Minnesota Heart Survey Research Articles

Physical Exercise Prevents the Cognitive Decline among Older Adults in Romania.

Cognitive decline is one of the most important challenges related to the aging process, due to its important impact on individuals. Several studies have reported that physical exercise with a specific intensity and frequency is beneficial for maintaining cognitive health in the ageing population. The present study investigated the impact of general physical exercise on cognitive health in the older population in Romania. The study involved 60 individuals (60% male, 40% female), with a mean age of 60.78 years (SD = 2.97). The Health Interview Survey and The Minnesota Heart Survey assessed exercise frequency and intensity, while the Montreal Cognitive Assessment (MoCA) determined mild cognitive impairment (MCI) levels. The results of the statistical analysis showed that high-intensity physical exercise at a frequency of three to four times a week at the age of 40-50 years is recommended in order to significantly reduce cognitive decline. In addition, for the age of 60 years old, the results established that engaging in physical activities of a moderate intensity with a frequency of 2-3 times per month is sufficient to maintain healthy cognition. The findings suggest that exercise can serve as a behavioral intervention to mitigate cognitive dysfunction and complement past research on its cognitive health advantages.

Estimation of Cardiovascular Risk from Self-Reported Knowledge of Risk Factors: Insights from the Minnesota Heart Survey.

BackgroundCost-effective primary prevention of cardiovascular disease (CVD) relies on accuracy of risk assessment. Current risk scores require clinical and laboratory measures, are expensive and are often difficult to apply in the population setting.ObjectiveThis study sought to estimate CVD risk from individuals’ knowledge of their own CVD risk factors and compare it to the risk calculated from measured risk factors.MethodsUsing the ACC/AHA Pooled Cohort Risk Equations (PCE), we calculated 10-year CVD risk for 9856 primary prevention individuals aged 40–79 in the Minnesota Heart Survey (MHS). Using log-linear regression models, we estimated PCE risk from the individual’s self-reported knowledge of four dichotomous risk factors: hypertension, hypercholesterolemia, diabetes, and smoking. Age was included in all models, and models were developed separately in women and men. Model performance was assessed internally using leave-one-out cross-validation.ResultsThe median measured PCE CVD risk in women was 2.1% (IQR: 0.8–5.6%), and in men was 6.3% (3.1–13.0%). Using the newly developed equations, the median estimated risk was 2.2% (0.9–5.8%) in women, and 6.9% (3.2–13.1%) in men. Using a threshold of 7.5% to categorize low and high risk, the novel risk calculation gave an accuracy of 95% for women and 87% for men compared to the measured PCE risk. The negative predictive value was 97% for women and 91% in men.ConclusionSelf-reported knowledge of risk may be useful in the identification of individuals at low risk for CV events, however, should always be followed up with measurement of risk factors if symptoms or history suggest CVD.

Abstract P364: Validity of Self-Reported Cardiovascular Disease Risk From Survey Questions

Introduction: Simple questionnaires with dichotomous responses evaluating atherosclerotic risk factors are frequently used to assess cardiovascular disease (CVD) risk in research and clinical settings. Such methods are easier and less costly than direct measurements, but the validity of self-reported risk compared to calculated CVD risk is not well studied. Hypothesis: Self-reported history of hypertension, hyperlipidemia, diabetes and smoking will predict measured CVD risk. Methods: Using the ACC/AHA Pooled Cohort Risk Equations (PCE), we calculated 10 year CVD risk from a randomly selected population sample of 9,856 individuals aged 40-79 without a history of CVD in the Minnesota Heart Survey (MHS). Using log-linear regression models, we estimated sex-specific PCE risk from the individual’s self-reported history of 4 dichotomous risk factors; hypertension, hypercholesterolemia, diabetes, and smoking. Age was included in all models. Model performance was assessed internally using leave-one-out cross-validation. Results: The median PCE 10 year CVD risk in women was 2.1% (IQR: 0.8%-5.6%), and in men was 6.3% (3.1%–13.0%). Using the newly developed equations, which included only the 4 self-reported risk factors and age, the estimated median risk was 2.2% (0.9%-5.8%) in women, and 6.9% (3.2%–13.1%) in men. The measured and estimated PCE risk using a threshold of 7.5% to categorize low and high risk gave an accuracy of 95% for women and 87% for men. The multivariable model-estimated PCE corresponded closely with the actual PCE (Figure). Conclusions: Self-reported history of atherosclerotic risk factors may be useful to estimate CVD risk in individuals, avoiding actual measurements.

Differences in Cardiovascular Mortality Risk among African Americans in the Minnesota Heart Survey: 1985-2015 vs The Atherosclerosis Risk in Communities Study Cohort: 1987-2015.

Geographic differences in cardiovascular disease (CVD) mortality among African Americans (AAs) are well-established, but not well-characterized. Using the Minnesota Heart Survey (MHS) and Atherosclerosis Risk in Communities (ARIC) Study, we aimed to assess whether CVD risk factors drive geographic disparities in CVD mortality among AAs. ARIC risk factors were measured between1987-1989 from a population-based sample of AAs, aged 45 to 64 years, living in Jackson, MS and Forsyth County, NC. Similar measures were made at MHS baseline, 1985, in AAs from Minneapolis-St. Paul, MN. CVD mortality was identified using ICD codes for underlying cause of death. We compared MHS and ARIC on CVD death rates using Poisson regression, risk factor prevalences, and hazard ratios using Cox regression. After CVD risk factor adjustment, AA men in MHS had 3.4 (95% CI: 2.1, 4.7) CVD deaths per 1000 person-years vs 9.9 (95% CI: 8.7, 11.1) in ARIC. AA women in MHS had 2.7 (95% CI: 1.8, 3.6) CVD deaths per 1000 person-years vs 6.7 (95% CI: 6.0, 7.4) in ARIC. A 2-fold higher CVD mortality rate remained in ARIC vs MHS after additional adjustment for education and income. ARIC had higher total cholesterol, hypertension, diabetes, and BMI, as well as less education and income than MHS. Risk factor hazard ratios of CVD death did not differ. The CVD death rate was lower in AAs in Minnesota (MHS) than AAs in the Southeast (ARIC). While our findings support maintaining low risk for CVD prevention, differences in CVD mortality reflect unidentified geographic variation.

Abstract P107: Differences in Cardiovascular Mortality Risk Among African Americans in the Minnesota Heart Survey, 1985-2015, versus African Americans in the Atherosclerosis Risk in Communities Study (ARIC) Cohort: 1987-2015

Geographic differences in CVD mortality across the U.S. are well-established, but frequently overlooked. ARIC enrolled African Americans (AA) from Jackson, MS and Forsyth County, NC, areas of the Southeast with some of the highest CVD mortality rates, especially among AAs. The Minnesota Heart Survey enrolled AAs from Minnesota where CVD rates are among the lowest. However, it is not known whether AAs in Minnesota also have low rates. Using these two cohorts, we assessed whether CVD-related mortality risk among AAs differs by region. Baseline measures of CVD risk factors for MHS were taken in 1985 from a population based sample of AAs, ages 45 to 65, living in the Minneapolis-St. Paul metropolitan area. These same measures were made at ARIC visit 1 (1987-89) in AA participants of the same age residing in Jackson, MS and Forsyth County, NC. CVD and total mortality were identified using ICD codes for underlying cause of death from State and National Death Index records in both cohorts. We compared MHS and ARIC on CVD death rates using Poisson regression, prevalence of risk factors, and risk factor hazard ratios using Cox regression. After risk factor adjustment, AA men in MHS had a rate of 5.2 (95% CI: 3.2, 7.2) CVD deaths per 1000 person-years compared to 15.1 (95% CI: 13.1, 17.1) for AA men in ARIC. For AA women, MHS had 4.1 (95% CI: 2.7, 5.5) CVD deaths per 1000 person-years versus 10.2 (95% CI: 9.0, 11.4) in ARIC. CVD mortality rates were higher in Jackson than Forsyth County within ARIC. CVD death rates paralleled risk factor prevalence at baseline. Compared to MHS, ARIC had significantly higher total cholesterol (215 vs. 202 mg/dL), albeit higher HDL cholesterol (55 vs. 53 mg/dL), as well as higher anti-hypertensive medication use (41 vs. 30%), diabetes (13 vs. 11%) and BMI (30 vs. 29 kg/m 2 ), while smoking did not differ. Despite risk factor differences, hazard ratios of CVD death associated with each risk factor did not differ between studies even after inclusion of a competing risk of non-CVD death. In conclusion, the CVD death rate was lower in AAs in MHS than in AAs residing in the Southeast in ARIC largely due to lower risk factor levels, since the hazard of CVD death for each risk factor did not differ. Study differences reflect incompletely identified geographic variation that need further exploration, especially in the context of health disparities, but support maintaining low risk as a key to CVD prevention.

Twenty‐Two‐Year Population Trends in Sodium and Potassium Consumption: The Minnesota Heart Survey

BackgroundLimiting dietary sodium consumption is a core lifestyle recommendation for the prevention of hypertension. There is increasing evidence that low potassium consumption also increases hypertension risk. We estimated sex‐specific 22‐year trends in sodium and potassium consumption.Methods and ResultsWe used data from the Minnesota Heart Survey, which performs surveillance of risk factors for cardiovascular disease in the Minneapolis–St. Paul metropolitan area. The Minnesota Heart Survey is a random population‐based sample of free‐living adults aged 25 to 74. Surveys were conducted in 1985–1987 (n=2273), 1990–1992 (n=2487), 1995–1997 (n=1842), 2000–2002 (n=2759), and 2007–2009 (n=1502). Dietary intake of sodium and potassium was estimated from one 24‐hour dietary recall. Over 22 years, age‐adjusted sodium and potassium intake among men remained relatively stable in 1985–1987 and 2007–2009 (Ptrend=0.41 and 0.29, respectively); sodium ranged from 3820 mg/day (1995–1997) to 3968 mg/day (2007–2009) and potassium from 3111 mg/day (2000–2002) to 3249 mg/day (1995–1997). Sodium and potassium intake increased among women, from 2531 mg/day in 1985–1987 to 2854 mg/day in 2007–2009 (Ptrend=0.001) for sodium and from 2285 to 2533 mg/day (Ptrend<0.0001) for potassium. We observed stable or increasing sodium and potassium intake within some strata of age, education, and body mass index.ConclusionsDespite long‐standing public health recommendations to limit sodium intake to <2300 mg/day, high sodium intake levels have persisted over the past 22 years. Furthermore, although potassium consumption increased in some subgroups over the study period, mean consumption remained significantly lower than the recommended 4700 mg/day in all groups.

Population trends in aspirin use for cardiovascular disease prevention 1980-2009

Background: Aspirin (ASA) is an established therapy for secondary prevention of cardiovascular disease (CVD). More recently the use of ASA for primary CVD prevention was confirmed in large prospective randomized clinical trials and is recommended by the United States Preventive Services Taskforce and other professional organizations for those at increased CVD risk. However, little is known about the prevalence of ASA use for primary or secondary CVD prevention in the general population. The Minnesota Heart Survey (MHS) describes population trends in CVD risk and therapies over the past 30 years. Data regarding ASA use for primary and secondary CVD prevention were collected from 1980 to 2009. Methods: Adult residents, ages 25-74 from the Minneapolis/St. Paul, USA metropolitan area (2.8 million, 2010 census) were randomly selected at five-year intervals from 1980-82 to 2007-09. In each of six cross-sectional surveys, interviewers collected data on medication use, risk factors, health history and demographics. Questions on regular ASA use were segregated according to primary and secondary prevention groups based on the question: "Have you ever been hospitalized for a heart attack (AMI) or stroke?" and "Are you taking aspirin regularly to avoid an AMI or stroke?" Individuals defined to be within the primary prevention cohort were asked: "Are you taking aspirin regularly to avoid an AMI or stroke?" Mixed model regression analysis estimated the age-adjusted trends for aspirin used in men and women. Results: 12,281 men and 14,258 women ages 25-74 were included in six surveys. Of those, 547 (4%) men and 280 (2%) women reported a previous AMI and/or stroke. Among men, trends in ASA use for secondary CVD prevention rose progressively from 14% in 1980-82 to 77% in 2007-09. Among women, ASA use for secondary prevention increased from 6% to 60% over the same period. Among men, trends in ASA use for primary CVD prevention rose progressively from 1% in 1980-82 to 29% in 2007-09. Among women, ASA use for primary prevention increased from 0.5% to 15% over the same period. ASA use for primary prevention also increased with age from 1% among 25-34 year olds to 37% among those 65-74 years in 2007-09. The use of ASA for CVD prevention was also positively associated with education, hypertension and hypercholesterolemia but negatively associated with smoking. Conclusions: Population use of ASA for primary and secondary prevention of CVD has substantially increased becoming widespread over the past 30 years. Men are more likely than women to use ASA. Those who are older and at increased risk are more likely to use ASA.

Low Serum Glutathione Peroxidase Activity Is Associated with Increased Cardiovascular Mortality in Individuals with Low HDLc’s

BackgroundSince oxidized LDL is thought to initiate atherosclerosis and the serum glutathione peroxidase (GPx3) reduces oxidized lipids, we investigated whether high GPx3 activity reduces cardiovascular disease (CVD) mortality.MethodsWe determined GPx3 in stored samples from the Minnesota Heart Survey of 130 participants who after 5 to 12 years of follow-up had died of CVD and 240 controls. Participants were 26 to 85 years old and predominantly white. In a nested case-control, study we performed logistic regressions to calculate odds ratios (OR) adjusted for age, sex, baseline year, body mass index, smoking, alcohol intake, physical activity, total and HDL cholesterols, systolic blood pressure, serum glucose and gamma glutamyltransferase (GTT) activity. The referent was the quartile with the highest GPx3 activity (quartile 4).ResultsOR’s for CVD mortality for increasing quartiles of GPx3 were 2.37, 2.14, 1.83 and 1.00 (P for trend 0.02). This inverse correlation was confined to those with HDLc’s below the median (P for interaction, 0.006). The OR’s for increasing quartiles of GPx3 in this group were 6.08, 5.00, 3.64 and 1.00 (P for trend, 0.002).ConclusionsIndividuals with both low HDLc and GPx3 activity are at markedly increased risk for death from CVD.

Consistency Between Increasing Trends in Added-Sugar Intake and Body Mass Index Among Adults: The Minnesota Heart Survey, 1980–1982 to 2007–2009

We described 27-year secular trends in added-sugar intake and body mass index (BMI) among Americans aged 25 to 74 years. The Minnesota Heart Survey (1980-1982 to 2007-2009) is a surveillance study of cardiovascular risk factors among residents of the Minneapolis-St Paul area. We used generalized linear mixed regressions to describe trends in added-sugar intake and BMI by gender and age groups and intake trends by weight status. BMI increased concurrently with added-sugar intake in both genders and all age and weight groups. Percentage of energy intake from added sugar increased by 54% in women between 1980 to 1982 and 2000 to 2002, but declined somewhat in 2007 to 2009; men followed the same pattern (all P < .001). Added-sugar intake was lower among women than men and higher among younger than older adults. BMI in women paralleled added-sugar intake, but men's BMI increased through 2009. Percentage of energy intake from added sugar was similar among weight groups. Limiting added-sugar intake should be part of energy balance strategies in response to the obesity epidemic.

Increased Cardiac Troponin I As Measured by a High-Sensitivity Assay Is Associated with High Odds of Cardiovascular Death: The Minnesota Heart Survey

We examined several novel biomarkers of different pathophysiologic pathways as predictors of cardiovascular mortality in participants enrolled in the Minnesota Heart Survey (MHS), a population-based study of cardiovascular disease (CVD) risk factors. In a nested case-control study within MHS, 7 biomarkers were assayed in serum samples from 211 patients identified after 8-15 years of follow-up who died of cardiovascular causes (cardiovascular heart disease, stroke, congestive heart failure) and 253 controls matched on age, sex, and study year. Logistic regression analysis, adjusted for age, race, sex, education, study year, smoking, abdominal obesity, diabetes, serum total cholesterol, systolic blood pressure, previous hospitalization for a CVD event, and other significant biomarkers, was used to evaluate the relations of biomarkers relative to the odds of CVD mortality. Cases survived a median of 7.2 years after enrollment. Increased N-terminal pro-B type natriuretic peptide (NT-proBNP) (19% vs 4.3%), increased high-sensitivity C-reactive protein (hs-CRP) (71% vs 51%), and increased high-sensitivity cardiac troponin I (hs-cTnI) (8.7% vs 1.0%) were more common among cases than among controls (all P < 0.001 in unadjusted analyses). The adjusted odds of death were greater among cases compared to controls for increased NT-proBNP [odds ratio (OR) 5.67, 95% CI 2.17-15], hs-CRP (OR 1.73, 95% CI 1.03-2.89), and hs-cTnI (OR 8.53, 95% CI 1.68-43), and decreased ST2 (OR 1.92, 95% CI 1.05-3.48). When measured by an hs-cTnI assay, cTnI is a key biomarker associated with increased cardiovascular death in a community sample when evaluated in a multiple biomarker analysis.

Abstract P397: Twenty-year Trends of Treatment and Control for Elevated Serum Cholesterol among Minnesota and U.S. Adults

Background: We recently reported lower CHD mortality rates and risk factor levels between 1980 and 2000 in Minnesotans compared to the general US population. Here we report the trends for treatment and control of elevated serum total cholesterol (TC). Methods: Cross-sectional surveys were conducted in men and women aged 25-74 years in the Minnesota Heart Survey (MHS) from 1990 to 2009 and in the National Health and Nutrition Examination survey (NH) from 1988 to 2008, in which height, weight, and medication use were obtained and TC measured. A single generalized linear mixed model was used to estimate age-adjusted and gender-specific linear trends of TC and of treatment and control of high TC in MHS and NH taking into account the complex sampling strategy as random effects, (i.e., neighborhood or strata and primary sampling unit pairings). Differences (pdiff) were calculated for slope and TC between surveys. Results: Between 1990 and 2008-09, percent obese increased. TC declined at the same rate in MHS and NH men and women, but TC levels were lower in MHS (pdiff0.05). TC was generally lower in MHS men and women compared to NH for each treatment and control category. Conclusion: Although TC levels have declined over the past several decades in both regional and national populations, the prevalence for untreated and treated but uncontrolled high TC remains high at 38% in MHS and 46% in NH. Findings were more favorable for Minnesotans than nationally. 20-Year Trends of Serum Cholesterol Treatment and Control in Men and Women: MHS vs. NHANES Untreated/ Controlled (%) Untreated/ Uncontrolled (%) Treated/ Controlled (%) Treated/ Uncontrolled (%) Year * MHS NH MHS NH MHS NH MHS NH Men 1991 41.9 40.7 35.4 36.9 6.0 3.8 16.8 18.5 1996 ** 39.1 38.3 36.0 35.7 6.3 8.1 18.6 17.8 2001 38.4 40.3 31.4 31.9 12.2 8.8 18.0 19.0 2008 40.6 39.1 21.2 30.7 22.0 16.3 16.1 13.9 Ptrend 0.32 0.36 &lt;=0.001 0.001 &lt;0.001 &lt;0.001 0.56 0.03 Pdiff p=0.90 p=0.001 p=0.005 p=0.20 Women 1991 48.7 42.9 30.1 34.8 4.2 3.4 17.0 18.9 1996 45.9 39.3 30.7 34.3 5.9 5.6 17.5 20.8 2001 47.0 43.9 27.7 32.8 6.8 5.9 18.4 17.5 2008 48.1 40.9 23.9 27.9 12.8 12.7 15.2 18.5 ptrend 0.86 0.25 &lt;0.001 &lt;0.001 &lt;0.001 &lt;0.001 0.21 0.73 pdiff p=0.45 p=0.86 p=0.91 p=0.52 Controlled total cholesterol=less than 200 mg/dL, Uncontrolled total cholesterol= greater than or equal to 200 mg/dL MHS=Minnesota Heart survey; NH=NHANES * Midpoint of survey time period ** Survey year for NHANES was 1999

Abstract P238: Long-Term Survival Trends in Hospitalized Heart Failure Patients

Background: Long-term survival data on patients with heart failure (HF) in community-based populations are limited. Preserved ejection fraction (PEF) is present in 50-60% of HF patients. We examined whether trends in long-term survival differed between HF patients with preserved (ejection fraction &gt;/= 45) and reduced ejection fraction (REF) in the context of modern treatment. Methods: The Minnesota Heart Survey, a community-based population study conducted in the Minneapolis-St. Paul metropolitan area, abstracted a random sample of hospital records for patients aged 35-84 with a discharge diagnosis of HF in 1995 and 2000. In the absence of a gold standard diagnosis of HF, hospitalization records that met at least four of six published classification algorithm definitions were considered HF related. Mortality was ascertained from medical records and by linkage to death certificates from the Department of Health. Kaplan-Meier was used for unadjusted survival and Cox proportional hazards regression was used to calculate adjusted hazard ratios (HR). Results: In 1995 1269 HF patients (PEF, n = 423; REF, n = 846) and in 2000 1103 HF patients (PEF, n = 413; REF, n = 690) were identified. The prevalence of hypertension, diabetes mellitus and hyperlipidemia were significantly higher in 2000; the utilization of ACE-Inhibitors, beta-blockers and revascularization were also significantly greater in 2000. In 1995, the unadjusted 9-year survival was 21% in REF and 28% in PEF; in 2000 these numbers were 28% in REF and 29% in PEF (Figure). After adjustment for sex and age the HR for 9-year mortality in 1995 was 0.77 (95% CI: 0.68 - 0.89) for HF patients with PEF compared to REF, p = 0.0003; in 2000 the adjusted HR for 9-year mortality in patients with PEF compared to REF was 0.95 (95%CI: 0.82 - 1.10), p = 0.48. Conclusion: Survival after a HF related hospitalization is low with less than 30% of patients surviving nine years. The increased utilization of ACE-Inhibitors and beta-blockers may partially explain the improved survival among HF patients with REF.

Trends in smoking among adults from 1980 to 2009: the Minnesota heart survey.

We examined population-based smoking trends in Minnesota between 1980 and 2009. The Minnesota Heart Survey (MHS) is a population-based, serial, cross-sectional study of cardiovascular risk factor trends among Minneapolis-Saint Paul metropolitan residents. The MHS recently completed its sixth survey (1980-1982 [n = 3799], 1985-1987 [n = 4641], 1990-1992 [n = 5159], 1995-1997 [n = 6690], 2000-2002 [n = 3281], and 2007-2009 [n = 3179]). We used MHS data to examine smoking trends among adults aged 25 to 74 years by means of age-adjusted generalized linear mixed models. Between 1980 and 2009, the prevalence of current smoking decreased from 32.8% to 15.5% for men and from 32.7% to 12.2% for women (P < .001 for each). Greater decreases occurred among those with higher income and those with more education. Among currently smoking men, the number of cigarettes smoked per day decreased from 26.0 in the 1980-1982 survey to 16.0 in the 2007-2009 survey (P < .001). Similar trends were observed among women. Although the prevalence of smoking and cigarette consumption decreased from the 1980-1982 period to the 2007-2009 period, interventions specifically designed for those of lower socioeconomic status are needed.

Abstract P275: Incidence and Case-Fatality Rates of Acute Myocardial Infarction in the United States: A Systematic Review

Introduction: Beginning in the late 1960s, the death rates attributed to coronary heart disease (CHD) in the U.S. declined, including deaths due to acute myocardial infarction (AMI). The decline in AMI related mortality is likely related to both a decrease in the incidence rates of new events in addition to declines in case-fatality rates (CFRs). The purpose of this summary over view is to describe long-term trends in the incidence and short-term CFRs after AMI in the US based on data from population-based community surveillance studies and, secondarily, to examine possible demographic differences in any observed trends. Methods: Systematic review of published studies providing data on incidence and/or CFRs after AMI in the U.S. published in English between 1980 and 2009. Results: Twenty one out of 436 retrieved articles met our eligibility criteria. Our findings are based on the results of 9 community surveillance studies covering different geographic locations and time periods. Eight studies where done in predominantly White populations. Incidence rates: Studies that had no upper age limits failed to show significant declines in overall incidence rates of AMI over the periods under study. Studies that had an upper age limit reported declines (Minnesota Heart Survey (MHS) 25% decline) or no changes (Atherosclerosis Risk in the Community (ARIC)) in the incidence rates of AMI. Declines were primarily observed in younger White men. Case-fatality rates: All studies reported declining short-term (hospital) CFRs (50% decline since the late 1960s). Declines were greatest among younger individuals. Unadjusted CFRs were 1.5 fold higher in women and non-Whites compared to men and Whites, respectively. Conclusion: Our review demonstrated encouraging declines in short-term CFRs after AMI while incidence rates did not show similar trends. Aging of the population and changes in AMI definitions might have played a role in the observed trends in AMI incidence rates. Advances in pre-hospital care, management, and critical cardiac care likely contributed to the declines in CFRs observed.

The Effect of Changing Diagnostic Algorithms on Acute Myocardial Infarction Rates

Population rates of acute myocardial infarction (AMI) are changing. Consistent case definitions to evaluate these trends and make comparisons are essential. The World Health Organization (WHO) AMI diagnostic algorithm and clinical judgments were the standards for classification. However, in recent years, five new algorithms, to include diagnostic advances, are advocated by professional organizations. This study compares AMI rates derived from six algorithms and the impact of troponins on those rates. The authors use the population-based Minnesota Heart Survey hospital data in 1995 and 2001 to compare six published diagnostic algorithms and the impact of troponins. In 1995 differences in AMI rates between algorithms ranged from 281/100,000 to 440/100,000 for men and 98/100,000 to 139/100,000 for women. The use of troponin, a more sensitive biomarker, adds to the differences by increasing eligible cases. Using 2001 data in patients where creatine kinase and troponin were simultaneously measured, a 64% and 95% increase in AMI rates among men and women, respectively, was observed. Accurate and consistent AMI definitions are crucial for clinical trials, epidemiology and public health research. Demonstrated here is the sensitivity of AMI rates to changing case definitions and the biomarker troponin.

Trends in Vitamin D Intake from Food Sources among Adults in the Minneapolis-St Paul, MN, Metropolitan Area, 1980-1982 through 2007-2009

Background Changes in eating habits could potentially be contributing to vitamin D insufficiency among US adults. Objective Describe secular trends in vitamin D intake from food sources during the past 25 years. Design Trends in dietary vitamin D intake from 1980-1982 to 2007-2009 were examined using data collected from the Minnesota Heart Survey, a surveillance study of trends in risk factors for cardiovascular disease among probability samples of adults aged 25 to 74 years in the Minneapolis-St Paul, MN, metropolitan area. Surveys were conducted in 1980-1982, 1985-1987, 1990-1992, 1995-1997, 2000-2002, and 2007-2009. One 24-hour recall was collected from survey participants during each survey period. Results Vitamin D intake from food sources decreased between 1980-1982 and 2007-2009 among men, with age-adjusted mean vitamin D intake decreasing from 7.24 μg/day in 1980-1982 to 6.15 μg/day in 2007-2009 ( P for trend <0.001). A decrease was also observed among women (4.77 μg/day in 1980-1982 in comparison to 4.53 μg/day in 2007-2009; P for trend <0.001). Conclusions Results suggest that vitamin D intake from food sources has been on the decline during the past 25 years among men and women, potentially contributing to vitamin D insufficiency.

Trends in Cardiovascular Risk Factor Levels in the Minnesota Heart Survey (1980-2002) as Compared With the National Health and Nutrition Examination Survey (1976-2002): A Partial Explanation for Minnesota's Low Cardiovascular Disease Mortality?

The authors compared trends in and levels of coronary heart disease (CHD) risk factors between the Minneapolis-St. Paul, Minnesota, metropolitan area (Twin Cities) and the entire US population to help explain the ongoing decline in US CHD mortality rates. The study populations for risk factors were adults aged 25-74 years enrolled in 2 population-based surveillance studies: the Minnesota Heart Survey (MHS) in 1980-1982, 1985-1987, 1990-1992, 1995-1997, and 2000-2002 and the National Health and Nutrition Examination Survey (NHANES) in 1976-1980, 1988-1994, 1999-2000, and 2001-2002. The authors found a continuous decline in CHD mortality rates in the Twin Cities and nationally between 1980 and 2000. Similar decreasing rates of change in risk factors across survey years, parallel to the CHD mortality rate decline, were observed in MHS and in NHANES. Adults in MHS had generally lower levels of CHD risk factors than NHANES adults, consistent with the CHD mortality rate difference. Approximately 47% of women and 44% of men in MHS had no elevated CHD risk factors, including smoking, hypertension, high cholesterol, and obesity, versus 36% of women and 34% of men in NHANES. The better CHD risk factor profile in the Twin Cities may partly explain the lower CHD death rate there.

Cardiovascular Disease Surveillance in the Comparative Effectiveness Landscape

As the leading cause of death in the Western world, cardiovascular disease (CVD) constitutes an enormous public health problem.1 The last 4 decades have been characterized chiefly by the postponement of CVD events and CVD related deaths until older age. Thus, the burden of CVD is increasing in parallel with the increase in life expectancy.2 Within this context, identifying persons with CVD, measuring its incidence and outcome and how these vary over time and across populations is essential. A central goal of this monitoring (otherwise termed surveillance) has been to understand the determinants of the trends in CVD and in particular the respective responsibility of primary prevention versus that of the care of established disease in the genesis of the CVD trends. A direct extension of surveillance is its application to assess the effectiveness of care and the response to interventions designed to improve the quality of care. Articles see pp 414, 475, and 508 Over the first year of its existence, the journal Circulation: Cardiovascular Quality and Outcomes published 3 important articles that illustrate the clinical relevance of surveillance and the applicability of trend studies to care improvement. The article by Lewsey et al constitutes a classic example of CVD surveillance.3 The authors present much needed data on recent (1986 to 2005) trends in the epidemiology of stroke indicating that age- and sex-specific incidence rates of fatal and nonfatal hospitalized strokes in Scotland declined in men from 235 (95% CI, 229 to 242) to 149 (144 to 154) and in women from 299 (292 to 306) to 182 (177 to 188). The decline in incidence of hospitalized stroke varied by age, but overall this equated to a relative reduction in the risk of stroke of 31% in men and 42% in women. Declines in the …

Association between serum gamma-glutamyltransferase and cardiovascular mortality varies by age: the Minnesota Heart Survey

Although serum gamma-glutamyltransferase (GGT) predicted cardiovascular diseases (CVD) in prospective studies and may be useful in risk assessment, prediction in older adults was weaker in several studies. We performed a nested case-control study with 5-12-year follow-up in 137 CVD deaths and 249 controls (frequency-matched on age, sex, and examination year, age range 26-85 years). An age interaction of serum GGT and CVD mortality (P value for interaction=0.02) was observed. After adjusting for known CVD risk factors, compared with the lowest tertile, odds ratios (95% confidence intervals) in participants less than 70 years (half the participants) were: middle tertile: 2.17 (0.68-6.97), top tertile up to GGT less than 50 U/l: 3.54 (1.07-11.7), and GGT >/=50 U/l: 4.69 (1.16-18.9). In participants aged more than or equal to 70 years, GGT was not related to CVD. Well-known demographic and health behavior associations with serum GGT were observed only in controls among participants aged less than 70 years. Our findings suggest that serum GGT within its normal range can predict CVD mortality in those aged less than 70 years, but may have limited usefulness for risk assessment in older adults.

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. …