Heart disease

Abstract

PURPOSE: To compare the mortality, incidence and case fatality rate from cardiovascular disease (CVD), including coronary heart disease (CHD) and stroke, among normal weight and overweight participants in the National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Follow-up Study (NHEFS) cohorts, and to evaluate secular trends in the CVD incidence and case-fatality rates to the decline in CVD mortality. METHODS: NHANES I collected data from 1971 to 1975 from a nationally representative sample of the civilian non-institutionalized population of the United States. The NHEFS cohort includes 14.407 persons ages 25–74 years old who completed a medical examination in NHANES I conducted during 1971–75. Two cohorts of adults aged 35 to 74 years were created from this data. 10,869 (5,057 normal weight, 5, 812 overweight) subjects in the 1971-1982 cohort and 9,774 (5,245 normal weight, 4,529 overweight) subjects in the 1982-1992 cohort were included in the analysis. The cohorts were followed-up prospectively for an average of 8.2 and 7.4 years, respectively. Incidence and mortality data for CVD were obtained from medical records and death certificates. RESULTS: After adjustment for age and sex , the declines in mortality, incidence, and 28-day case fatality rate due to CVD were 32% (p = 0.000), 22% (p = 0.002), and 18% (p = 0.278), respectively, in normal weight subjects, and 33% (p = 0.000), 22% (p = 0.000), and 45% (p = 0.000) in overweight subjects. The decline in age-adjusted CVD mortality was 35% (p = 0.000) and 23% (p = 0.100) for normal weight men and women, and 32% (p = 0.000) and 38% (p = 0.058) for overweight men and women, respectively. Reductions in the age adjusted incidence (27% (p = 0.001) and 17.5% (p = 0.246) for normal weight men and women, respectively, and 22.1% (p = 0.0.43) and 21.5% (p = 0.006) for overweight men and women, respectively), and 28-day case fatality rate (28.7% (p = 0.092) for normal weight men, respectively, and 17.8% (p = 0.070) and 68.7% (p = 0.001) for overweight men and women, respectively) for CVD contributed to the decline in mortality. After adjustment for age and sex, the declines in mortality, incidence, and 28-day case fatality rate for CHD were 35% (p = 0.028), 17% (p = 0.206), and 31% (p = 0.081), respectively, in normal weight subjects, and 37% (p = 0.006), 10% (p = 0.137), and 51% (p = 0.000), respectively, in overweight subjects. Following adjustment for age and sex , the declines in mortality, incidence, and 28-day case fatality rate due to stroke were 18% (p = 0.386), 40% (p = 0.000), and 2% (p = 0.992), respectively, in normal weight subjects, and 55% (p = 0.025), 24% (p = 0.015), and 65% (p = 0.019), respectively, in overweight subjects. CONCLUSION: These findings suggest that the substantial decline in CVD mortality in the overweight group is mainly due to reduction in case fatality rate.