Decline 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.

Abstract P659: Cluster Analysis of County-Level Cardiovascular Disease Mortality in the United States

Introduction: In the United States, cardiovascular disease (CVD) mortality has been declining since 1980s. However, the decline in CVD mortality is not uniform across regions and may show different trajectories that are driven by place-based social determinants of health (SDOH) such as physical and built environment, social-cultural environment, and health care system. We conducted a cluster analysis of county-level CVD mortality and SDOH indicators from 2009 to 2018. Hypothesis: We test the hypothesis that CVD mortality in US counties show different trajectories that can be grouped by clusters, and within each cluster, there are different SDOH variables that predict CVD mortality. Methods: We linked the Centers for Disease Control and Prevention's CVD mortality data with the Agency for Healthcare Research and Quality's public database on SDOH using county identifiers. CVD mortality rate was calculated as the number of deaths per 100,000 people in each county. There were 179 SDOH variables included in the model, classified into five different domains: the biological, behavioral, built and physical environment, health care system, and sociocultural environment domain. We employed a linear mixed-effects model fitted with a doubly penalized likelihood to induce sparsity for parameter estimation and effect selection. Results: We identified three clusters among a total of 3,136 counties. Overall, 1,182 counties were identified as cluster 1 that showed a consistent decline of CVD mortality over the past decade. The most important driving factor of CVD mortality in cluster 1 was population distribution - the percentage of population aged 15-17 (coefficient=7.032). Secondly, 1,116 counties were identified as cluster 2 that showed a decline between 2009 and 2012, and then a steady increase in CVD mortality after 2012. Within cluster 2, the number of mild drought months was the most predictive factor of CVD mortality (coefficient= -1.065), and the percentage of adults reporting no leisure-time physical activity was the second important predictor (coefficient= 0.646). Finally, 838 counties were identified as cluster 3 that showed a flattening trend in CVD mortality. Within cluster 3, the total number of obstetrics and gynecology, generalist, and primary care hospital residents plays the most important role (coefficient = -25.537). Each cluster has unique pattern and distinctive associations between certain SDOH variables and CVD mortality. Conclusions: In conclusion, we identified three intrinsic clusters that showed distinguishing trajectories of CVD mortality during the past decade. The SDOH indicators most predictive of CVD mortality were different within each cluster. This study suggests that place based SDOH drive substantial differences in CVD outcomes across regions.

Health improvements impact income inequality

This paper investigates whether and to what extent long-run trends in population health affected income inequality in the United States over the period 1960–2000. To isolate exogenous variation in health over time, the analysis exploits the sharp decline in cardiovascular disease mortality across states that originated from medical advances in the treatment and prevention of these diseases after 1960. The results demonstrate that health improvements contributed to rising income inequality through mechanisms related to education.

Secular trends in serum lipid profiles in young adults in Norway, 2001-19

BackgroundLower prevalence of major cardiovascular disease (CVD) risk factors, such as dyslipidemia, hypertension and smoking, can explain a substantial part of the decline in CVD mortality and incidence for the past decades in Western countries. However, some studies have indicated less favorable trends in risk factors in recent years. We have assessed time trends in lipid profiles among young adults in Norway measured between 2001 and 2019. MethodsSamples of serum lipids analyzed at one large medical laboratory in Oslo, Norway, mainly requisitioned by primary care physicians, were analyzed cross-sectionally to estimate year-to-year trends among men and women aged 18–49 years. We also assessed the lipid distributions and proportions with adverse lipid levels. ResultsIn total, more than 2,6 million blood samples, comprising more than 1 million individuals (mean age 37.7 years) from all regions of Norway were included. All measures improved among all age groups in both women and men, especially in total and non-HDL cholesterol (-0.22 and -0.25 mmol/l per decade, respectively). There were downward shifts in the population distribution of total, non-HDL-C and LDL-C. The overall prevalences of total cholesterol ≥5.0 mmol/l and non-HDL-C ≥3.9 mmol/l similarly decreased, from ∼63 to 46% and from ∼52 to 34%, respectively. More than 1/3 had elevated levels of total and/or non-HDL-C in 2019. ConclusionIn a large proportion of the Norwegian population aged 18–49 years old, the lipid profiles improved during the last two decades. As the use of lipid-lowering medications is low in this age group, this likely reflects favorable secular trends.

Time Trends of Epidemiology of Hemorrhagic Stroke among Urban Population in Kazakhstan

AIM: Central Asia has been known among the highest hemorrhagic stroke (HS) and subarachnoid hemorrhage (SAH) burden regions globally. Despite the decline in cardiovascular disease mortality (CVD), HS and SAH have been remaining a public health concern in Kazakhstan. This study aimed to evaluate the trends of HS and SAH among the urban population in Kazakhstan.&#x0D; METHODS: We studied HS and SAH cases aged 18 years and older between 2013 and 2017 hospitalized to stroke centers in Almaty (Kazakhstan). HS and SAH were confirmed by neuroimaging. We calculated age-standardized event, mortality and in-hospital case-fatality rates (per 100,000 populations) with 95% CIs for each individual year and over the five years using SAS University Edition and Joinpoint Regression Program.&#x0D; RESULTS: Out of 2759 HS and 413 SAH cases admitted into the stroke centers of Almaty (Kazakhstan), 27.4% cases died in a hospital. The age-standardized HS event rates decreased in both sexes over the five years while age-standardized SAH event rates increased for the same period of time. The age-standardized mortality and case-fatality rates decreased in women among HS and SAH cases and men with HS. However, the age-standardized mortality and case-fatality SAH rates increased in men over same period.&#x0D; CONCLUSIONS: Despite the overall decline in HS and slight increase in SAH over the 5 years, the burden remains high. We need to further monitor HS and SAH trends to develop targeted interventions and ensure that the preventive strategies are reducing the burden.&#x0D;

Second Primary Malignancies and Cardiovascular Mortality in Hodgkin disease Survivors — a Surveillance, Epidemiology, and End Results Registry Database Study

BackgroundOver the last few decades there has been significant improvements in survival in patients with Hodgkin disease (HD). But long-term HD survivors, especially those treated with radiation therapy (RT) have an increased risk of second primary malignancy and cardiovascular disease (CVD) related mortality. In this context, we conducted this population based study to analyze trends in CVD related mortality and incidence of lung and thyroid cancer in HD survivors treated with RT.Materials and methodsWe used the Surveillance, Epidemiology, and End Results 9 database to calculate the Standardized Incidence Ratio (SIR) and Excess Absolute Risk (EAR) of lung and thyroid cancer as second primary malignancies in survivors of HD diagnosed between 1973 and 2011, and who were treated with RT. Poisson regression models were used to calculate adjusted incidence of lung and thyroid cancer. We further divided the patients diagnosed with HD during this period into two groups based on if or not they received RT and calculated the mortality due to CVD for each group, by year of diagnosis. Poisson regression models were used to calculate adjusted CVD mortality by year of HD diagnosis for each group. In all three cases, trends in incidence or mortality were evaluated by calculating the Estimated Annual Percentage Change (EAPC) from the regression coefficient for year of diagnosis.ResultsWe identified 11,916 HD cases that received RT from the SEER database, who were followed up for a median duration of 160 months (range - 12 to 480 months). Table 1 provides characteristics of the study population. 319 patients developed lung cancer (SIR of 3.72, 95% CI 3.32 - 4.15; EAR of 13.19 per 10,000 person years at risk) and 86 patients developed thyroid cancer (SIR of 3.67, 95% CI 2.94 - 4.53; EAR of 3.54 per 10,000 person years at risk). Median ages at diagnosis of secondary lung and thyroid cancers were 59 years and 42 years respectively, with median latency periods of 16 years and 17 years respectively. 965 patients among 11,916 patients who received RT died from CVD while the number of CVD deaths was 1,182 among the 12,507 patients who were not administered RT.Using Poisson regression models, we calculated the adjusted incidence of secondary lung cancer and thyroid cancer and the adjusted mortality from CVD, by year of diagnosis. Year of diagnosis, age at diagnosis of HD and latency (time since diagnosis of HD) were the independent variables used in the regression model. Between 1973 and 2011, the adjusted incidence of lung cancer declined at an EAPC of -2.68 (95% CI -13.06 to -3.92) and that of thyroid cancer declined at an EAPC of -3.35 (95% CI -5.73 to -1.00) (Figure 1). Over the same period, CVD mortality per 10,000 person years at risk for patients who received RT declined at an EAPC of -4.34 (95% CI -4.97 to -3.73) and that of patients who did not receive RT declined at an EAPC of -1.92 (95% CI -2.47 to -1.39) (Figure 2).ConclusionWe observed a decline in incidence of lung and thyroid malignancies and CVD mortality in HD survivors over the study period. The decline in CVD mortality over time in patients who received RT was steeper compared to that of patients who did not receive RT. Though our study was limited by the lack of details regarding RT, chemotherapy and comorbidities, these findings are most likely a reflection of recent trends in use of reduced doses and field of RT. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Recent trends in cardiovascular disease deaths: a state specific perspective

BackgroundThe rate of decline in cardiovascular disease (CVD) mortality has lessened nationally. How these findings apply to specific states or causes of CVD deaths is not known. Examining these trends at the state level is important to plan local interventions.MethodsWe analyzed CVD mortality trends in Minnesota (MN) using the U.S. Centers for Disease Control and Prevention (CDC) Wide-ranging ONline Data for Epidemiologic Research (WONDER). Trends were analyzed by age, sex, type of CVD and location of death.ResultsCVD mortality rates in MN declined in 2000–2009 and then leveled off in 2010–2018, paralleling national rates. Age- and sex-adjusted CVD mortality decreased by 3.7% per year in 2000–2009 (average annual percent changes [AAPC]: -3.7; 95% CI: − 4.8, − 2.6) with no change observed in 2010–2018. Those aged 65–84 years had the most rapid early decline in CVD mortality (AAPC: -5.9, 95% CI: − 6.2, − 5.7) and had less improvement in 2010–2018 (AAPC: -1.8, 95% CI: − 2.2, − 1.5), and the younger age group (25–64 years) now experiences the most adverse trends (AAPC: 1.2, 95% CI: 0.7–1.8). Coronary heart disease (CHD) and cerebrovascular disease had the largest relative decreases in mortality in 2000–2009 (CHD AAPC: -5.2; 95% CI: − 6.5,-3.9; cerebrovascular disease AAPC: -4.4, 95% CI: − 5.2, − 3.6) with no change 2010–2018. Heart failure (HF)/cardiomyopathy followed similar trends with a 2.5% decrease (AAPC 95% CI: − 3.5, − 1.5) per year in 2000–2009 and no change in 2010–2018. Deaths from other CVD also decreased in the early time period (AAPC: -1.6, 95% CI: − 2.7, − 0.5) but increased in 2010–2018 (AAPC: 1.9, 95% CI: 0.5, 3.3). In- and out-of-hospital death rates improved in 2000–2009 with a slowing in improvement for in-hospital death and no further improvement for out-of-hospital death in 2010–2018.ConclusionConcerning CVD mortality trends occurred in MN. In the most recent decade (2010–2018) mortality from all CVD subtypes plateaued or even increased. CVD mortality among the younger age groups increased as well. These data are congruent with adverse national trends supporting their generalizability. These adverse trends underscore the urgent need for CVD prevention and treatment, as well as continued surveillance to assess progress at the state and national level.

Blood Pressure in Young Adults and Cardiovascular Disease Later in Life.

Cardiovascular disease (CVD) mortality has declined markedly over the past several decades among middle-age and older adults in the United States. However, young adults (18-39 years of age) have had a lower rate of decline in CVD mortality. This trend may be related to the prevalence of high blood pressure (BP) having increased among young US adults. Additionally, awareness, treatment, and control of hypertension are low among US adults between 20 and 39 years of age. Many young adults and healthcare providers may not be aware of the impact of high BP during young adulthood on their later life, the associations of BP patterns with adverse outcomes later in life, and benefit-to-harm ratios of pharmacological treatment. This review provides a synthesis of the related resources available in the literature to better understand BP-related CVD risk among young adults and better identify BP patterns and levels during young adulthood that are associated with CVD events later in life, and lastly, to clarify future challenges in BP management for young adults.

The relation between cardiovascular mortality and development: Study for small areas in Brazil, 2001–2015

Background: Cardiovascular disease (CVD) is one of the most serious health issues and the leading cause of death in Brazil, accounting for 30% of all deaths. Previous research shows that CVD mortality rates are not uniformly distributed across Brazil and have been changing over time. There is also previous evidence from other countries that economic development and improvements in the educational level have important effects in reducing CVD mortality. Objective: The goal of this paper is to contribute to this discussion by investigating the relation between CVD mortality and economic development over time and space, measured by gross domestic product (GDP) per capita, in Brazilian micro-regions from 2001 to 2015. Methods: We used data from the Mortality Information System (SIM-DATASUS) from 2001 to 2015. GDP data by micro-region were extracted from the Sistema IBGE de Recuperacao Automatica (SIDRA). Bivariate maps were used to establish the relationship between CVD mortality and GDP per capita. Results: The results show that GDP per capita increased in all micro-regions between 2001 and 2015. The results also suggest a rapid decline in CVD mortality in the South and Southeast micro-regions and a slower decline in the Central-West region. Meanwhile, the less developed North and Northeast regions showed an increase in CVD mortality over time. This spatial heterogeneity over the examined period appears to be associated with access to proper healthcare and strongly related to socioeconomic factors. In addition, males have higher mortality rates than females in approximately 72% of micro-regions. Contribution: This study provides useful clues for policymakers establishing public health planning and effective measures for the prevention of deaths from cardiovascular disease. The reduction of CVD mortality can positively impact GDP growth because it can increase life expectancy and consequently enable people to contribute to the Brazilian economy for a longer time.

Is the long-term decline in cardiovascular-disease mortality in high-income countries over? Evidence from national vital statistics.

The substantial decline in cardiovascular-disease (CVD) mortality in high-income countries has underpinned their increasing longevity over the past half-century. However, recent evidence suggests this long-term decline may have stagnated, and even reversed in younger populations. We assess recent CVD-mortality trends in high-income populations and discuss the findings in relation to trends in risk factors. We used vital statistics since 2000 for 23 high-income countries published in the World Health Organization Mortality Database. Age-standardized CVD death rates by sex for all ages, and at ages 35-74 years, were calculated and smoothed using LOWESS regression. Findings were contrasted with the Global Burden of Disease (GBD) Study. The rate of decline in CVD mortality has slowed considerably in most countries in recent years for both males and females, particularly at ages 35-74 years. Based on the latest year of data, the decline in the CVD-mortality rate at ages 35-74 years was <2% (about half the annual average since 2000) for at least one sex in more than half the countries. In North America (US males and females, Canada females), the CVD-mortality rate even increased in the most recent year. The GBD Study estimates, after correcting for misdiagnoses, suggest an even more alarming reversal, with CVD death rates rising in seven countries for at least one sex in 2017. The rate of decline and initial level of CVD mortality appear largely unrelated. A significant slowdown in CVD-mortality decline is now apparent across high-income countries with diverse epidemiological environments. High and increasing obesity levels, limited potential future gains from further reducing already low smoking prevalence, especially in English-speaking countries, and persistent inequalities in mortality risk pose significant challenges for public policy to promote better cardiovascular health.

Second Primary Malignancies and Cardiovascular Mortality in Hodgkin Disease (HD) Survivors – A SEER Database Study

Over the last few decades there has been significant improvements in survival in patients (pts) with HD. But long-term HD survivors, especially those treated with radiation therapy (RT) have an increased risk of second primary malignancy (SPM) and cardiovascular disease (CVD) related mortality. We conducted this population based study to analyze trends in CVD related mortality and incidence of lung and thyroid cancer (CA) in HD survivors treated with RT. We used the SEER 9 database to calculate the Standardized Incidence Ratio (SIR) and Excess Absolute Risk (EAR) of lung and thyroid CA as SPM in survivors of HD diagnosed between 1973 and 2011, who were treated with RT. Poisson regression models were used to calculate adjusted incidence of lung and thyroid CA. We also divided the pts diagnosed with HD during this period into two groups based on if or not they received RT and calculated the mortality due to CVD for each group, by year of diagnosis (YOD). Poisson regression models were used to calculate adjusted CVD mortality by YOD for each group. In all three cases, trends in incidence or mortality were evaluated by calculating the Estimated Annual Percentage Change (EAPC) from the regression coefficient for YOD. We identified 11,916 HD cases that received RT, who were followed up for a median duration of 160 months (range – 12 to 480 months). 319 pts developed lung CA (SIR of 3.72, 95% CI 3.32 – 4.15; EAR of 13.19 per 10,000 person years at risk (PYAR)) and 86 pts developed thyroid CA (SIR of 3.67, 95% CI 2.94 – 4.53; EAR of 3.54 per 10,000 PYAR). Median ages at diagnosis of secondary lung and thyroid CA were 59 yrs and 42 yrs, with median latency periods of 16 yrs and 17 yrs respectively. 965 pts among 11,916 pts who received RT died from CVD while the number of CVD deaths was 1,182 among the 12,507 pts who were not given RT. Using Poisson regression models, we calculated the adjusted incidence of secondary lung CA and thyroid CA and the adjusted mortality from CVD, by YOD. YOD, age at diagnosis of HD and latency (time since diagnosis of HD) were the independent variables used in the regression model. Between 1973 and 2011, the adjusted incidence of lung CA declined at an EAPC of -2.68 (95% CI -13.06 to -3.92) and that of thyroid CA declined at an EAPC of -3.35 (95% CI -5.73 to -1.00). Over the same period, CVD mortality per 10,000 PYAR for pts who received RT declined at an EAPC of -4.34 (95% CI -4.97 to -3.73) and that of pts who did not receive RT declined at an EAPC of -1.92 (95% CI -2.47 to -1.39). We observed a decline in incidence of lung and thyroid CA and CVD mortality in HD survivors over the study period. The decline in CVD mortality over time in pts who received RT was steeper compared to that of pts who did not receive RT. Though our study was limited by the lack of details regarding RT, chemotherapy and comorbidities, these findings are most likely a reflection of recent trends in use of reduced doses and field of RT.

Abstract P374: Trends in Hypertension Prevalence, Awareness, Treatment, and Control: The National Health and Nutrition Examination Survey, 1999-2014

Introduction: The decline in cardiovascular disease mortality in the US has stalled in recent years, though patterns have varied by age and sociodemographic characteristics. Trends in prevalence of hypertension, as well as awareness, treatment, and control in population subgroups can shed light on opportunities for improving hypertension management and CVD prevention. Hypothesis: There has been greater improvement in hypertension control among adults aged ≥65 years than in middle- and younger-age (45-64 and 25-44 years) adults and that race and socioeconomic disparities may be narrower among adults aged ≥65 years. Methods: We analyzed data for adults aged ≥25 years from the 1999-2014 National Health and Nutrition Examination Survey (NHANES). We examined mean systolic blood pressure (SBP), prevalence of hypertension, and among those with hypertension, prevalence of awareness, treatment, and control by age category and survey cycle. We fit linear regression models for trends with interaction terms for age category and time. Results: Among those aged ≥65, mean SBP decreased 10.4 mmHg, from 143.2 to 132.9 mmHg, a significantly greater decrease than among those aged 45-64 (-3.1 mmHg) or 25-44 (-0.1 mmHg), though absolute SBP values are highest among those aged ≥65 ( Table ). Hypertension awareness, treatment, and control increased significantly each age category, but to a lesser extent among those 45-64 than those ≥65 (p-values for interaction: 0.031, 0.054, 0.051, respectively). Differences in hypertension control and mean SBP among whites and blacks were greater among those 45-64 than those ≥65. Within age categories, there were few significant differences in trends over time by race/ethnicity, education, or poverty to income ratio. Conclusions: Our findings highlight the need to address hypertension management among middle- and younger-age adults. Persistent disparities in hypertension control over time demonstrate that prevention and management of hypertension is a priority health equity issue.

Abstract MP67: Transition From Cardiovascular Disease to Cancer as the Leading Cause of Death in US States, 1999-2013

Introduction: Cardiovascular disease (CVD) has been the leading cause of death in the US, and cancer the second leading cause of death, consistently since the 1940s. In recent decades, the gap has narrowed due to the steep decline in CVD mortality and relatively modest decline in cancer mortality. We hypothesized that national-level mortality data obscure state-specific transitions from CVD to cancer as the leading cause of death. Methods: We used state-specific mortality data from the US National Vital Statistics System to calculate state-specific mortality rate ratios (RRs) of CVD vs cancer for each US state annually from 1999 to 2013. Results: From 1999 to 2013 the national CVD mortality rate fell from 265.9 to 193.3 per 100,000 and the national cancer mortality rate fell from 201.6 to 185.0 per 100,000. Accordingly, the national CVD/cancer mortality RR fell from 1.32 to 1.04. However, from 1999 to 2013 many states transitioned from CVD to cancer as the leading cause of death (see Figure). In 1999 CVD was the leading cause of death in 49 states, with median state-specific CVD/cancer mortality RR of 1.29 (IQR: 1.16, 1.36). New York had the highest mortality RR of 1.57. Only in Alaska was cancer the leading cause of death in 1999, with CVD/cancer mortality RR of 0.89. In contrast, by 2013 CVD remained the leading cause of death in only 27 states, with median state-specific CVD/cancer mortality RR of 1.08 (IQR: 1.04, 1.13). New York still had the highest mortality RR of 1.23. Cancer had become the leading cause of death in 23 states by 2013, with median state-specific CVD/cancer mortality RR of 0.95 (IQR: 0.88, 0.99). Conclusion: Due to rapidly declining CVD mortality rates, the transition from CVD to cancer as the leading cause of death has already occurred in nearly half of US states. National-level data mask this reality, implying an oversimplified public health message that “CVD is the leading cause of death.” State-specific data highlight successes in CVD prevention and control and the need for further improvements in cancer prevention and control.

Abstract 19455: Risk Factor Changes Had a Minor Net Contribution to the Decline in Cardiovascular Mortality in the US, 1988-2004

Introduction: The role of primary prevention and changes in risk factors in explaining cardiovascular disease (CVD) mortality trends is controversial. Previous studies did not consider simultaneous changes in multiple cardiovascular risk factors over time. Objectives: To evaluate the impact of changes in smoking, obesity, physical inactivity, hypertension, diabetes, chronic kidney disease and dyslipidemia to explain the decreasing trend in CVD mortality that occurred in the US from 1988-1994 to 1999-2004. Methods: Cohort study of 25,297 adult men and women ≥20 years old participating in the National Health and Nutrition Examination Survey (NHANES) III and 1999-2004 Mortality Follow-up. We used causal mediation analyses with additive hazard models to estimate the absolute and relative reductions in CVD mortality rates over time explained through risk factor changes. Results: CVD mortality rates in the US decreased from 1988-1994 to 1999-2004 by 52.7% in men and by 45.5% women. Net changes in CVD risk factors explained 12.6 and 10.9% of this decline in men and women, respectively. The reductions in smoking and in leisure time physical inactivity rates were the main factors explaining this decline. The increased in chronic kidney disease, however, independently attenuated the decline in CVD mortality in both men and women. Adjustment for changes in self-reported use of risk factor treatments did not materially change the findings. Conclusions: The net impact of changes in CVD risk factors on mortality changes in the US was small. While prevention strategies have intensified, increases in the prevalence of certain risk factors, such as chronic kidney disease, seem to attenuate the impact of primary prevention interventions. The mortality decline may have been driven by clinical interventions in patients with events, by secondary prevention, or by changes in non-traditional risk factors. Our findings also suggest that primordial prevention strategies are needed to control the increase recent trends in chronic kidney disease and to maximize the benefit of preventive interventions.

Long-term trends in cardiovascular disease mortality and association with respiratory disease.

The recent decline in cardiovascular disease mortality in Western countries has been linked with changes in life style and treatment. This study considers periods of decline before effective medical interventions or knowledge about risk factors. Trends in annual age-standardized death rates from cerebrovascular disease, heart disease and circulatory disease, and all cardiovascular disease are reviewed for three phases, 1881-1916, 1920-1939, and 1940-2000. There was a consistent decline in the cerebrovascular disease death rate between 1891 and 2000, apart from brief increases after the two world wars. The heart disease and circulatory disease death rate was declining between 1891 and 1910 before cigarette smoking became prevalent. The early peak in cardiovascular mortality in 1891 coincided with an influenza pandemic and a peak in the death rate from bronchitis, pneumonia and influenza. There is also correspondence between short-term fluctuations in the death rates from these respiratory diseases and cardiovascular disease. This evidence of ecological association is consistent with the findings of many studies that seasonal influenza can trigger acute myocardial infarction and episodes of respiratory infection are followed by increased risk of cardiovascular events. Vaccination studies could provide more definitive evidence of the role in cardiovascular disease and mortality of influenza, other viruses, and common bacterial agents of respiratory infection.

The association between obesity and severe disability among adults aged 50 or over in nine high-income, middle-income and low-income countries: a cross-sectional study

ObjectiveThe association between obesity and disability may differ between high-income and low-income/middle-income countries but there are no studies comparing this association between these settings. The aim of the study was...

Exploring the Life Expectancy Increase in Poland in the Context of CVD Mortality Fall: The Risk Assessment Bottom-Up Approach, From Health Outcome to Policies.

Life expectancy at birth is considered the best mortality-based summary indicator of the health status of the population and is useful for measuring long-term health changes. The objective of this article was to present the concept of the bottom-up policy risk assessment approach, developed to identify challenges involved in analyzing risk factor reduction policies and in assessing how the related health indicators have changed over time. This article focuses on the reasons of the significant life expectancy prolongation in Poland over the past 2 decades, thus includes policy context. The methodology details a bottom-up risk assessment approach, a chain of relations between the health outcome, risk factors, and health policy, based on Risk Assessment From Policy to Impact Dimension project guidance. A decline in cardiovascular disease mortality was a key factor that followed life expectancy prolongation. Among basic factors, tobacco and alcohol consumption, diet, physical activity, and new treatment technologies were identified. Poor health outcomes of the Polish population at the beginning of 1990s highlighted the need of the implementation of various health promotion programs, legal acts, and more effective public health policies. Evidence-based public health policy needs translating scientific research into policy and practice. The bottom-up case study template can be one of the focal tools in this process. Accountability for the health impact of policies and programs and legitimization of the decisions of policy makers has become one of the key questions nowadays in European countries’ decision-making process and in EU public health strategy.

Joint British Societies’ consensus recommendations for the prevention of cardiovascular disease (JBS3)

In 1961, the publication of the findings of the Framingham study provided the National Institutes of Health (NIH), the USA, and the world at large with a huge return on...

Declining Stroke and Myocardial Infarction Mortality Between 1989 and 2010 in a Country of the African Region

In low- and middle-income countries, the total burden of cardiovascular diseases is expected to increase due to demographic and epidemiological transitions. However, data on cause-specific mortality are lacking in sub-Saharan Africa. Seychelles is one of the few countries in the region where all deaths are registered and medically certified. In this study, we examine trends in mortality for stroke and myocardial infarction (MI) between 1989 and 2010. Based on vital statistics, we ascertained stroke and MI as the cause of death if appearing in any of the 4 fields for immediate, intermediate, underlying, and contributory causes in death certificates. Mortality rates (per 100 000, age-standardized to World Health Organization standard population) decreased from 1669/710 (men/women) in 1989 to 1991 to 1113/535 in 2008-10 for all causes, from 250/140 to 141/86 for stroke, and from 117/51 to 59/24 for MI, corresponding to proportionate decreases of 33%/25% for all-cause mortality, 44%/39% for stroke, and 50%/53% for MI over 22 years. The absolute number of stroke and MI deaths did not increase over time. In 2008 to 2010, the median age of death was 65/78 years (men/women) for all causes, 68/78 for stroke, and 66/73 for MI. Between 1989 and 2010, age-standardized stroke and MI mortality decreased markedly and more rapidly than all-cause mortality. The absolute number of cardiovascular disease deaths did not increase over time because the impact of population aging was fully compensated by the decline in cardiovascular disease mortality. Stroke mortality remained high, emphasizing the need to strengthen cardiovascular disease prevention and control.

The relationship between body size and mortality in the linked Scottish Health Surveys: cross-sectional surveys with follow-up.

Objective:To investigate the relationship between body mass index (BMI), waist circumference (WC) or waist–hip ratio (WHR) and all-cause mortality or cause-specific mortality.Design:Cross-sectional surveys linked to hospital admissions and death records.Subjects:In total, 20 117 adults (aged 18–86 years) from a nationally representative sample of the Scottish population.Measurements:Cox proportional hazards models were used to estimate hazard ratios (HRs) for all-cause, or cause-specific, mortality. The three anthropometric measurements BMI, WC and WHR were the main variables of interest. The following were adjustment variables: age, gender, smoking status, alcohol consumption, survey year, social class and area of deprivation.Results:BMI-defined obesity (⩾30 kg m−2) was not associated with increased risk of mortality (HR=0.93; 95% confidence interval=0.80–1.08), whereas the overweight category (25–<30 kg m−2) was associated with a decreased risk (0.80; 0.70–0.91). In contrast, the HR for a high WC (men⩾102 cm, women⩾88 cm) was 1.17 (1.02–1.34) and a high WHR (men⩾1, women⩾0.85) was 1.34 (1.16–1.55). There was an increased risk of cardiovascular disease (CVD) mortality associated with BMI-defined obesity, a high WC and a high WHR categories; the HR estimates for these were 1.36 (1.05–1.77), 1.41 (1.11–1.79) and 1.44 (1.12–1.85), respectively. A low BMI (<18.5 kg m−2) was associated with elevated HR for all-cause mortality (2.66; 1.97–3.60), for chronic respiratory disease mortality (3.17; 1.39–7.21) and for acute respiratory disease mortality (11.68; 5.01–27.21). This pattern was repeated for WC but not for WHR.Conclusions:It might be prudent not to use BMI as the sole measure to summarize body size. The alternatives WC and WHR may more clearly define the health risks associated with excess body fat accumulation. The lack of association between elevated BMI and mortality may reflect the secular decline in CVD mortality.