Decline In Coronary Disease Mortality Research Articles

Coronary Disease Deaths: From Birth Cohorts to Prevention

Cardiovascular diseases remain the number one cause of death in most of the western world. However, mortality from coronary disease nonetheless started to decline in several countries including the United States and part of western Europe 4 decades ago, and this decline has continued until the present time. Conceptually, the decline in coronary disease mortality could reflect a decrease in the incidence of coronary disease with fewer new cases occurring, or a decline in its case fatality, or a combination thereof. Progress in the primary prevention of coronary disease would decrease incidence while improvement in medical care and secondary prevention would increase survival. Hence, describing temporal trends in different populations and examining their causes is important and can help to design interventions, deploy prevention strategies, and advocate for policy changes. Despite the importance of this endeavor, quantifying the role of each of the aforementioned components in coronary mortality decline remains a difficult task and the determinants of the decline are still incompletely understood. This matter is further complicated by the fact that the respective contribution of potential determinants likely evolved over time and across countries. Within this context, studies of trends according to person, place, and time have the potential to shed some light on this subject. The article by Ocana-Riola et al reports an in-depth analysis of temporal trends in mortality from ischemic heart disease in southern Spain, aiming at separating age, birth cohort, and period effects. In epidemiology, age effect can be defined as a change in the outcome rate according to age, irrespective of birth cohort and calendar time; cohort effect can be defined as a change in the outcome rate according to year of birth, irrespective of age and calendar time; and period effect can be defined as a change in the outcome rate affecting an entire population at some point in time, irrespective of age and birth cohort. The study pertains to 145 539 deaths from ischemic heart disease that occurred in Andalusia between 1981 and 2008 among individuals aged between 30 and 84 years. For age effect, as expected, mortality from ischemic heart disease increased substantially with age for both men and women. Concerning birth cohort effect, the risk of

Severity of Myocardial Infarction

Cardiovascular disease constitutes a burden of epidemic proportion,1 and understanding its determinants is essential to designing effective interventions. Doing so requires the ability to track disease burden at the population level. In the United States, without national registries, community surveillance is the method of choice.2 Community surveillance studies are mostly retrospective by design, rely on diagnostic codes for case finding, and require a defined population in which events can be consistently and reliably captured and validated with standardized approaches. Applied to cardiovascular disease, community surveillance measures its burden in communities by tracking the incidence of events, their severity, and their mortality, thereby enabling the appraisal of the components of cardiovascular diseases in a given population.2 Because of the aforementioned methodological requirements, few surveillance studies exist in the United States. They include the Atherosclerosis Risk in Communities (ARIC) Study,3 the Minnesota Heart Survey,4 the Olmsted County Study,5 and the Worcester Heart Attack Study.6 The data from these studies indicate that, although deaths from coronary disease have declined, the incidence of myocardial infarction in the United States has remained mostly stable. Thus, the decline in mortality can be envisioned as reflecting an improvement in survival, which may be mediated by a declining severity of myocardial infarction. Article p 503 The article by Myerson et al7 in this issue of Circulation specifically addresses this important and understudied issue in ARIC between 1987 and 2002. They examined a large, multiracial population and relied on several indicators, including the composite Predicting Risk of Death in Cardiac Disease Tool (PREDICT) score to conclude that the severity of infarction declined over time. Indeed, the proportion of infarctions with major ECG abnormalities, ST-segment elevation, and Q waves decreased, as did biomarker values and the proportion of persons presenting with shock. …

Sex-specific trends in validated coronary heart disease rates in southeastern New England, 1980-1991.

Although the national decline in coronary heart disease mortality began earlier and was steeper in women relative to men, recent data suggest that the decline in women has slowed. The purpose of this study was to document sex-specific trends in coronary disease morbidity and mortality for the period 1980-1991 in two southeastern New England communities, and to determine whether temporal trends have been similar in men and women aged 35-74 years. Analyses were based on 6,282 validated in-hospital and out-of-hospital coronary disease events ascertained by the retrospective surveillance system of the Pawtucket Heart Health Program. Total (fatal plus non-fatal) coronary disease rates remained stable during this period. The flat trend was the result of an increase in non-fatal hospitalizations and a simultaneous decrease in both in-hospital and out-of-hospital mortality. The decline in fatal coronary disease was steeper for men, for both in- and out-of-hospital mortality, although the sex difference was statistically significant only for out-of-hospital deaths. In-hospital case-fatality for validated coronary disease declined for both men and women. The steeper decline in coronary disease mortality for men suggests the need for more information regarding sex differential trends in prevention, diagnosis, classification, and treatment.

Exploitation of autopsy in determining natural cause of death: Trends in Finland with special reference to the diagnostics of ischemic heart diseases and cerebrovascular diseases in middle-aged males, 1974–1993

Finnish mortality statistics show a marked decrease in coronary disease mortality especially among middle-aged males during the last 20 to 25 years. At the same time, the overall autopsy rate in deaths due to natural, non-violent causes has diminished in Finland. National mortality statistics are based on medical information given in death certificates. How often are the causes of death based on autopsy and is there any definitive trend? Possible changes in cause-of-death determination practices may have contributed to the mortality changes observed. In this study, deaths due to ischemic heart diseases (IHD) and cerebrovascular diseases (CVD) from 1974 to 1993 in Finland were compared with natural deaths, i.e. all of the deaths due to natural causes, in regard to use of autopsy. It was found that IHD-diagnosis as the underlying cause-of-death was, unlike natural deaths and CVD in particular, increasingly based on autopsy. It is thus concluded that the recent decline in coronary disease mortality among middle-aged men in Finland cannot be explained by any deterioration in cause-of-death examination practices.