Changes In Cardiovascular Disease Mortality Research Articles

Trends in All-Cause, Cardiovascular, and Noncardiovascular Mortality Among US Adults With Hypertension.

Death certificate data indicate that hypertension may have increased as a contributing cause of death among US adults. Hypertension is not commonly recorded on death certificates although it contributes to a substantial proportion of cardiovascular disease (CVD) deaths. We estimated changes in all-cause, CVD, and non-CVD mortality over 5 years of follow-up among 4 cohorts of US adults with hypertension using mortality follow-up data from National Health and Nutrition Examination Survey III in 1988 to 1994, and National Health and Nutrition Examination Survey cycles from 1999 to 2000 through 2015 to 2016 (n=20 927). Hypertension was defined as systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or antihypertensive medication use. Participants were grouped according to the date of their National Health and Nutrition Examination Survey study visit (1988-1994, 1999-2004, 2005-2010, 2011-2016). There were 2646, 1048, and 1598 all-cause, CVD, and non-CVD deaths, respectively. After age, gender, and race/ethnicity adjustment and compared with the 1988 to 1994 cohort, the hazard ratio of all-cause mortality was 0.88 (95% CI, 0.76-1.01) for the 1999 to 2004 cohort, 0.82 (95% CI, 0.70-0.95) for the 2005 to 2010 cohort, and 0.89 (95% CI, 0.75-1.05) for the 2011 to 2016 cohort (P trend=0.123). The age, gender, and race/ethnicity-adjusted hazard ratios for CVD mortality compared with the 1988 to 1994 cohort were 0.74 (95% CI, 0.60-0.90) for the 1999 to 2004 cohort, 0.61 (95% CI, 0.50-0.74) for the 2005 to 2010 cohort, and 0.57 (95% CI, 0.44-0.74) for the 2011 to 2016 cohort (P trend <0.001). There was no evidence of a change in CVD mortality between the 2005 to 2010 and 2011 to 2016 cohorts (P=0.661). Noncardiovascular mortality did not decline over the study period (P trend=0.145). The decline in CVD mortality among US adults with hypertension stalled after 2005 to 2010.

Age-Period-Cohort Analysis of Cardiovascular Mortality Attributable to Environmental Risks in China

This study aimed to analyze changes in cardiovascular disease (CVD) mortality attributable to major environmental risks in China during 1990-2019, and their associations with age, period, and birth cohort. Mortality data were obtained from the Global Burden of Disease Study 2019. Major environmental risks included ambient particulate matter pollution (APMP), household air pollution from solid fuels (HAP), low temperature, high temperature, and lead exposure. Age-period-cohort modeling was used to estimate the overall annual percentage change in CVD mortality (net drift), annual percentage change for each age group (local drift), expected longitudinal age-specific rate (longitudinal age curve), period and cohort relative risks (RRs, period/cohort effects) between 1990 and 2019. Analyses were conducted in 2021-2022. In China, five major environmental risks led to 1.62 million CVD deaths in 2019. Among these risks, the primary contributor to CVD mortality transited from HAP in 1990 to APMP in 2019. There was also an improvement in attributable CVD mortality rates for low temperature and lead exposure during 1990-2019, while an unfavorable trend was noted for high temperature. The longitudinal age curve demonstrated increased attributable CVD mortality rates with age groups for all environmental risks, with similar patterns for both sexes. Period and cohort RRs suggested generally improved risks of attributable CVD mortality for HAP, low temperature, and lead exposure, but worsening risks for APMP and high temperature in both genders, except for period risks after 2010-2014 for APMP in both sexes, period risks after 2000-2004 for high temperature in females, and cohort risks in cohorts born after 1955 for APMP and high temperature in females. Over the study period, there was a significant improvement in attributable CVD mortality rates in China for HAP, low temperature and lead exposure, but an unfavorable trend was noted for APMP and high temperature.

Mortality from cardiovascular diseases and life expectancy in Russia

High premature mortality from cardiovascular disease (CVD) and its long-term negative trends are one of the main reasons for Russia's lag behind the developed countries in life expectancy, especially of its female population. Despite the decline in mortality since 2003, CVD mortality rates at particular ages (30-74 years for males and 30-49 for females) are still higher than in 1970.&#x0D; Decomposition of long-term changes in life expectancy in Russia shows a negative contribution of changes in CVD mortality for men (-1.0 years in 1972-2010) and a small positive contribution for women (+0.7 years from 1972 to 2010).&#x0D; The mortality structure within the full class of cardiovascular diseases in Russia is significantly different from that observed in the countries with the lowest level of CVD mortality. Ischemic heart disease constitutes more than half of all deaths, and this share, in contrast to Western countries, is tending to rise. Second place belongs to deaths from cerebrovascular diseases, the share of which is declining, but remains significantly higher than in Western countries. The share of deaths from other cardiovascular diseases accounts for about 50% of all CVD mortality in Western countries, while in Russia it is only about 15%, but these are characterized by a very low age at death.&#x0D; Regional patterns of CVD mortality in Russia are discussed, as well as the quality of statistics on causes of death and changes in the coding practices in the Russian Federation.

Abstract 25: The Impact of Excess Body Weight on Cardiovascular Disease Mortality From 1990 to 2015 and Drivers of Change at the State-Level in the United States

Introduction: Maintaining a healthy weight is a key step toward ideal cardiovascular health and achieving AHA 2020 goals. State-level estimates of excess body weight and its impact on cardiovascular disease (CVD) mortality are necessary to inform interventions and track progress. Objective: To systematically quantify CVD deaths attributable to high body mass index (BMI) by age, sex, and state between 1990 and 2015. Methods: We synthesized 118 surveys (12,972,378 person-years) to characterize the population distribution of BMI by age, sex, and state from 1990-2015. We used a hierarchical mixed-effects linear regression to quantify and adjust for bias in self-reported height and weight data. Using the Global Burden of Disease analytic framework, we estimated CVD deaths attributable to high BMI in five-year increments from 1990 to 2015. We also quantified the contribution of changes in population structure, background mortality rate, and risk exposure to overall changes in CVD mortality. Results: In 2015, 173,180 (95% uncertainty interval: 130,890-218,620) CVD deaths were attributable to high BMI in the US: 70.4% from ischemic heart disease, 11.6% from hypertensive heart disease, 9.7% from hemorrhagic stroke and 8.2% from ischemic stroke. Mississippi had the highest attributable death rate (65.6 per 100,000 [51.6-80.3]), whereas Colorado had the lowest (23.4 [17.1-30.6]) (Figure). While the prevalence of excess body weight increased in all states from 1990-2015, reductions in background mortality rate offset increases in risk exposure (Figure). As a result, over the past 25 years the death rate attributable to high BMI increased in only 3 states (annual percent change: OK [0.53%], AL [0.17%], AK [0.08%]). The 3 states with the greatest annual decrease in attributable death rate were MN (-1.52%), NH (-1.47%), and MA (-1.45%). Conclusions: Our results highlight the need for implementation of evidence-based interventions at the state-level to reduce the prevalence and disease burden of high BMI in order to meet AHA 2020 goals.

Cardiovascular Disease in Central and East Europe

Cardiovascular disease (CVD) contributes greatly to inequalities in health in Europe. The CVD death rate in Ukraine (the highest) is seven fold higher than in France (the lowest). There is also a striking difference in CVD mortality between European Union (EU) members before the enlargement in 2004 and Central and East European (CEE) countries that joined the EU in 2004 and non-EU countries. The difference in CVD mortality between West and East Europe grew during the 1970s and 1980s when rates declined in the West and either remained the same or rose in the CEE countries. Political reforms at the beginning of the 1990s, which were followed by great socio-economic changes coincided with further diversification in CVD mortality in CEE countries. Diverse trends in CVD mortality were followed by larger gaps in life expectancy between West and East Europe and within the CEE. Rapid development of high technology treatment procedures, which followed the economic recovery of the CEE countries, would have only limited influence on the overall control of CVD. Exposure to classic risk factors might largely explain the longitudinal trend in falling CVD mortality in some countries, but it is unlikely that it could explain rapid changes in the others. Still, large potential to control the disease lies in developing effective preventive policies with targets to lower exposure to the classic CVD risk factors. The recent history of CVD in CEE countries makes the “alcohol hypothesis” less convincing as an explanation for CVD mortality trends and differences between East and West Europe. The hypothesis that dynamic changes in CVD mortality in CEE countries are triggered and explained largely by psychosocial factors is attractive. However, if confirmed, transforming such knowledge into a practical health policy would be a great challenge.

Can dietary changes rapidly decrease cardiovascular mortality rates?

The UK National Institute for Health and Clinical Excellence (NICE) recently published guidance on the prevention of cardiovascular disease (CVD) in whole populations.1 The lukewarm government response demonstrated a surprising ignorance of the scale and rapidity of the potential benefits. Most heart attacks and ischaemic strokes are caused by complicated atheroma, usually compounded by thrombosis suddenly reducing blood flow in a critical artery. Extensive evidence suggests that this atheroma silently builds up over decades. Thus, early atheroma streaks were seen in classical autopsy studies on Korean war casualties and teenage traffic fatalities.2 Hence, the emerging paradigm describing the temporal relationship between risk factor change and the corresponding change in CVD mortality. The time scales for this paradigm are generally perceived in terms of decades. Thus, Rose thought the ‘incubation period’ was a decade or more,3 whereas Law et al .4 proposed a three-decade lag time to explain the paradoxically low French CVD rates. Reversing the CVD process following reductions in major cardiovascular risk factors has therefore also been assumed to require decades. However, this is wrong. ### Evidence from clinical trials Evidence in individuals and in populations actually suggests that decreases in fatal and non-fatal CVD events can rapidly follow reductions in risk. Thus, individual patients in therapeutic randomized trials often demonstrate mortality reductions within 1 or 2 years of blood pressure or cholesterol lowering.5 Trials in diet and lifestyle interventions also demonstrate rapid and substantial changes in multiple risk factors, notably DASH, DASH-Sodium, OMNI-Heart, and PREMIER. Even more importantly, several randomized controlled trials showed that diet interventions could have relatively rapid effects on CVD outcomes.6 The rapid reduction in diabetes incidence achieved with lifestyle interventions is also relevant, meaning subsequent reductions in costly diabetic care, as well …

Potential to promote healthy eating in Baltic workplaces

PurposeThe purpose of this paper is to define the potential to promote healthy nutrition in workplaces in the Baltic States and to provide the strategic structure for health promotion at national level.Design/methodology/approachA survey, using the telephone questionnaire method, was conducted among the adult population in the three Baltic countries in 2007, to compare the general eating habits of the residents in those states. The sample for the survey was random, with 500 (or slightly more) consumers between the ages of 15 and 74 in all three countries surveyed.FindingsThe survey showed that eating habits in Estonia differ from other Baltic countries. Estonians are the most urban consumers, who eat their lunch outside of the home; they use a broader selection of ready‐to‐eat meals than Latvians and Lithuanians. The lunch choice made by Estonians is therefore more influenced by what is offered in their workplaces. Estonian National Strategy for the prevention of cardiovascular disease (CVD) and Estonian health are the main national public health policy documents. The development of the Network for Workplace Health Promotion is one of the actions carried out within above‐mentioned strategies, as are county‐based health councils, responsible for management and coordination of implementation of the strategies at local level, including cooperation with local workplaces.Originality/valueThe paper presents useful, practical examples of where changes in the composition of food in catering have improved not only workers' eating habits, but also their satisfaction and commitment to work. There have been positive changes in CVD mortality in Estonia. Still, the mortality rate in Baltic countries is considerably higher compared to the other EU countries and this calls for the direction of the health promotion activities in workplaces in other Baltic States also.

Racial Misclassification and Disparities in Cardiovascular Disease Among American Indians and Alaska Natives

National vital event data suggest that cardiovascular disease (CVD) mortality rates are lower for American Indians and Alaska Natives (AIAN) than for the general US population, but these data are disproportionately flawed for AIAN because of racial misclassification. Vital event data adjusted for racial misclassification and published by the Indian Health Service were used to compare trends in CVD mortality from 1989 to 1991 to 1996 to 1998 between AIAN, US all-races, and US white populations. Without misclassification accounted for, AIAN initially had the lowest mortality rates from major CVD, but by the end of the study, their rates were the highest. Adjustment for misclassification revealed an early and rapidly growing disparity between CVD mortality rates among AIAN compared with rates in the US all-races and white populations. By 1996 to 1998, the age- and misclassification-adjusted number of CVD deaths per 100,000 among AIAN was 195.9 compared with age-adjusted rates of 166.1 and 159.1 for US all races and whites, respectively. The annual percent change in CVD mortality for AIAN was 0.5 compared with -1.8 in the other groups. Regardless of racial misclassification, the most striking and widening disparities were found for middle-aged AIAN, but CVD mortality among AIAN > or =65 years of age was lower than in the other populations. A previously underrecognized disparity in CVD mortality exists for AIAN, particularly among middle-aged adults. Moreover, these disparities are increasing. Efforts to reduce CVD mortality in AIAN must begin before the onset of middle age.

Widening socioeconomic inequalities in mortality in six Western European countries.

During the past decades a widening of the relative gap in death rates between upper and lower socioeconomic groups has been reported for several European countries. Although differential mortality decline for cardiovascular diseases has been suggested as an important contributory factor, it is not known what its quantitative contribution was, and to what extent other causes of death have contributed to the widening gap in total mortality. We collected data on mortality by educational level and occupational class among men and women from national longitudinal studies in Finland, Sweden, Norway, Denmark, England/Wales, and Italy (Turin), and analysed age-standardized death rates in two recent time periods (1981-1985 and 1991-1995), both total mortality and by cause of death. For simplicity, we report on inequalities in mortality between two broad socioeconomic groups (high and low educational level, non-manual and manual occupations). Relative inequalities in total mortality have increased in all six countries, but absolute differences in total mortality were fairly stable, with the exception of Finland where an increase occurred. In most countries, mortality from cardiovascular diseases declined proportionally faster in the upper socioeconomic groups. The exception is Italy (Turin) where the reverse occurred. In all countries with the exception of Italy (Turin), changes in cardiovascular disease mortality contributed about half of the widening relative gap for total mortality. Other causes also made important contributions to the widening gap in total mortality. For these causes, widening inequalities were sometimes due to increasing mortality rates in the lower socioeconomic groups. We found rising rates of mortality from lung cancer, breast cancer, respiratory disease, gastrointestinal disease, and injuries among men and/or women in lower socioeconomic groups in several countries. Reducing socioeconomic inequalities in mortality in Western Europe critically depends upon speeding up mortality declines from cardiovascular diseases in lower socioeconomic groups, and countering mortality increases from several other causes of death in lower socioeconomic groups.

Changes in nutrition, cholesterol concentration, and cardiovascular disease mortality in the czech population in the past decade

Changes in nutrition, cholesterol concentration, and cardiovascular disease mortality in the czech population in the past decade

The risk-map of Europe. WHO ERICA Research Group.

In Europe around 1970 there were only a few small and often poorly known epidemiological studies on risk factors and the incidence of coronary heart disease. In order to enhance the utilization of the information contained in them, the Medical Clinic in Heidelberg offered uniform data analysis to qualifying contributing centres. Thirty-five studies from 17 countries joined this WHO project covering a total sample of 151,923 men and women. The first objective was to draw up a risk distribution map of Europe that would help to understand changes in cardiovascular disease mortality. In this first report the geographical distribution of the four main risk factors--blood pressure, cholesterol, smoking, and weight--is presented together with an overall risk estimate. The well known north-west--east-south decrement in coronary heart disease mortality is clearly supported by this analysis. The second publication will deal with multivariate risk prediction calculated from European data.

Mortality related to cardiovascular disease and diabetes mellitus in a modernizing population

Excessive adiposity is associated with elevated rates of middle-aged mortality, particularly that related to cardiovascular disease (CVD) and diabetes mellitus (DM). One purpose of this study was to determine whether the population of American Samoa demonstrated the expected elevation of mortality rates related to these two causes. Accordingly for all American Samoan death records ( N = 1588) during the period 1962–74, both crude and age-standardized rates were calculated and interpopulation comparisons of DM and CVD were made. The second purpose of this research was to determine if elevated CVD mortality was associated with the islands' recent trend toward modernization. For this purpose 902 deaths of persons aged 30 or more were analyzed to determine change in CVD mortality over time and differences by degree of participation in modern life. The CVD-related mortality rate for Samoa was 82.1 per 100,000, compared to 368.6 reported for the United States in 1962. After age standardization the Samoan rate increased to 242.5, still below that of the United States. The Samoan DM-related mortality rate was 13.9 per 100,000, compared to a United States rate of 15.9 in 1959. After age adjustment, the respective rates were 32.2 and 13.4 (1957–59), the Samoan rate being more than double that the United States. Female CVD mortality in Samoa increased from 196.2 in the period 1963–66 to 363.0 in 1971–74, while male rates remained essentially unchanged (417.3 and 429.0 respectively). CVD mortality among males living in more modernized areas of the islands was 46.5% higher than that for male residents of more traditional areas (343.5 and 234.5 respectively); among females, however, the rate was highest for those living in traditional areas (398.7). CVD mortality for males classified to the ‘sedentary’ occupational category was 50% greater than that for males in the ‘active’.