Trends In Coronary Heart Disease Research Articles

Historic and recent trends in county-level coronary heart disease death rates by race, gender, and age group, United States, 1979-2017.

Given recent slowing of declines in national all-cause, heart disease, and stroke mortality, examining spatiotemporal distributions of coronary heart disease (CHD) death rates and trends can provide data critical to improving the cardiovascular health of populations. This paper documents county-level CHD death rates and trends by age group, race, and gender from 1979 through 2017. Using data from the National Vital Statistics System and a Bayesian multivariate space-time conditional autoregressive model, we estimated county-level age-standardized annual CHD death rates for 1979 through 2017 by age group (35-64 years, 65 years and older), race (white, black, other), and gender (men, women). We then estimated county-level total percent change in CHD death rates during four intervals (1979-1990, 1990-2000, 2000-2010, 2010-2017) using log-linear regression models. For all intervals, national CHD death rates declined for all groups. Prior to 2010, although most counties across age, race, and gender experienced declines, pockets of increasing CHD death rates were observed in the Mississippi Delta, Oklahoma, East Texas, and New Mexico across age groups and gender, and were more prominent among non-white populations than whites. Since 2010, across age, race, and gender, county-level declines in CHD death rates have slowed, with a marked increase in the percent of counties with increasing CHD death rates (e.g. 4.4% and 19.9% for ages 35 and older during 1979-1990 and 2010-2017, respectively). Recent increases were especially prevalent and geographically widespread among ages 35-64 years, with 40.5% of counties (95% CI: 38.4, 43.1) experiencing increases. Spatiotemporal differences in these long term, county-level results can inform responses by the public health community, medical providers, researchers, and communities to address troubling recent trends.

Coronary heart disease mortality is decreasing in Argentina, and Colombia, but keeps increasing in Mexico: a time trend study

BackgroundMortality rates due to coronary heart disease (CHD) have decreased in most countries, but increased in low and middle-income countries. Few studies have analyzed the trends of coronary heart disease mortality in Latin America, specifically the trends in young-adults and the effect of correcting these comparisons for nonspecific causes of death (garbage codes). The objective of this study was to describe and compare standardized, age-specific, and garbage-code corrected mortality trends for coronary heart disease from 1985 to 2015 in Argentina, Colombia, and Mexico.MethodsDeaths from coronary heart disease were grouped by country, year of registration, sex, and 10-year age bands to calculate age-adjusted and age and sex-specific rates for adults aged ≥25. We corrected for garbage-codes using the methodology proposed by the Global Burden of Disease. Finally, we fitted Joinpoint regression models.ResultsIn 1985, age-standardized mortality rates per 100,000 population were 136.6 in Argentina, 160.6 in Colombia, and 87.51 in Mexico; by 2015 rates decreased 51% in Argentina and 6.5% in Colombia, yet increased by 61% in Mexico, where an upward trend in mortality was observed in young adults. Garbage-code corrections produced increases in mortality rates, particularly in Argentina with approximately 80 additional deaths per 100,000, 14 in Colombia and 13 in Mexico.ConclusionsLatin American countries are at different stages of the cardiovascular disease epidemic. Garbage code correction produce large changes in the mortality rates in Argentina, yet smaller in Mexico and Colombia, suggesting garbage code corrections may be needed for specific countries. While coronary heart disease (CHD) mortality is falling in Argentina, modest falls in Colombia and substantial increases in Mexico highlight the need for the region to propose and implement population-wide prevention policies.

Trends in coronary heart disease in France from 2006 to 2014: Results from the MONICA registers

In the past decades, decreasing trends in coronary heart disease (CHD) morbidity and mortality rates have been observed in all of the western world, including France. We aimed to assess whether gender- and age-specific trends were still favourable between 2006 and 2014 in France. We analysed data from the three geographical areas covered by the French MONICA population registers (inhabitants aged 35–74 years from the Urban Community of Lille in the north of France, the district of Bas-Rhin in the north-east and the district of Haute Garonne in the south-west. Registered events were all hospitalised/non-hospitalised fatal/non-fatal acute coronary events. Log-linear Poisson regression models were used to analyse trends. There was still a decrease in standardized event rates of CHD from 2006 to 2014 in the 35–74 age-group (annual decrease of 1.6% in average in men ( P = 0.0003) and of 1.8% in women ( P = 0.003)). This decrease was significant in women only in the 65–74 age-group (-3.9%, P = 0.0005) and in men in the 55–64 and 65–74 age-groups (-0.8%, P = 0.002 and -2.2%, P = 0.006, respectively). No significant decrease could be observed in the younger individuals. Standardized mortality rates followed the same pattern. A clear decline in CHD event rates and CHD mortality rates was observed between 2006 and 2014, especially among subjects above 54 years, but not in younger subjects, particularly in women. Primary and secondary prevention still need to be strengthened, in particular in the youngest.

Abstract P115: Better Methodologies to Compare Coronary Heart Disease Mortality Trends in Latin American Countries: Argentina, Colombia and Mexico From 1985 to 2012

Introduction: Coronary heart disease (CHD) is the leading cause of death worldwide. CHD mortality rates have decreased in most high-income countries, but increased in some Latin-American countries. CHD mortality rates have plateaued among young adults (<55 years) in the US, UK and Australia, but trends in Latin-America are largely unknown. Few studies have analyzed trends in age and sex-specific CHD mortality rates in this region, and almost none has assured data quality by correcting for garbage codes (ICD codes for nonspecific causes of death) as recommended by WHO. Objective: To describe and compare standardized, age-specific and garbage-code corrected mortality trends for coronary heart disease (CHD) from 1985 to 2012 in three contrasting Latin American countries. Methods: CHD deaths (1985-2012) in Argentina, Colombia and Mexico were grouped by calendar year, sex and 10-year age bands to calculate the overall age-adjusted and age and sex specific mortality rates for adults aged ≥25 years. We corrected for garbage-codes for the three countries (1997-2012) using the Global Burden of Disease (GBD) methodology. We then fitted Joinpoint regression models, using the original and garbage code corrected rates, to estimate the annual percent change (APC) and detect points in time when significant changes in the trends occurred. Results: In 2012, age-standardised mortality rates per 100,000 were 65.3 in Argentina, 132.4 in Colombia and 130.3 in Mexico. Compared to 1985, by 2012 mortality fell by 17.5% in Colombia and 52.5% in Argentina. The largest annual decreases in mortality rates were observed in Argentina from 1988-1994 (APC=-5.7 p-value<0.01). The declines in Colombia were constant and smaller for the full period (APC=-0.4 p-value<0.01). CHD mortality rose by 48.9% in Mexico, particularly after 2000. Mortality rates increased in both men and women, particularly in younger men (<39 years) and older women (>60 years). Application of the garbage code corrections produced dramatic increases in mortality rates, more in women than men, and particularly in Argentina: approximately 80 additional deaths per 100,000 (compared with just 14 additional deaths per 10 5 in Colombia and 13 per 10 5 in Mexico). Conclusions: Different Latin American countries demonstrate dramatically different CHD epidemiology. Mortality rates increased after correcting for garbage code misclassification. Although CHD mortality is falling in Argentina, the modest falls in Colombia and substantial rises in Mexico highlight the region’s urgent need for effective, population-wide prevention policies.

Comparison of Trends in Mortality from Coronary Heart and Cerebrovascular Diseases in North and South America: 1980 to 2013

Until the past century, mortality trends from coronary heart disease (CHD) and cerebrovascular disease (CVD) were less favorable in Latin than in North America. We calculated age-standardized mortality rates using data from the World Health Organization database over the period 1980 to 2013. To identify significant changes in trends, we performed joinpoint analysis. Since the early 2000's, CHD mortality rates decreased by about 35% in the USA and Canada in both genders; similar decreases were observed in some Latin American countries (i.e., Ecuador, Puerto Rico, and Chile), whereas the decreases were smaller in the other countries. In 2011 to 2013, the highest rates were in Venezuela (114.4/100,000 men) and Colombia (86.1/100,000 men) and the lowest ones (apart from Ecuador) in Panama, Chile, and Argentina (from 41 to 46/100,000 men and 18 to 19/100,000 women). For CVD mortality, a decrease by about 30% was observed in Argentina, Panama, and Uruguay plus Colombia for women, in addition to the USA and Canada. Smaller declines were observed in the other Latin American countries (from 23% in Colombian men to 5% in Venezuelan men). Throughout the period, rates in Latin America remained appreciably higher than those in North America. The highest CVD rates were observed in Brazil (51.6/100,000 men) and the lowest ones in Canada (12.9/100,000 women). In conclusion, trends in CHD and CVD mortality continue to be less favorable in Latin America than in Canada and the USA. The marked excess of CVD mortality is partly or largely attributable to inadequate control of dyslipidemia and hypertension.

Microsimulation Modeling of Coronary Heart Disease: Maximizing the Impact of Nonprofit Hospital-Based Interventions.

We use microsimulation to forecast changes in coronary heart disease (CHD) among adults 45 or above over a 20-year time horizon in Los Angeles County (N = 3.4 million), a county with 12 635 CHD deaths in 2010. We simulate individuals’ life course and calibrate CHD trends to observed trends in the past. Using the Health Forecasting Community Health Simulation Model, we simulate CHD prevalence and CHD mortality in 2 CHD prevention scenarios: (1) “comprehensive hypertension intervention” and (2) “gradual reduction of the average adult body mass index back to the year 2000 level.” We use microsimulation methodology so that nonprofit hospitals can easily use our model to forecast intervention results in their specific hospital catchment area. Our baseline model (without intervention) forecasts an increase in CHD prevalence that will reach 13.01% among those 45+ in Los Angeles County in 2030. Under scenario 1, the increase in CHD prevalence is slower (12.47% in 2030), and the prevalence in scenario 2 reaches 12.83% in 2030. The baseline scenario projects a number of 21 300 CHD deaths in 2030, whereas there will be 20 070 CHD deaths under scenario 1 and 20 970 CHD deaths under scenario 2. At the population level, the CHD mortality outcome, as compared with the metric of CHD prevalence, might be more sensitive to preventive lifestyle interventions. Both CHD prevalence and CHD mortality might be more sensitive to the hypertension intervention than to the obesity reduction in the time horizon of 20 years.

Fall in population-based mortality from coronary heart disease negated in people with diabetes mellitus: data from England.

Mortality rates for coronary heart disease (CHD) have declined substantially in developed countries. Diabetes mellitus is an important risk factor for CHD; its prevalence is increasing. We aimed to compare trends in population-based mortality for CHD without diabetes on the death certificate with trends for CHD with diabetes on the same certificate. Analysis of an all-England dataset with multiple-cause coded mortality records from 1995 to 2010. Analysis of a similar dataset for Oxford, because it has the longest run of multiple-cause coded mortality in England, from 1979. Age-specific and age-standardized mortality rates were calculated. In the all-England dataset, there were 1772760 deaths with CHD and no mention of diabetes; and 173184 deaths with CHD and diabetes on the same death certificate. Of deaths with CHD without a mention of diabetes, rates per million men fell by more than half from 2843 (95% confidence interval: 2822-2862) in 1995 to 1379 (1366-1391) in 2010; and those in women halved from 1324 (1314-1336) to 628 (621-635). Of deaths with CHD and diabetes, rates per million men increased from 194 (188-200) to 215 (210-220); and those for women fell, but only very slightly, from 114 (111-118) to 101 (98-104). The longer run in Oxford, from 1979, showed that rates in men and women without diabetes had fallen by two-thirds; but that rates for CHD with diabetes had not fallen. The fall in mortality from CHD without diabetes has been spectacular. There has been no comparable fall in mortality from CHD with diabetes.

Twenty-five-year trends in myocardial infarction attack and mortality rates, and case-fatality, in six European populations

ObjectiveDue to the burden of coronary heart disease (CHD), the monitoring of CHD trends is required. This study sought to examine the acute myocardial infarction (AMI) trends in attack and...

Abstract P052: Coronary Heart Disease Mortality Declines in the United States From 1980 through 2011: Evidence for Stagnation in Young Adults, Especially Women

Background: Cardiovascular mortality rates have fallen dramatically over the past four decades. However, recent unfavorable trends in coronary heart disease (CHD) risk factors among young adults (obesity, diabetes, and tobacco use) raise concerns about their subsequent impact on CHD mortality. Furthermore, recent data from the US and other countries suggest a worsening of CHD incidence and mortality among young women. We therefore examined recent trends in CHD mortality rates in the US according to age and sex. Methods: We used mortality data between 1980 and 2011 from US adults ≥ 25 years. We calculated age-specific CHD mortality rates and estimated annual percentage change (EAPC) for US adults, and compared three decades of data (1980-1989, 1990-1999, and 2000-2011). We also used Joinpoint regression modeling to assess changes in trends over time, based on inflection points of the mortality distribution. Results: Young men and women (aged<55 years) showed a robust decline in CHD mortality from 1980 until 1989 (EAPC -5.5% in men and -4.6% in women). However, the two subsequent decades saw stagnation with minimal improvement (Table). This was particularly true for young women who had no improvements between 1990 and 1999 (EAPC +0.1%), and only -1% EAPC since 2000. In contrast, older adults (65+years) showed steep annual declines since 2000, approximately doubled compared with the previous period (women, -5.0% and men, -4.4%). Jointpoint analyses provided consistent results. Conclusions: The dramatic declines in cardiovascular mortality since 1980 conceals major heterogeneities. CHD death rates in older groups are now falling steeply. However, young men and women have enjoyed small decreases in CHD mortality rates since 1990. The drivers of these major differences in CHD mortality trends by age and sex needs urgent study.

Serum cholesterol as a risk factor for coronary heart disease revisited

The biology of lipoproteins and lipoprotein particles as mediators of atherosclerosis has been documented extensively. Numerous prospective epidemiological studies have shown a robust relationship between low-density lipoprotein (LDL) cholesterol, or particles bearing apolipoprotein B, and increased risk of coronary heart disease (CHD); and between high-density lipoprotein (HDL) cholesterol or particles bearing apolipoprotein A1, and decreased risk. These relationships are present across the age spectrum and in both sexes. The causality of LDL cholesterol for CHD has been established by the clinical trials on cholesterol lowering and the Mendelian randomisation studies. However, clinical trials that focus on raising HDL cholesterol, or lowering triglycerides, have yielded mixed results, and the Mendelian randomisation studies have generally not supported causality. Research on the effects of diet on serum cholesterol led to public health guidelines, whose implementation within the last five decades was accompanied by lower population cholesterol levels and CHD burden in all of the countries studied. Over the last three decades, the favourable trends in cholesterol levels and CHD have been supported by the increasing use of statin drugs and improved treatments for myocardial infarction.

Secular changes in rates of coronary heart disease, fatal coronary heart disease, and out-of-hospital fatal coronary heart disease

Secular changes in rates of coronary heart disease, fatal coronary heart disease, and out-of-hospital fatal coronary heart disease

Decreasing trends in cardiovascular mortality in Turkey between 1988 and 2008.

BackgroundCardiovascular disease (CVD) mortality increased in developed countries until the 1970s then started to decline. Turkey is about to complete its demographic transition, which may also influence mortality trends. This study evaluated trends in coronary heart disease (CHD) and stroke mortality between 1988 and 2008.MethodsThe number of deaths by cause (ICD-8), age and sex were obtained from the Turkish Statistical Institute (TurkStat) annually between 1988 and 2008. Population statistics were based on census data (1990 and 2000) and Turkstat projections. European population standardised mortality rates for CHD and stroke were calculated for men and women over 35 years old. Joinpoint Regression was used to identify the points at which a statistically significant (p < 0.05) change of the trend occurred.ResultsThe CHD mortality rate increased by 2.9% in men and 2.0% in women annually from 1988 to 1994, then started to decline. The annual rate of decline for men was 1.7% between 1994–2008, whilst in women it was 2.8% between 1994–2000 and 6.7% between 2005–2008 (p < 0.05 for all periods).Stroke mortality declined between 1990–1994 (annual fall of 3.8% in both sexes), followed by a slight increase between 1994–2004 (0.6% in men, 1.1% in women), then a further decline until 2008 (annual reduction of 4.4% in men, 7.9% in women) (p < 0.05 for all periods).ConclusionsA decrease in CVD mortality was observed from 1995 onwards in Turkey. The causes need to be explored in detail to inform future policy priorities in noncommunicable disease control.

Comparing the decline in coronary heart disease and stroke mortality in neighbouring countries with different healthcare systems

ObjectiveTo examine age and gender specific trends in coronary heart disease (CHD) and stroke mortality in two neighbouring countries, the Republic of Ireland (ROI) and Northern Ireland (NI).DesignEpidemiological study of...

Analyzing Recent Coronary Heart Disease Mortality Trends in Tunisia between 1997 and 2009

BackgroundIn Tunisia, Cardiovascular Diseases are the leading causes of death (30%), 70% of those are coronary heart disease (CHD) deaths and population studies have demonstrated that major risk factor levels are increasing.ObjectiveTo explain recent CHD trends in Tunisia between 1997 and 2009.MethodsData Sources: Published and unpublished data were identified by extensive searches, complemented with specifically designed surveys.AnalysisData were integrated and analyzed using the previously validated IMPACT CHD policy model. Data items included: (i)number of CHD patients in specific groups (including acute coronary syndromes, congestive heart failure and chronic angina)(ii) uptake of specific medical and surgical treatments, and(iii) population trends in major cardiovascular risk factors (smoking, total cholesterol, systolic blood pressure (SBP), body mass index (BMI), diabetes and physical inactivity).ResultsCHD mortality rates increased by 11.8% for men and 23.8% for women, resulting in 680 additional CHD deaths in 2009 compared with the 1997 baseline, after adjusting for population change. Almost all (98%) of this rise was explained by risk factor increases, though men and women differed. A large rise in total cholesterol level in men (0.73 mmol/L) generated 440 additional deaths. In women, a fall (−0.43 mmol/L), apparently avoided about 95 deaths. For SBP a rise in men (4 mmHg) generated 270 additional deaths. In women, a 2 mmHg fall avoided 65 deaths. BMI and diabetes increased substantially resulting respectively in 105 and 75 additional deaths. Increased treatment uptake prevented about 450 deaths in 2009. The most important contributions came from secondary prevention following Acute Myocardial Infarction (AMI) (95 fewer deaths), initial AMI treatments (90), antihypertensive medications (80) and unstable angina (75).ConclusionsRecent trends in CHD mortality mainly reflected increases in major modifiable risk factors, notably SBP and cholesterol, BMI and diabetes. Current prevention strategies are mainly focused on treatments but should become more comprehensive.

Abstract P242: US Secular Trends in Coronary Heart Disease, Heart Attack/Myocardial Infarction, and Stroke Prevalence, by Race/Ethnicity, 2005-2010

Background: Cardiovascular disease (CVD) trends are important for the evaluation of disease burden in the context of health disparities. The US has become increasingly diverse in the last few decades, calling for a greater understanding of secular trends in coronary heart disease (CHD), heart attack (HA)/myocardial infarction (MI), and stroke, particularly among Hispanics. For this study, the main objective is to identify secular trends in CVD between 2005-2010 by race/ethnicity, with focus on Hispanic men and women, to shed light on the epidemiological phenomenon known as the Hispanic Paradox. Methods: Data from the Behavioral Risk Factor Surveillance Survey was used to assess secular trends between 2005 and 2010. Respondents of the survey were 18 years of age or older and all data was self-report. The telephone survey was conducted cross-sectionally each year. Questions included, “Ever diagnosed with angina or coronary heart disease?” “Ever diagnosed with stroke?” and “Ever diagnosed with a heart attack?”. Means, frequencies, chi-square tests, and Cochran-Armitage trend tests were performed to assess comparisons across groups and to determine statistical significance for trends. Results: Data in this study were weighted to account for over- and under-representation of ages, race, and income. There were statistically significant differences in prevalence between race/ethnicities for all years, with Hispanics having the lowest prevalence of all three conditions compared to the other races. Among Hispanics, there were statistically significant differences between genders, with men having higher prevalence of CHD/Angina, HA/MI, and stroke than women. No significant trends were found, other than between 2008 and 2010 in all races for CHD/Angina. Conclusions: Overall, there were no significant secular trends for CHD/Angina, HA/MI, or stroke among Hispanics in this study. However, the consistently low prevalence over time of CVD among Hispanics, as compared to other African Americans and Caucasians in this sample, may indicate that more attention is needed for relevant social determinants of health in this population. Furthermore, this data may help to further strengthen support for the Hispanic Paradox, though these results should be interpreted within the limitations inherent to the dataset.

Racial and geographic variation in coronary heart disease mortality trends.

BackgroundMagnitudes, geographic and racial variation in trends in coronary heart disease (CHD) mortality within the US require updating for health services and health disparities research. Therefore the aim of this study is to present data on these trends through 2007.MethodsData for CHD were analyzed using the US mortality files for 1999–2007 obtained from the US Centers for Disease Control and Prevention. Age-adjusted annual death rates were computed for non-Hispanic African Americans (AA) and European Americans (EA) aged 35–84 years. The direct method was used to standardize rates by age, using the 2000 US standard population. Joinpoint regression models were used to evaluate trends, expressed as annual percent change (APC).ResultsFor both AA men and women the magnitude in CHD mortality is higher compared to EA men and women, respectively. Between 1999 and 2007 the rate declined both in AA and in EA of both sexes in every geographic division; however, relative declines varied. For example, among men, relative average annual declines ranged from 3.2% to 4.7% in AA and from 4.4% to 5.5% in EA among geographic divisions. In women, rates declined more in later years of the decade and in women over 54 years. In 2007, age-adjusted death rate per 100,000 for CHD ranged from 93 in EA women in New England to 345 in AA men in the East North Central division. In EA, areas near the Ohio and lower Mississippi Rivers had above average rates. Disparities in trends by urbanization level were also found. For AA in the East North Central division, the APC was similar in large central metro (−4.2), large fringe metro (−4.3), medium metro urbanization strata (−4.4), and small metro (−3.9). APC was somewhat higher in the micropolitan/non-metro (−5.3), and especially the non-core/non-metro (−6.5). For EA in the East South Central division, the APC was higher in large central metro (−5.3), large fringe metro (−4.3) and medium metro urbanization strata (−5.1) than in small metro (−3.8), micropolitan/non-metro (−4.0), and non-core/non-metro (−3.3) urbanization strata.ConclusionsBetween 1999 and 2007, the level and rate of decline in CHD mortality displayed persistent disparities. Declines were greater in EA than AA racial groups. Rates were greater in the Ohio and Mississippi River than other geographic regions.

Twenty-Two–Year Trends in Incidence of Myocardial Infarction, Coronary Heart Disease Mortality, and Case Fatality in 4 US Communities, 1987–2008

Knowledge of trends in the incidence of and survival after myocardial infarction (MI) in a community setting is important to understanding trends in coronary heart disease (CHD) mortality rates. We estimated race- and gender-specific trends in the incidence of hospitalized MI, case fatality, and CHD mortality from community-wide surveillance and validation of hospital discharges and of in- and out-of-hospital deaths among 35- to 74-year-old residents of 4 communities in the Atherosclerosis Risk in Communities (ARIC) Study. Biomarker adjustment accounted for change from reliance on cardiac enzymes to widespread use of troponin measurements over time. During 1987-2008, a total of 30 985 fatal or nonfatal hospitalized acute MI events occurred. Rates of CHD death among persons without a history of MI fell an average 4.7%/y among men and 4.3%/y among women. Rates of both in- and out-of-hospital CHD death declined significantly throughout the period. Age- and biomarker-adjusted average annual rate of incident MI decreased 4.3% among white men, 3.8% among white women, 3.4% among black women, and 1.5% among black men. Declines in CHD mortality and MI incidence were greater in the second decade (1997-2008). Failure to account for biomarker shift would have masked declines in incidence, particularly among blacks. Age-adjusted 28-day case fatality after hospitalized MI declined 3.5%/y among white men, 3.6%/y among black men, 3.0%/y among white women, and 2.6%/y among black women. Although these findings from 4 communities may not be directly generalizable to blacks and whites in the entire United States, we observed significant declines in MI incidence, primarily as a result of downward trends in rates between 1997 and 2008.

Trends in hospitalisation rates for coronary heart disease in Beijing, 2007–2009

ObjectivesTo examine the trends in hospitalisation rates for coronary heart disease from 2007 to 2009 in Beijing.MethodsThe authors determined hospitalisation rates for coronary heart disease using data from Beijing Hospital...

Cohort Profile: The Corogene study

Coronary artery disease (CAD) risk factor profiles change over time. The death rate from coronary disease has been decreasing mainly due to changes in levels of risk factors, and improvement in CAD treatments. However, there are risk factors, whose prevalence is increasing, such as diabetes and obesity. When the risk factor profile changes, we can assume that gene profiles and epigenetics also change. This has not been studied widely. The Corogene study was designed as a large cohort to study mainly CAD, but also other related heart diseases such as heart failure and aortic valve disease. We selected the patients from the CAD point of view, and decided to include over 5000 consecutive patients assigned for coronary angiogram. In Finland, coronary angiogram is performed to practically all patients assigned for invasive heart examination. Despite technical developments in diagnostics, coronary angiogram is still the gold standard for evaluating coronaries. The purpose of this study is to follow contemporary trends in coronary heart disease, and related heart disease risk factors, genetics and epigenetics by collecting cohorts referred to heart examination. New cohorts will be collected at 5-year intervals in order to see trends in CAD, its risk factors and epigenetics.

Coronary heart disease and cerebrovascular disease mortality in young adults: recent trends in Europe

Over the last two decades, mortality from coronary heart disease (CHD) and cerebrovascular disease (CVD) declined by about 30% in the European Union (EU). We analyzed trends in CHD (X ICD codes: I20-I25) and CVD (X ICD codes: I60-I69) mortality in young adults (age 35-44 years) in the EU as a whole and in 12 selected European countries, over the period 1980-2007. Data were derived from the World Health Organization mortality database. With joinpoint regression analysis, we identified significant changes in trends and estimated average annual percent changes (AAPC). CHD mortality rates at ages 35-44 years have decreased in both sexes since the 1980s for most countries, except for Russia (130/100,000 men and 24/100,000 women, in 2005-7). The lowest rates (around 9/100,000 men, 2/100,000 women) were in France, Italy and Sweden. In men, the steepest declines in mortality were in the Czech Republic (AAPC = -6.1%), the Netherlands (-5.2%), Poland (-4.5%), and England and Wales (-4.5%). Patterns were similar in women, though with appreciably lower rates. The AAPC in the EU was -3.3% for men (rate = 16.6/100,000 in 2005-7) and -2.1% for women (rate = 3.5/100,000). For CVD, Russian rates in 2005-7 were 40/100,000 men and 16/100,000 women, 5 to 10-fold higher than in most western European countries. The steepest declines were in the Czech Republic and Italy for men, in Sweden and the Czech Republic for women. The AAPC in the EU was -2.5% in both sexes, with steeper declines after the mid-late 1990s (rates = 6.4/100,000 men and 4.3/100,000 women in 2005-7). CHD and CVD mortality steadily declined in Europe, except in Russia, whose rates were 10 to 15-fold higher than those of France, Italy or Sweden. Hungary and Poland, and also Scotland, where CHD trends were less favourable than in other western European countries, also emerge as priorities for preventive interventions.