Coronary Mortality Declines in the U.S. Between 1980 and 2000

Young, F. H.; Capewell, Simon; Ford, Earl S.; Critchley, Julia

doi:10.1016/j.amepre.2010.05.009

Cited by 68 publications

(21 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Changes in case fatality would signal the relative importance of secondary prevention and access to quality care; changes in incidence would point to the relative importance of primary prevention. Nationally, >50% of the decline in heart disease mortality is estimated to be attributable to primary prevention 54 ; however, the proportions could vary regionally and locally.…”

Section: Discussionmentioning

confidence: 99%

Changes in the Geographic Patterns of Heart Disease Mortality in the United States

et al. 2016

View full text Add to dashboard Cite

Background Although many studies have documented the dramatic declines in heart disease mortality in the United States at the national level, little attention has been given to the temporal changes in the geographic patterns of heart disease mortality. Methods and Results Age-adjusted and spatially smoothed county-level heart disease death rates were calculated for 2-year intervals from 1973 to 1974 to 2009 to 2010 for those aged ≥35 years. Heart disease deaths were defined according to the International Classification of Diseases codes for diseases of the heart in the eighth, ninth, and tenth revisions of the International Classification of Diseases. A fully Bayesian spatiotemporal model was used to produce precise rate estimates, even in counties with small populations. A substantial shift in the concentration of high-rate counties from the Northeast to the Deep South was observed, along with a concentration of slow-decline counties in the South and a nearly 2-fold increase in the geographic inequality among counties. Conclusions The dramatic change in the geographic patterns of heart disease mortality during 40 years highlights the importance of small-area surveillance to reveal patterns that are hidden at the national level, gives communities the historical context for understanding their current burden of heart disease, and provides important clues for understanding the determinants of the geographic disparities in heart disease mortality.

show abstract

Section: Discussionmentioning

confidence: 99%

Changes in the Geographic Patterns of Heart Disease Mortality in the United States

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Together with improvements in care for patients hospitalized with acute myocardial infarction, these efforts have led to a sustained decline in mortality attributed to coronary heart disease (12–14). However, the increasing prevalence of obesity (15,16) and diabetes (17–19) during recent decades could have opposite effects on changing trends in the burden of coronary heart disease (20,21).…”

mentioning

confidence: 99%

Trends in Incidence of Hospitalized Acute Myocardial Infarction in the Cardiovascular Research Network (CVRN)

Reynolds

Leong

et al. 2017

The American Journal of Medicine

View full text Add to dashboard Cite

Background Monitoring trends in cardiovascular events can provide key insights into the effectiveness of prevention efforts. Leveraging data from electronic health records provides a unique opportunity to examine contemporary, community-based trends in acute myocardial infarction hospitalizations. Methods We examined trends in hospitalized acute myocardial infarction incidence among adults aged ≥25 years in 13 U.S. health plans in the Cardiovascular Research Network. The first hospitalization per member for acute myocardial infarction overall and for ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction was identified by ICD-9 primary discharge codes in each calendar year from 2000 through 2008. Age- and sex-adjusted incidence was calculated per 100,000 person-years using direct adjustment with 2000 U.S. census data. Results Between 2000 and 2008, we identified 125,435 acute myocardial infarction hospitalizations. Age- and sex-adjusted incidence rates (per 100,000 person-years) of acute myocardial infarction declined an average 3.8%/year from 230.5 in 2000 to 168.6 in 2008. Incidence of ST-segment elevation myocardial infarction declined 8.7%/year from 104.3 in 2000 to 51.7 in 2008 while incidence of non-ST-segment elevation myocardial infarction increased from 126.1 to 129.4 between 2000 and 2004 and then declined thereafter to 116.8 in 2008. Age- and sex-specific incidence rates generally reflected similar patterns, with relatively larger declines in ST-segment elevation myocardial infarction rates in women compared with men. As compared to 2000, the age-adjusted incidence of ST-segment elevation myocardial infarction in 2008 was 48% lower among men and 61% lower among women. Conclusions and Relevance Among a large, diverse, multicenter community-based insured population, there were significant declines in incidence of hospitalized acute myocardial infarction and the more serious ST-segment elevation myocardial infarctions between 2000 and 2008. Declines in ST-segment elevation myocardial infarctions were most pronounced among women. While ecologic in nature, these secular declines likely reflect, at least in part, results of improvement in primary prevention efforts.

show abstract

“…Even though deaths from coronary heart disease (CHD) have fallen during the past 2 decades, the mortality rate from this disease remains the top cause of death in the US, and, by 2020, will attain that status globally as well. An analysis of the fall in CHD death rates from 1980 to 2000 using the IMPACT model of analyzing data from the US National Center for Health Statistics1,2 revealed that half of this decline was due to improvements in risk factors; 79% was attributable to primary prevention and 21% to secondary prevention 3. Cholesterol reduction accounted for 42.7% of the death rate reduction in asymptomatic individuals, and for 34% in those with CHD.…”

Section: Introductionmentioning

confidence: 99%

Rosuvastatin, inflammation, C-reactive protein, JUPITER, and primary prevention of cardiovascular disease – a perspective

Kones¹

2010

DDDT

104

View full text Add to dashboard Cite

The major public health concern worldwide is coronary heart disease, with dyslipidemia as a major risk factor. Statin drugs are recommended by several guidelines for both primary and secondary prevention. Rosuvastatin has been widely accepted because of its efficacy, potency, and superior safety profile. Inflammation is involved in all phases of atherosclerosis, with the process beginning in early youth and advancing relentlessly for decades throughout life. C-reactive protein (CRP) is a well-studied, nonspecific marker of inflammation which may reflect general health risk. Considerable evidence suggests CRP is an independent predictor of future cardiovascular events, but direct involvement in atherosclerosis remains controversial. Rosuvastatin is a synthetic, hydrophilic statin with unique stereochemistry. A large proportion of patients achieve evidence-based lipid targets while using the drug, and it slows progression and induces regression of atherosclerotic coronary lesions. Rosuvastatin lowers CRP levels significantly. The Justification for Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) trial was designed after the observation that when both low density lipoprotein and CRP were reduced, patients fared better than when only LDL was lowered. Advocates and critics alike acknowledge that the benefits of rosuvastatin in JUPITER were real. After a review, the US Food and Drug Administration extended the indications for rosuvastatin to include asymptomatic JUPITER-eligible individuals with one additional risk factor. The American Heart Association and Centers of Disease Control and Prevention had previously recognized the use of CRP in persons with “intermediate risk” as defined by global risk scores. The Canadian Cardiovascular Society guidelines went further and recommended use of statins in persons with low LDL and high CRP levels at intermediate risk. The JUPITER study focused attention on ostensibly healthy individuals with “normal” lipid profiles and high CRP values who benefited from statin therapy. The backdrop to JUPITER during this period was an increasing awareness of a rising cardiovascular risk burden and imperfect methods of risk evaluation, so that a significant number of individuals were being denied beneficial therapies. Other concerns have been a high level of residual risk in those who are treated, poor patient adherence, a need to follow guidelines more closely, a dual global epidemic of obesity and diabetes, and a progressively deteriorating level of physical activity in the population. Calls for new and more effective means of reducing risk for coronary heart disease are intensifying. In view of compelling evidence supporting earlier and aggressive therapy in people with high risk burdens, JUPITER simply offers another choice for stratification and earlier risk reduction in primary prevention patients. When indicated, and in individuals unwilling or unable to change their diet and lifestyles sufficiently, the benefits of statins greatly exceed the risks. ...

show abstract

Coronary Mortality Declines in the U.S. Between 1980 and 2000

Cited by 68 publications

References 41 publications

Changes in the Geographic Patterns of Heart Disease Mortality in the United States

Changes in the Geographic Patterns of Heart Disease Mortality in the United States

Trends in Incidence of Hospitalized Acute Myocardial Infarction in the Cardiovascular Research Network (CVRN)

Rosuvastatin, inflammation, C-reactive protein, JUPITER, and primary prevention of cardiovascular disease – a perspective

Contact Info

Product

Resources

About

Coronary Mortality Declines in the U.S. Between 1980 and 2000

Cited by 68 publications

References 41 publications

Changes in the Geographic Patterns of Heart Disease Mortality in the United States

Changes in the Geographic Patterns of Heart Disease Mortality in the United States

Trends in Incidence of Hospitalized Acute Myocardial Infarction in the Cardiovascular Research Network (CVRN)

Rosuvastatin, inflammation, C-reactive protein, JUPITER, and primary prevention of cardiovascular disease &ndash; a perspective

Contact Info

Product

Resources

About

Rosuvastatin, inflammation, C-reactive protein, JUPITER, and primary prevention of cardiovascular disease – a perspective