Trends In Cardiovascular Mortality Research Articles

Trends in the incidence, mortality, and survival rate of cardiovascular disease in a Japanese community: the Hisayama study.

The slowdown of a steeply declining trend in cardiovascular mortality has been reported in Japan, but precise reasons for this trend are uncertain. We established 3 study cohorts of Hisayama residents aged > or =40 years without a history of stroke or myocardial infarction in 1961 (1618 subjects, first cohort), 1974 (2038 subjects, second cohort), and 1988 (2637 subjects, third cohort). We followed up with each cohort for 12 years, comparing the incidence, mortality, and survival rate of cardiovascular disease. The age-adjusted incidence of cerebral infarction significantly declined by 37% for men and by 32% for women from the first to the second cohort. It continued to decline by 29% for men, but the decline decelerated for women in the third cohort. The incidence of cerebral hemorrhage steeply declined by 61% from the first to the second cohort in men only, while it was sustained for both sexes in the third cohort. Stroke mortality continuously declined as a result of these incidence changes and significant improvement of survival. In contrast, the incidence and mortality rate of coronary heart disease were unchanged except for the increasing incidence in the elderly. The prevalence of severe hypertension and current smoking significantly decreased, while that of glucose intolerance, hypercholesterolemia, and obesity greatly increased among the cohorts. Our data suggest that the decline in stroke incidence is slowing down and that the incidence of coronary heart disease has been increasing in the elderly in recent years. Insufficient control of hypertension and the increase in metabolic disorders may contribute to these trends.

Correlations among trends in cardiovascular mortality, hypertensive nephrosclerosis and antihypertensive medication prescriptions in North America

Correlations among trends in cardiovascular mortality, hypertensive nephrosclerosis and antihypertensive medication prescriptions in North America

The Effect of Fasting in Ramadan on the Values and Interrelations Between Biochemical, Coagulation and Hematological Factors

The possible consequences of the long intermittent fasting schedule during Ramadan (one month of food and water intake limited to night hours, a practice that is followed by the majority of the Muslims worldwide) on certain biochemical constituents or coagulation variables have not been extensively documented. During the month of Ramadan and two months after, we monitored the concentration of different plasma lipoproteins, lipoprotein (a) [Lp(a)], apoproteins A(1) and B, fibrinogen, factor VII activity and some selected hematological factors in 50 healthy subjects who were employees of institutes related to the Isfahan University of Medical Sciences and aged between 30 and 45 years. The effect of fasting in Ramadan on the relationship between biochemical and coagulation variables was also investigated. The values of apoprotein B, Lp(a) and low-density lipoprotein cholesterol (LDL-C)/high-density lipoprotein cholesterol (HDL-C) ratio were significantly decreased during Ramadan (P<0.05), while total cholesterol (Tot-C), triglycerides (TG), LDL-C, HDL-C and fasting blood glucose did not change during that month. Among coagulation and hematological factors, fibrinogen level and factor VII activity were significantly decreased during the month (P<0.05). Results also indicated a significant positive association between fibrinogen level and Lp(a), factor VII activity and Tot-C, LDL-C, TG and Apo B during Ramadan. Our findings contribute to a better understanding of previous reports, as the metabolic and coagulation changes that are considered as atherosclerosis risk factors are counterbalanced during Ramadan.

PRIMARY CANCER PREVENTION TRIALS

Great progress has been made in cancer chemoprevention during the past 2 decades. Nevertheless, the field could benefit from the experiences of investigators studying the prevention of cardiovascular disease. During the past 50 years, prevention of cardiovascular disease has gone from a dream to a reality, with major clinical impact. The trend during the last 30 years has been impressive and sustained. From 1987 to 1994, there was a sustained major decrease in age-adjusted mortality from coronary heart disease in both men (from 3.1 to 2.2 per thousand persons) and women (from 1.1 to 0.9 per thousand persons). This trend is believed to have resulted from improvements in the treatment of myocardial infarction and, more substantively, from improvements in secondary prevention. This explanation is consistent with earlier computer simulations of trends in cardiovascular mortality during the 1980s, which estimated that 25% of the declines were attributable to primary prevention and 70% were caused by reductions in risk factors or treatment. The greatest effect of primary prevention had previously been noted in the late 1960s and 1970s. Most of these important findings occurred before cholesterol-lowering drugs became widely available, so further improvements are expected. Researchers in cancer prevention should follow in the footsteps of their cardiovascular colleagues. The tools are now available to make prevention of cancer a clinical reality. As the science of prevention improves, it must be remembered that effective and efficient preventive services do not help if they are not used. It is difficult to motivate practitioners and patients to implement preventive services. Also, preventive services are often considered a luxury. Persons without health insurance and those covered by Medicaid are much more likely to be diagnosed with late-stage cancer; therefore, they are key cohorts to target for effective preventive approaches. Finally, the most effective cancer prevention program will probably use both rational drug therapy targeting specific risk factors and public health efforts to promote healthy lifestyle choices in the population at large.

Time trends of cardiovascular mortality and post-menopausal hormone use in Finland

The purpose of this paper was to study the relationship of post-menopausal hormone therapy to cardiovascular mortality by time trend analysis. Mortality and incidence figures by age and sex in 1970–1993 in Finland were obtained from published and unpublished statistics and the extent of hormone therapy use by age from previous nationwide surveys. Percent changes in mortality were calculated for different age groups and time periods (1970–1976, 1977–1987 and 1988–1993, chosen by the extent of hormone use). A theoretical reduction in mortality among 50–54 and 55–59 year old women was calculated by using the time trends among men and older women (60–64 years) as the bases and by multiplying the proportion of users by four hypothetical estimates (100, 50, 30, and 0% of benefit among users). The actual reduction in ischaemic heart disease and total cardiovascular mortality in the age groups with highest post-menopausal hormone use was not larger than in other female age groups or among men. Until 1987, the actual mortality of 50–54 and 55–59 year old women was lower than that predicted from both the data of older women and men and from the assumed benefits of hormone therapy. In the last time period the actual mortality was relatively nearer the predicted mortality both among 50–54 and 55–59 year old women. This time trend analysis does not support the claim that post-menopausal hormone therapy notably prevents cardiovascular mortality.

Current trends in the treatment of hypertension: a mixed picture.

It has been calculated that hypertension ranks as the fourth largest mortality risk factor in the world, predicting 6% of all deaths. Mild hypertension accounts for the largest proportion of cardiovascular deaths in the United States because of its high prevalence. Thus, mild hypertension should be the focus of treatment efforts. In addition, to achieve better results in the next century, we will have to refocus the treatment from the global goal of blood pressure lowering to exploration of specific effects of drugs on the diverse pathophysiologic aspects of hypertension including the complex metabolic and hemodynamic aberrations associated with human hypertension, as well as trophic factors. Another disconcerting feature of current hypertension management is the inadequate lowering of the blood pressure in those patients treated for hypertension. The National Health and Nutrition Examination Study (NHANES) survey in United States shows that patients treated for hypertension have blood pressure values that are only slightly lower than in untreated hypertensives and remain higher than in normotensive subjects. Patient compliance with treatment is one major problem. The development of better tolerated drugs ought to bring improvement. Overall, an educational effort aimed at physicians, the general public, and health care providers is necessary to improve the treatment of hypertension and reverse the negative trends in cardiovascular mortality.

1.P.353 Trends in cardiovascular mortality in a developing country

1.P.353 Trends in cardiovascular mortality in a developing country

The burden of cardiovascular diseases mortality in Europe: Task Force of the European Society of Cardiology on Cardiovascular Mortality and Morbidity Statistics in Europe

Cardiovascular diseases are the major cause of death in adults and the elderly in the majority of the developed countries and in many developing countries. Cardiovascular diseases result in substantial disability and loss of productivity and contribute in large part, to the escalating costs of health care, especially in the presence of an ageing population. Papers published by the World Health Organization of the United Nations (WHO) and others have previously reported trends in cardiovascular mortality over time. These reports showed large international between-country differences both in the levels and in the trends in mortality from cardiovascular diseases, especially from ischaemic heart disease. More recent analysis of mortality data points to a substantial increase in cardiovascular diseases in countries of Central and Eastern Europe concomitant with recent nutritional, economical and political changes. Although most European countries perform analysis of mortality at the sub-national (regional) level, international analysis using sub-national data have been made only for selected diseases, for example cancer mortality by the International Agency for Research on Cancer, Lyon. The advantage of this type of analysis is that spatial variability in mortality patterns can be shown across borders. This may help in identifying factors responsible for this variation. The importance of population control of cardiovascular diseases was highlighted by the European Union in article 129 of the Treaty on European Union, which contains specific provisions on public health and focuses on the ‘prevention of disease, in particular the major health scourges’. The Council Resolution recognized the need for monitoring and surveillance of cardiovascular diseases within the general framework of health monitoring. Accordingly, the Board of the European Society of Cardiology upon recommendation from the Committee for Scientific and Clinical Initiatives, set up a Task Force to study the latest available data on cardiovascular mortality and morbidity in order to assess the burden of these diseases in Europe. This report reviews total cardiovascular, ischaemic heart disease, cerebrovascular and all causes mortality in European countries for the years 1990–1992. Regional mortality rates are presented for the years 1990–1991. Finally, the country mortality trends for the period 1970 to 1992 are analysed.

Tendencias en la mortalidad por enfermedades cardiovasculares en la Comunidad Valenciana (1976–1992)

Age-adjusted cardiovascular mortality has experienced a sharp decrease in Spain and, also, in the Valencian Community since approximately the mid-seventies. The objective of the present study is to describe the evolution of mortality due to cardiovascular and cerebrovascular diseases in the Valencian Community and their provinces, during 1976-1992. The annual series of raw, specific and age-standardized mortality rates have been constructed and analyzed for the Valencian Community and provinces, from 1976 to 1992, fitting subsequently Poisson regression models to the rates. There exists a significant descendent trend of cardiovascular mortality, with an even more marked decrease for cerebrovascular disease. Mortality rates are higher in the Valencian Community than in general population of Spain. There is a rise in mortality rates with the increase of age. The female gender has a significant protective effect. Valencia and Alicante present higher risks than Castellón. Cardiovascular mortality in the Valencian Community during the period 1976-1992 decreased in all age groups, especially for cerebrovascular mortality. A greater magnitude in the masculine rates is observed. Castellón is the province associated with the lowest risk of death by cardiovascular disease.

Cardiovascular disease mortality in Belgrade: trends from 1975-89.

To determine trends in cardiovascular disease mortality. This was a descriptive study analysing mortality data. Belgrade, Yugoslavia. The population of Belgrade in the age group 30-69 years was studied (about 760,000 inhabitants). Mortality rates were standardised directly using those of the "European population" as the standard, and regression analysis was undertaken. Between 1975 and 1989 "all causes" mortality increased by 27% (95% confidence interval 18.5, 35.9) in men and by 19% (11.6, 27.1) in women. The increase in cardiovascular disease mortality was 7% (1.7, 11.5) for men and 4% (0.2, 7.8) for women. Mortality from ischaemic heart disease fell in both sexes by 32% (23.0, 41.0), but mortality from other heart diseases rose by 31% (22.0, 40.2) in men and 25% (16.2, 33.0) in women. In men the death rate for cerebrovascular disease increased by 37% (27.8, 46.8), but in women the rate fell by 0.4% (-0.8, 1.6). Mortality from the observed causes of death was higher in men than in women. Cardiovascular mortality trends in Belgrade are similar to those in most eastern European countries. If the distribution of cigarette smoking and a "rich" diet in the Belgrade population is taken into account, a considerable decline in cardiovascular mortality trends cannot be expected in the near future.

Ecological analysis of the association between mortality and major risk factors of cardiovascular disease. The World Health Organization MONICA Project.

The WHO Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) Project has been established to measure trends in cardiovascular mortality and coronary heart disease and cerebrovascular disease morbidity and to assess the extent to which these trends are related to changes in known risk factors at the same time in defined communities in different countries. This cross-sectional study is based on data from the early part of the Project and assesses the association between mortality and population risk factor levels. Thirty-five populations of men and women aged 35-64 years are used in correlation analyses between four mortality measures (deaths from all causes, cardiovascular diseases, ischaemic heart disease and stroke) and three cardiovascular risk factors (regular cigarette smoking, blood pressure and total cholesterol). In male populations all-causes mortality and stroke mortality had more than 39% of their variance explained by the three risk factors but all cardiovascular and ischaemic heart disease mortality had less than 25% of their variance explained. For female populations each mortality measure except ischaemic heart disease mortality had more than 33% of their variances accounted for by the three risk factors. For both the male and female populations each of the mortality measures shows strong associations with high blood pressure but the associations with smoking and high cholesterol are generally weaker and much less consistent. This analysis has shown that accepted cardiovascular mortality risk factors measured cross-sectionally at the population level do not reflect well the variation in mortality between populations.

The role of stroke attack rate and case fatality in the decline of stroke mortality The Minnesota heart survey

The Minnesota Heart Survey is a population-based study designed to monitor and explain trends in cardiovascular mortality, morbidity, and risk factors in the Minneapolis-St. Paul (Twin Cities) metropolitan area. Trends in stroke mortality were examined from 1960 to 1991; stroke morbidity trends were examined in 50% samples of patients discharged with an acute stroke diagnosis in 1970, 1980, and 1985. Stroke mortality in Twin Cities residents aged 30 to 74 years declined by more than 70% from 1960 to 1991 in both men and women. The decline occurred at a rate of 2.5% per year until 1972, accelerated between 1972 and 1984 (7.9% per year), and slowed considerably thereafter (1.8% per year). Hospitalized acute-stroke discharge rates among those aged 30 to 74 years declined substantially between 1970 and 1985 in both sexes (P < 0.01), but there was no change in definite stroke rates defined by standardized clinical criteria. Both short-term (28 days) and long-term (5 years) survival of definite-stroke patients improved significantly between 1970 and 1985. These improvements, however, were not found in the entire samples of unverified acute-stroke discharges. The proportion of hospitalized acute-stroke patients who had computed tomography performed increased from 0% in 1970 to 75% in 1985. There were also improvements in hospital records pertaining to the documentation of stroke symptoms and signs. These data indicate that the impressive declines in stroke mortality observed in the 1970s and early 1980s have slowed dramatically in the latter half of the 1980s. The decline in stroke mortality likely reflects both a decline in attack rate and improved survival after stroke.(ABSTRACT TRUNCATED AT 250 WORDS)

Trends in Mortality, Morbidity, and Risk Factor Levels for Stroke From 1960 Through 1990

The Minnesota Heart Survey is a population-based study designed to monitor and explain trends in cardiovascular mortality, morbidity, and risk factors. Surveillance time-trends study. The following trends were examined among men and women aged 25 to 74 years living in Minneapolis-St Paul, Minn: (1) stroke mortality from 1960 through 1990; (2) risk factors in population-based surveys conducted in 1973 through 1974, 1980 through 1982, and 1985 through 1987; and (3) morbidity in a 50% sample of hospitalized discharges for acute-stroke in 1970, 1980, and 1985. Stroke mortality in Minneapolis-St Paul declined slowly from 1960 through 1972 (average fall, 2.4% per year), dropped sharply from 1972 through 1984 (average fall, 6.5% per year), but exhibited little change thereafter (average fall, 1.5% per year). The average level of cardiovascular disease risk factors fell from 1973-1974 to 1985-1987, with the exception of body mass index. In particular, hypertension diagnosis, treatment, and control levels improved substantially between 1973-1974 and 1980-1982, although there was little improvement after 1980-1982. While discharge rates for hospital-coded acute stroke declined substantially between 1970 and 1985 in both sexes, no clear trend was observed in definite stroke rates as validated using standard clinical criteria. Twenty-eight-day case fatality rates of definite stroke improved significantly from 1970 to 1985. The substantial decline in stroke mortality of more than 50% from 1960 through 1990 appears to have been attributable to both primary and secondary prevention. These data suggest that the long decline in stroke mortality and morbidity in Minneapolis-St Paul has plateaued, although improved detection of stroke with computed tomography prevents an unequivocal conclusion.

Trends in survival of hospitalized myocardial infarction patients between 1970 and 1985. The Minnesota Heart Survey.

The Minnesota Heart Survey is a population-based study designed to monitor and explain trends in cardiovascular mortality, morbidity, and risk factors. As part of this effort, a 50% sample of patients hospitalized for myocardial infarction (MI) in the seven-county Twin Cities (Minneapolis and St. Paul) metropolitan area was reviewed in 1970, 1980, and 1985. Those with a validated definite MI were followed for 4-year mortality. The purpose was to determine whether the improved survival observed between 1970 and 1980 was extended to the 1980-1985 period. Crude 28-day mortality in men changed from 18% in 1970 to 12% in 1980 to 13% in 1985; in women it changed from 27% in 1970 to 22% in 1980 to 18% in 1985. After adjustment for severity factors (e.g., age, previous MI, and admission heart rate and systolic blood pressure), 28-day mortality was significantly lower in 1980 than in 1970 in men (RR, 0.66; 95% CI, 0.47, 0.92) and in women (RR, 0.69; 95% CI, 0.46, 1.04), but no change occurred from from 1980 to 1985 (p greater than 0.25). After adjustment for severity indicators, 4-year survival was better in 1980 than in 1970 for men (RR, 0.67; 95% CI, 0.54, 0.83) and for women (RR, 0.72; 95% CI, 0.54, 0.98), but there was no significant change from 1980 to 1985 (p greater than 0.25). These results suggest that improvements in survival among hospitalized MI patients contributed to the overall decline in coronary heart disease mortality in the Twin Cities area between 1970 and 1980 but not between 1980 and 1985.

Cardiovascular Risk Factors: Multiple Interventions in Man

Cardiovascular disease, especially coronary heart disease, is multifactoral. Therefore, it is reasonable to use multiple interventions to try to obtain the greatest reduction in risk. This has been attempted in several controlled clinical trials and in two community educational trials. The results have been variable, showing either benefit or a favorable trend with no statistically significance change. Although the benefit of multiple intervention has not been conclusively demonstrated, there has been a downward trend in cardiovascular mortality in many countries which parallels a downward trend in the level of cardiovascular risk, supporting the concept of benefit from multiple intervention.

WHO MONICA Project: Objectives and Design

The WHO MONICA Project is a multicentre international collaborative project coordinated by the World Health Organization. Its objective is to measure trends in cardiovascular mortality and morbidity and to assess the extent to which these trends are related to changes in risk factor levels and/or medical care, measured at the same time in defined communities in different countries. Thirty-nine collaborating centres from 26 countries of Europe, North America, and the Western Pacific collaborate in this project, using a standardized protocol and covering a population of approximately 10 million men and women aged 35-64. The WHO MONICA Project is directed by the Council of Principal Investigators and a Steering Committee, and it is managed by a Management Centre, Data Centre, Quality Control Centres (for event registration, ECG coding and lipid determinations) and Reference Centres (for optional studies). The MONICA methodology is increasingly used as a measurement tool for cardiovascular and non-communicable diseases prevention and control programmes by centres within and outside the project.

International trends in cardiovascular diseases in the elderly.

The only available statistical data on cardiovascular diseases which are relatively reliable and internationally comparable are those on mortality. Cardiovascular diseases constitute the leading cause of death in the elderly, especially in industrialized countries. In recent years, the majority of these countries have recorded a decreasing trend in cardiovascular mortality in the elderly as well as in younger people. Data on morbidity are not sufficiently standardized to allow international comparisons, and even within a country chronologically comparable statistical series rarely exist, especially population-based data. The U.S.A. and Japan, two of the countries which have maintained such data series and which have registered the most rapid mortality decline, do not show similar improvements in the morbidity level for cardiovascular diseases. Cardiovascular diseases, therefore, seem to continue to impose a great burden on society in general and on the elderly population in particular, despite some improvements in survival.

Analysing trends in cardiovascular mortality: some methodological points.

This paper comments on the drop in coronary heart disease mortality observed in Switzerland among middle-aged men since the mid-seventies. Several methodological points are made regarding the consistency of this decline (relationships with mortality from other causes), and the reasons for this drop (possible change in population mix). It is suggested that a more complete use of vital statistics is still possible and that this can provide useful clues for the assessment and the interpretation of mortality trends in the field of cardiovascular epidemiology.

Declining Autopsy Rates and Diagnosis of Myocardial Infarction-Reply

In Reply.— Dr Altman has raised an interesting question regarding the possible association between trends in cardiovascular mortality and the declining trend in autopsies, as revealed in vital statistics data. This is a subject in which we have considerable interest, as reflected in our recent publication of an annotated bibliography of cause-of-death validation studies. 1 While National Center for Health Statistics data on trends in autopsies and in cardiovascular mortality are consistent with those reported by Dr Altman, as shown in the Table, I do not believe they support his interpretation. Reductions in mortality for major cardiovascular diseases between 1972 and 1980 far exceed what could reasonably be explained by the decline in the changing rate of autopsies during this period. 2 The death rate (ageadjusted) for major cardiovascular diseases during this period dropped by almost 23%, and for all causes combined by more than 16%. An example may illustrate

Tranquilizers and Decline in Cardiovascular Mortality

To the Editor.— I wish to comment on the article Meaning of the Downward Trend in Cardiovascular Mortality (1982;247:877). The substantial decline in cardiovascular mortality since the mid-1960s is hypothesized to be due to combination of changes in diet, smoking, treatment of hypertension, and increased physical activity. The article also mentioned that a strong case can be made for influences operating in the entire population because the effect has been universal in both sexes, blacks as well as whites, and in all age groups. It appears that emotional stress as major risk factor has been overlooked. Could it be, and I consider it likely, that we owe this reversal of cardiovascular mortality and risk reduction at least partially to the introduction and widespread use of minor tranquilizers, particularly the benzodiazepines? Observations in the experimental laboratory, in the animal kingdom, and in epidemiologic surveys all attest to the validity