Decline in Cardiovascular Mortality

Abstract

If the control of infectious diseases was the public health success story of the first half of the 20th century, then the decline in mortality from coronary heart disease (CHD) and stroke has been the success story of the century’s last 4 decades. The early phase of this decline in CHD and stroke was unexpected and controversial when first reported in the mid-1970s, having followed 60 years of gradual increase as the U.S. population aged. However, in 1978 the participants in a conference convened by the National Heart, Lung, and Blood Institute (NHLBI) concluded that a significant recent downtick in CHD and stroke mortality rates had definitely occurred, at least in the U.S. Since 1978, a sharp decline in mortality rates from CHD and stroke has become unmistakable throughout the industrialized world, with age-adjusted mortality rates having declined to about one-third of their 1960s baseline by 2000. Models have shown that this remarkable decline has been fueled by rapid progress in both prevention and treatment, including precipitous declines in cigarette smoking, improvements in hypertension treatment and control, widespread use of statins to lower circulating cholesterol levels, and the development and timely use of thrombolysis and stents in acute coronary syndrome to limit or prevent infarction. However, despite the huge growth in knowledge and advances in prevention and treatment, there remain many questions about this decline. In fact, there is evidence that the rate of decline may have abated and may even be showing early signs of reversal in some population groups. The NHLBI, through a request for information, is soliciting input that could inform a follow-up conference on or near the 40th anniversary of the original landmark conference in order to further explore these trends in cardiovascular mortality in the context of what has come before and what may lie ahead.

Environmental Determinants of Cardiovascular Disease

“…As discussed, much of CVD is preventable and since the 1960s, primary prevention has been the major reason for the decline in CVD mortality. 1 In comparison with improved clinical care and treatment, preventive measures are likely to garner more widespread and enduring gains and, if not cost-prohibitive, could be adopted worldwide, even in resource-poor countries, which now seemed destined to bear the largest brunt of this epidemic. But most prevention strategies to date have been focused on individual interventions.…”

“…Deaths from ischemic heart disease and stroke have increased worldwide. Even in the US, where the rates of CVD mortality have been steadily decreasing from their peak in the 1960s, this rate of decline has substantially slowed down since the 1990s 1 , and by 2030, 40.5% of the population is projected to have some form of CVD. 2 While some of this increase may be due to an aging population, the near universal pervasiveness of CVD reflects our inability to prevent its escalating occurrence or to understand its fundamental nature.…”

Status of Early-Career Academic Cardiology

“…In the United States (U.S.) alone, it is projected that by the year 2030, 45% of the population will have at least one CVD condition (2). Notably, after a long period of sustained decline in age adjusted CVD death rate (1950–2014) (3), age adjusted death rates for heart disease and stroke in the US demonstrated statistically significant increases from 2014 to 2015 (4). To address this rising burden of cardiovascular disease, society relies on academic cardiologists in all settings to drive research (basic, translational, clinical, and population) and to train the next generation of cardiologists.…”

The 21st Century Echocardiography Laboratory in Australia and New Zealand: Rapid Evolution of Training and Workforce, Practice and Technology

“…In addition to increase in clinical demand, our population is ageing and survival from cardiovascular disease is improving [6,7]. As a result, the number of older patients, with existing cardiovascular disease (CVD), requiring echocardiography is growing also.…”