Sudden death and the decline in coronary heart disease mortality

Abstract

INTRODUCTlON THE DECLINE in coronary heart disease (CHD) mortality in the United States has been extensively described [l-4]. The decline probably began around 1963-1964. It has been noted in all four race-sex groups in most states and in other countries [ 1, 5,6]. The greatest decrease in CHD mortality has occurred in the young age groups, 35-44. Between 1968 and 1978, coronary heart disease death rates declined 31.7% for white women, 31.9% for white men, 32.2% for black men, and 46.6% for black women aged 3544 [7]. There have been relatively few studies that have evaluated the accuracy of death certificate classification of the cause of death due to heart diseases during this time period [8,9]. Especially missing are studies of the circumstances of the death, such as the place of death, hospital vs non-hospital, suddenness of the death, length of survival and history of prior cardiovascular disease. In previous studies of coronary heart disease mortality in the community, we demonstrated that 6&70% of coronary heart disease deaths occur outside of a hospital [lo], two-thirds are classified as sudden, having occurred within 24 hours of onset among individuals not restricted to their home or hospital or having major disabilities prior to death. About 60% of all sudden non-traumatic deaths in a community were due to coronary heart disease [ll]. Approximately half of the coronary heart disease deaths, especially those under the age of 65, had a prior history of heart disease [lo]. The decline in CHD mortality could be limited to sudden CHD deaths only, possibly only deaths without a prior history of heart disease, incident events. The decline in these incident sudden CHD deaths would most likely be due to a reduction in risk factors rather