Proportion of the Decline in Cardiovascular Mortality Disease due to Prevention Versus Treatment: Public Health Versus Clinical Care

Ford, Earl S.; Capewell, Simon

doi:10.1146/annurev-publhealth-031210-101211

Cited by 259 publications

(200 citation statements)

References 112 publications

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“…Circulatory disease in particular, which affects those at older ages, had very different effects on inequality across countries because of different age patterns of mortality decline, although we did not systematically consider contextual factors in these results. Most research on the relative contributions of treatment of CVD and prevention suggests that these two components contributed equally to declines in cardiovascular mortality rates (19,20). However, it is difficult to clearly define which interventions are preventive as opposed to treating disease, and the age patterns of their effects are unclear.…”

Section: Discussionmentioning

confidence: 99%

Equity and length of lifespan are not the same

Seligman

Greenberg

Tuljapurkar

2016

Proc. Natl. Acad. Sci. U.S.A.

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Efforts to understand the dramatic declines in mortality over the past century have focused on life expectancy. However, understanding changes in disparity in age of death is important to understanding mechanisms of mortality improvement and devising policy to promote health equity. We derive a novel decomposition of variance in age of death, a measure of inequality, and apply it to cause-specific contributions to the change in variance among the G7 countries (Canada, France, Germany, Italy, Japan, the United Kingdom, and the United States) from 1950 to 2010. We find that the causes of death that contributed most to declines in the variance are different from those that contributed most to increase in life expectancy; in particular, they affect mortality at younger ages. We also find that, for two leading causes of death [cancers and cardiovascular disease (CVD)], there are no consistent relationships between changes in life expectancy and variance either within countries over time or between countries. These results show that promoting health at younger ages is critical for health equity and that policies to control cancer and CVD may have differing implications for equity.health equity | age of death variance | life expectancy | inequality | mortality T he 20th century was an epoch of unprecedented declines in mortality rates in most countries. Causes of death shifted from infections, which primarily killed children, to cardiovascular disease (CVD) and cancer, which primarily killed adults, in the epidemiological transition (1, 2). Understanding mortality change largely focused on understanding changes in the average age of death, the life expectancy (e 0 ). In recent years, attention has shifted to disparities in mortality, and health equity is now recognized as an important policy goal. Here, we develop and use a new method to show how changes in inequality, as measured by the variance V, are driven by changes in mortality caused by specific causes, accounting for the interdependence of changes in the different causes of death. We find differences between the magnitudes of cause-specific contributions to e 0 and V and unexpectedly inconsistent relationships between the two over time and across countries, with important scientific and policy implications.Work to date on understanding change in e 0 has found that, among wealthy nations, much of the gain in the second half of the 20th century was because of declines in CVD mortality (3-5). The male-female difference in e 0 , which widened and then, narrowed over the course of the century, has also been driven by CVD mortality as a consequence of smoking behavior (6-8). Disparities across countries in e 0 have been studied most notably by the Global Burden of Disease Project, which has noted gains to life expectancy across countries and declines in global disparity for certain age-specific mortality rates (9, 10). Related work has shown how changes in different causes of death would have different effects on the health of global poor vs. rich (11).Analyses of al...

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Section: Discussionmentioning

confidence: 99%

Equity and length of lifespan are not the same

Seligman

Greenberg

Tuljapurkar

2016

Proc. Natl. Acad. Sci. U.S.A.

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“…Lifestyle changes such as improved nutrition and less smoking and/or treatment of risk factors such as blood pressure and high cholesterol have influenced death rates differentially among countries 5 . Experiments of nature and secular economic trends suggest that changes in dietary caloric intake in countries significantly lowers cardiovascular mortality 6 .…”

Section: Risk Factor Modification and Altered Incidence Of Acute Cardmentioning

confidence: 99%

Temporal shifts in clinical presentation and underlying mechanisms of atherosclerotic disease

2016

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The concept of "the vulnerable plaque" originated from pathological observations in patients who succumbed to fatal acute coronary syndromes. This recognition spawned a generation of research that led to achievement of considerable understanding of how complicated atherosclerotic plaques form and precipitate thrombotic events.In current practice, an increasing number of patients present with non ST-elevation myocardial infarction (NSTEMI) rather than myocardial infarction (MI) with ST-elevation Key points• An increasing number of patients presenting with myocardial infarction (MI) are diagnosed with a non ST-elevated myocardial infarction (NSTEMI) rather than a MI with ST-elevation (STEMI) and consequently survive their first event.• The shift in the clinical presentations of the acute coronary syndromes mandates a critical reassessment of the underlying mechanisms and the concept of the 3 vulnerable plaque.• The change in clinical presentation and warrant critical re-assessment of currently applied cardiovascular risk scores, pre-clinical experiments, and the usefulness of population data and samples harvested before the application of current preventive interventions.4

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“…However, because of an aging population9 and the high prevalence of CVD risk factors,1 increased CVD prevalence and a slowing or reversal in previously declining overall cardiovascular event rate trends have been reported up through 2011 and forecast to continue if additional efforts are not taken 10, 11, 12, 13. Some have suggested that the United States needs to establish and take action on achieving aggressive targets for CVD risk factor prevention and management and continue to improve adherence to evidence‐based treatments to make substantial gains in decreasing the CVD burden 14, 15, 16…”

Section: Introductionmentioning

confidence: 99%

“…These intermediate measures have been tracked since Million Hearts began and will continue to be monitored 18, 19. Population‐level improvements in these risk factors have been demonstrated to lead to decreases in cardiovascular events 14, 17, 20, 21, 22…”

Section: Introductionmentioning

confidence: 99%

Million Hearts: Description of the National Surveillance and Modeling Methodology Used to Monitor the Number of Cardiovascular Events Prevented During 2012–2016

Ritchey

Loustalot

Wall

et al. 2017

JAHA

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BackgroundThis study describes the national surveillance and modeling methodology developed to monitor achievement of the Million Hearts initiative's aim of preventing 1 million acute myocardial infarctions, strokes, and other related cardiovascular events during 2012–2016.Methods and ResultsWe calculate sex‐ and age‐specific cardiovascular event rates (combination of emergency department, hospitalization, and death events) among US adults aged ≥18 from 2006 to 2011 and, based on log‐linear models fitted to the rates, calculate their annual percent change. We describe 2 baseline strategies to be used to compare observed versus expected event totals during 2012–2016: (1) stable baselines assume no rate changes, with modeled 2011 rates held constant through 2016; and (2) trend baselines assume 2006–2011 rate trends will continue, with the annual percent changes applied to the modeled 2011 rates to calculate expected 2012–2016 rates. Events prevented estimates during 2012–2013 were calculated using available data: 115 210 (95% CI, 60 858, 169 562) events were prevented using stable baselines and an excess of 43 934 (95% CI, −14 264, 102 132) events occurred using trend baselines. Women aged ≥75 had the most events prevented (stable, 76 242 [42 067, 110 417]; trend, 39 049 [1901, 76 197]). Men aged 45 to 64 had the greatest number of excess events (stable, 22 912 [95% CI, 855, 44 969]; trend, 38 810 [95% CI, 15 567, 62 053]).ConclusionsAround 115 000 events were prevented during the initiative's first 2 years compared with what would have occurred had 2011 rates remained stable. Recent flattening or reversals in some event rate trends were observed supporting intensifying national action to prevent cardiovascular events.

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Proportion of the Decline in Cardiovascular Mortality Disease due to Prevention Versus Treatment: Public Health Versus Clinical Care

Cited by 259 publications

References 112 publications

Equity and length of lifespan are not the same

Equity and length of lifespan are not the same

Temporal shifts in clinical presentation and underlying mechanisms of atherosclerotic disease

Million Hearts: Description of the National Surveillance and Modeling Methodology Used to Monitor the Number of Cardiovascular Events Prevented During 2012–2016

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