise, depend too much on their cars and don't eat right.
"We have plenty of trees and woods in Atlanta, but no sidewalks," he said. "I'm looking at our parking lot emptying for lunch. They're leaving and going up the road to fast food places where they're going to get an average of about 1,100 calories for one meal."