CLINICAL RESEARCH: CORONARY ARTERY DISEASE
Coronary Heart Disease Mortality Among Young Adults in the U.S. From 1980 Through 2002Concealed Leveling of Mortality Rates
Earl S. Ford, MD, MPH*,* and
Simon Capewell, MD
* Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Department of Public Health, University of Liverpool, Liverpool, United Kingdom.
Manuscript received February 14, 2007;
revised manuscript received April 24, 2007,
accepted May 14, 2007.
* Reprint requests and correspondence: Dr. Earl S. Ford, Centers for Disease Control and Prevention, 4770 Buford Highway, MS K66, Atlanta, Georgia 30341. (Email: eford{at}cdc.gov).
 |
Abstract
|
|---|
Objectives: The objective of our study was to examine age-specific mortality rates from coronary heart disease (CHD), particularly those among younger adults.
Background: Trends for obesity, diabetes, blood pressure, and metabolic syndrome among young adults raise concerns about the mortality rates from CHD in this group.
Methods: We used mortality data from 1980 to 2002 to calculate age-specific mortality rates from CHD for U.S. adults age  35 years.
Results: Overall, the age-adjusted mortality rate decreased by 52% in men and 49% in women. Among women age 35 to 54 years, the estimated annual percentage change (EAPC) in mortality was –5.4% (95% confidence interval [CI] –5.8 to –4.9) from 1980 until 1989, –1.2% (95% CI –1.6 to –0.8) from 1989 until 2000, and 1.5% (95% CI –3.4 to 6.6) from 2000 until 2002. Among men age 35 to 54 years, the EAPC in mortality was –6.2% (95% CI –6.4 to –5.9) from 1980 until 1989, –2.3% (95% CI –2.6 to –2.1) from 1989 until 2000, and –0.5% (95% CI –3.7 to 2.9) from 2000 until 2002. Among women and men age 55 years, the estimated annual percentage decrease in mortality from CHD accelerated in more recent years compared with earlier periods.
Conclusions: The mortality rates for CHD among younger adults may serve as a sentinel event. Unfavorable trends in several risk factors for CHD provide a likely explanation for the observed mortality rates.
|
Abbreviations and Acronyms
| | CHD = coronary heart disease | | CI = confidence interval | | EAPC = estimated annual percentage change | | ICD = International Classification of Diseases |
|
In the U.S., mortality rates from coronary heart disease (CHD) have continued to decline steadily since 1968 (1). Nevertheless, CHD remains the leading cause of death and exacts a heavy social and economic toll. Improvements in population risk factors and in medical treatments of patients with CHD both contributed substantially to the declines seen between 1980 and 1990 (2).
Concern had been expressed that the rate of decline in the age-adjusted mortality rate from CHD has slowed during the 1990s compared with the earlier decade (3). The trends in the age-adjusted mortality rate may conceal differences in the trends in the age-specific rates, which have received little attention. The particularly unfavorable trends in several risk factors for CHD among young adults raises the possibility that the trends in the mortality rates from CHD among younger adults declined less than those in older ones (4–9). Therefore, our objective was to examine the trends in the age-specific rates for CHD among U.S. adults from 1980 to 2002, particularly among younger adults.
|
Methods
|
|---|
Vital statistics data from the U.S. were used (10). We limited our analyses to people age 35 years or older. The underlying cause of death from CHD was determined using the International Classification of Diseases (ICD)-9 codes 410-414 and 429.2 for 1980 to 1998 and ICD-10 codes I20-I25 for 1999 to 2002. Population counts from the U.S. Census were used to calculate rates. We used census counts for the years 1980, 1990, and 2000 and intercensal estimates for the other years. Age adjustment was performed using the direct method to the estimated U.S. population of the year 2000 (11).
We used the software Joinpoint, version 3.0 (National Cancer Institute, Bethesda, Maryland), to examine changes in the annual percentage change in mortality rates from CHD (12). This software uses a Monte Carlo permutation test to identify points where the direction or magnitude of the trend changes and then fits the simplest model containing the fewest number of trend segments. We specified a maximum number of 3 joinpoints and assumed a Poisson distribution. For each segment, the software calculates the estimated annual percentage change (EAPC) and its 95% confidence interval (CI). In addition, the software tests whether the slope of each trend segment differs significantly from the segment immediately preceding it by using a t test.
|
Results
|
|---|
The overall age-adjusted mortality rate declined from 1980 through 2002 by 52% in men and by 49% in women (Fig. 1). The average annual rate of decline for men was 2.9% during the 1980s, decreasing to 2.6% during the 1990s, and for women, it was 2.6% decreasing to 2.4%. From 2000 through 2002, the average annual rate of decline was 4.4% for both men and women.
View larger version (14K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 1 Trends in Age-Adjusted Mortality Rates From Coronary Heart Disease
Among both U.S. men and women age 35 years, the age-adjusted mortality rates from coronary heart disease have decreased steadily from 1980 through 2002.
|
|
The age-adjusted rates concealed striking differences in the trends in age-specific rates (Tables 1 and 2, Fig. 2). When the overall time period was split into 2, the robust decrease in mortality rates that was observed for both men and women age 35 to 54 years during the period from 1980 to 1990 decelerated significantly for both genders during the period from 1991 to 2002. For those age 55 years, however, the rate of decrease was larger in the later period than the earlier one for both genders.
View this table:
[in this window]
[in a new window]
|
Table 1 EAPC in Unadjusted Mortality Rates From Coronary Heart Disease Among U.S. Adults Age 35 Years, 1980 to 2002
|
|
View this table:
[in this window]
[in a new window]
|
Table 2 EAPC in Age-Specific Mortality Rates From Coronary Heart Disease Among U.S. Adults Age 35 Years, 1980 to 2002
|
|
View larger version (46K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 2 Trends in Age-Specific Mortality Rates From Coronary Heart Disease
Among adults age 35 to 44 years, the mortality rate from coronary heart disease changed little among women (squares) since the late 1980s and showed evidence of leveling off in more recent years among men (triangles). Among adults age 45 to 54 years, the rate of decline in the mortality rate from coronary heart disease slowed around 1990 in both men and women.
|
|
To provide a more nuanced examination of the data in each gender and age group, changes in the trend during the 23-year period were detected by Joinpoint regression modeling. Among women age 35 to 54 years, mortality decreased significantly by 5.4% from 1980 to 1989, slowed to an annual rate of decrease of 1.2%, and turned positive between 2000 and 2002, albeit with a wide CI that included 0%. Among men age 35 to 54 years, the mortality rate decreased by 6.2% per year from 1980 to 1989, slowed to 2.3% per year from 1989 to 2000, and leveled off between 2000 and 2002. Among women age 55 years, the EAPC was –1.5% between 1980 and 1999 and accelerated to –4.8% from 1999 until 2002. Among men age 55 years, the EAPC was –2.6% between 1980 and 1990, slowed to 1.9% from 1990 to 1996, and accelerated to –3.7% from 1996 until 2002.
|
Discussion
|
|---|
The trends for mortality from CHD among U.S. adults age 35 to 54 years are disquieting. The EAPC slowed markedly from 1980 to 2002 in both men and women. Particularly noteworthy is that the mortality rate among women age 35 to 44 years has been increasing on average by 1.3% (95% CI 0.2 to 2.5) per year since 1997.
Changes in mortality rates generally reflect changes in incidence and case-fatality rate (13). Unfortunately, solid data about incidence of CHD in the U.S. are not readily available. Many studies use hospitalization rates as a rather unsatisfactory proxy that can be difficult to interpret (14). Thus, data from the Worcester Heart study and Olmsted County both reported decreases in incidence from the late 1970s into the late 1980s (15,16). Data from the Nurses’ Health study from 1980 to 1994 also reported a reduction in the incidence of CHD among participants age 34 to 59 years (17). Conversely, an analysis of data from the Atherosclerosis Risk in Communities study reported an increase in the incidence of hospitalizations for myocardial infarction between 1987 and 1994 among residents age 35 to 74 years (18). A subsequent analysis of the data from this same study showed a decrease in the hospitalization rate of non–ST-segment elevation acute coronary syndrome between 1987 and 1994 (19). Among women living in Olmsted County, the incidence of CHD appeared to have increased during the early 1990s (16). An analysis of data from the National Health and Nutrition Examination Survey I Epidemiologic Follow-up study suggested that both reductions in incidence and case-fatality rates contributed to the decline in cardiovascular disease between 1971 and 1992, as in other industrialized countries (20). Data from the Framingham Heart study showed declines in mortality from sudden cardiac death and nonsudden CHD between 1950 and 1999, suggesting that both primary and secondary prevention contributed to the declines (21). Reductions in the case-fatality rate for CHD have been reported consistently (15,16,18,19,22–25).
Unfortunately, data concerning the incidence and case-fatality rates of CHD among young adults are not readily available. However, the unfavorable trends during the 1990s in mortality rates from CHD among young adults coincided with a substantial deterioration in several risk factors for CHD. Considerable increases in abdominal obesity, diabetes, and hypertension in younger adults (4,5,8,9) have been compounded by stasis in cholesterol concentrations (6,7).
The increases in the prevalence of obesity and diabetes in the U.S. since 1976 to 1980 (26–28) and the increases in the prevalence of the metabolic syndrome and hypertension during the 1990s (5,8) are potential warning signs that the hard-fought gains in mortality improvements might be arrested or even reversed. In addition, the decline in concentrations of total cholesterol slowed during the 1990s, even as the use of cholesterol-lowering medications escalated (6,7). However, the prevalence of smoking continues to decline (29), and a slight decrease in the proportion of U.S. adults who are totally sedentary during leisure time has also occurred during the late 1990s (30). As a result of the conflicting trends in the various risk factors, the risk of CHD as determined by the National Cholesterol Education Program risk score for CHD has not changed (31).
The adverse mortality trends in young adults have occurred despite the increasingly wide use of evidence-based therapies such as angioplasty, thrombolysis, angiotensin-converting enzyme inhibitors, statins, and antiplatelet agents. This suggests that a vigorous public health response is needed to address lifestyle behaviors. Efforts to accelerate the past declines in smoking must be continued. Increased efforts to improve diet are now urgently required (32,33). Policy change at the national and state levels potentially offers the most effective and cost-effective interventions (33,34). To prevent obesity, energy intake must be less than energy expenditure. For many, messages of caloric restriction and increased physical activity, therefore, need to be amplified. Clinicians should also be aware of the unfavorable trends in coronary heart disease among younger adults in recent years and vigorously screen for risk factors for cardiovascular disease as recommended by guidelines and provide counsel about appropriate lifestyle behaviors. For patients found to have 1 or more risk factors, clinicians should optimally manage these risk factors according to prevailing guidelines.
Timely actions could potentially transform the abhorrent risk factor profile that currently characterizes much of the U.S. population and counteract the adverse trends that are now killing younger adults. Complacency runs a high risk: mortality rates among younger adults may represent the leading edge of a brewing storm.
|
Appendix
|
|---|
For the annual percent changes in mortality rates from CHD among U.S. adults age 35 years by gender and age group, please see the online version of this article.
|
Footnotes
|
|---|
The findings and conclusions in this article are those of the authors and do not represent the views of the Centers for Disease Control and Prevention.
|
References
|
|---|
1. National Institutes for Health, National Heart, Lung, and Blood Institute. Morbidity and Mortality: 2007 Chartbook on Cardiovascular, Lung, and Blood Diseases. Available at: http://www.nhlbi.nih.gov/resources/docs/07_chtbk.pdf. Accessed October 15, 2007.2. Hunink MG, Goldman L, Tosteson AN, et al. The recent decline in mortality from coronary heart disease, 1980–1990The effect of secular trends in risk factors and treatment. JAMA 1997;277:535-542.[Abstract/Free Full Text] 3. Cooper R, Cutler J, Desvigne-Nickens P, et al. Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States: findings of the National Conference on Cardiovascular Disease Prevention Circulation 2000;102:3137-3147.[Abstract/Free Full Text] 4. Ford ES, Mokdad AH, Giles WH. Trends in waist circumference among U.S. adults Obes Res 2003;11:1223-1231.[Web of Science][Medline] 5. Ford ES, Giles WH, Mokdad AH. Increasing prevalence of the metabolic syndrome among U.S. adults Diabetes Care 2004;27:2444-2449.[Abstract/Free Full Text] 6. Ford ES, Mokdad AH, Giles WH, Mensah GA. Serum total cholesterol concentrations and awareness, treatment, and control of hypercholesterolemia among US adults: findings from the National Health and Nutrition Examination Survey, 1999–2000 Circulation 2003;107:2185-2189.[Abstract/Free Full Text] 7. Carroll MD, Lacher DA, Sorlie PD, et al. Trends in serum lipids and lipoproteins of adults, 1960–2002 JAMA 2005;294:1773-1781.[Abstract/Free Full Text] 8. Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000 JAMA 2003;290:199-206.[Abstract/Free Full Text] 9. Centers for Disease Control and Prevention Prevalence of diabetes and impaired fasting glucose in adults—United States, 1999–2000 MMWR Morb Mortal Wkly Rep 2003;52:833-837.[Medline] 10. Centers for Disease Control and Prevention. Compressed Mortality File. Underlying Cause-of-Death. Available at: http://wonder.cdc.gov/mortSQL.html. Accessed May 9, 2006. 11. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People 2010 Statistical Notes, No. 20, 2001. Available at: http://0-www.cdc.gov.mill1.sjlibrary.org/nchs/data/statnt/statnt20.pdf. Accessed October 15, 2007. 12. Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates Stat Med 2000;19:335-351.[CrossRef][Web of Science][Medline] 13. Tunstall-Pedoe H, Kuulasmaa K, Mahonen M, Tolonen H, Ruokokoski E, Amouyel P. Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA project populationsMonitoring trends and determinants in cardiovascular disease. Lancet 1999;353:1547-1557.[CrossRef][Web of Science][Medline] 14. Pearson TA. The epidemiologic basis for population-wide cholesterol reduction in the primary prevention of coronary artery disease Am J Cardiol 2004;94:4F-8F.[CrossRef][Web of Science][Medline] 15. Goldberg RJ, Yarzebski J, Lessard D, Gore JM. A two-decades (1975 to 1995) long experience in the incidence, in-hospital and long-term case-fatality rates of acute myocardial infarction: a community-wide perspective J Am Coll Cardiol 1999;33:1533-1539.[Abstract/Free Full Text] 16. Roger VL, Jacobsen SJ, Weston SA, et al. Trends in the incidence and survival of patients with hospitalized myocardial infarction, Olmsted County, Minnesota, 1979 to 1994 Ann Intern Med 2002;136:341-348.[Abstract/Free Full Text] 17. Hu FB, Stampfer MJ, Manson JE, et al. Trends in the incidence of coronary heart disease and changes in diet and lifestyle in women N Engl J Med 2000;343:530-537.[CrossRef][Web of Science][Medline] 18. Rosamond WD, Chambless LE, Folsom AR, et al. Trends in the incidence of myocardial infarction and in mortality due to coronary heart disease, 1987 to 1994 N Engl J Med 1998;339:861-867.[CrossRef][Web of Science][Medline] 19. Watkins S, Thiemann D, Coresh J, Powe N, Folsom AR, Rosamond W. Fourteen-year (1987 to 2000) trends in the attack rates of, therapy for, and mortality from non–ST-elevation acute coronary syndromes in four United States communities Am J Cardiol 2005;96:1349-1355.[CrossRef][Web of Science][Medline] 20. Ergin A, Muntner P, Sherwin R, He J. Secular trends in cardiovascular disease mortality, incidence, and case fatality rates in adults in the United States Am J Med 2004;117:219-227.[CrossRef][Web of Science][Medline] 21. Fox CS, Evans JC, Larson MG, Kannel WB, Levy D. Temporal trends in coronary heart disease mortality and sudden cardiac death from 1950 to 1999: the Framingham Heart Study Circulation 2004;110:522-527.[Abstract/Free Full Text] 22. Burke GL, Sprafka JM, Folsom AR, Luepker RV, Norsted SW, Blackburn H. Trends in CHD mortality, morbidity and risk factor levels from 1960 to 1986: the Minnesota Heart Survey Int J Epidemiol 1989;18(Suppl 1):S73-S81.[Web of Science][Medline] 23. Derby CA, Lapane KL, Feldman HA, Carleton RA. Sex-specific trends in validated coronary heart disease rates in southeastern New England, 1980–1991 Am J Epidemiol 2000;151:417-429.[Abstract/Free Full Text] 24. McGovern PG, Jacobs Jr. DR, Shahar E, et al. Trends in acute coronary heart disease mortality, morbidity, and medical care from 1985 through 1997: the Minnesota Heart Survey Circulation 2001;104:19-24.[Abstract/Free Full Text] 25. Yarzebski J, Bujor CF, Lessard D, Gore JM, Goldberg RJ. Recent and temporal trends (1975 to 1999) in the treatment, hospital, and long-term outcomes of Hispanic and non-Hispanic white patients hospitalized with acute myocardial infarction: a population-based perspective Am Heart J 2004;147:690-697.[CrossRef][Web of Science][Medline] 26. Flegal KM, Carroll, MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999–2000 JAMA 2002;288:1723-1727.[Abstract/Free Full Text] 27. Harris MI, Hadden WC, Knowler WC, Bennett PH. Prevalence of diabetes and impaired glucose tolerance and plasma glucose levels in U.S. population aged 20–74 years Diabetes 1987;36:523-534.[Abstract] 28. Harris MI, Flegal KM, Cowie CC, et al. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adultsThe Third National Health and Nutrition Examination Survey, 1988–1994. Diabetes Care 1998;21:518-524.[Abstract/Free Full Text] 29. Centers for Disease Control and Prevention. Percentage of adults who were current, former, or never smokers, overall and by sex, race, Hispanic origin, age, education, and poverty status. National Health Interview Surveys, Selected Years—United States, 1965–2004. Available at: http://www.cdc.gov/tobacco/data_statistics/tables/adult/table_2.htm. Accessed October 15, 2007. 30. Centers for Disease Control and Prevention Prevalence of no leisure-time physical activity—35 states and the District of Columbia, 1988–2002 MMWR Morb Mortal Wkly Rep 2004;53:82-86.[Medline] 31. Ajani UA, Ford ES. Has the risk for coronary heart disease changed among US adults? J Am Coll Cardiol 2006;48:1177-1182.[Abstract/Free Full Text] 32. Havas S, Roccella EJ, Lenfant C. Reducing the public health burden from elevated blood pressure levels in the United States by lowering intake of dietary sodium Am J Public Health 2004;94:19-22.[Web of Science][Medline] 33. U.S. Department of Health and Human Services A Public Health Action Plan to Prevent Heart Disease and StrokeAtlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2003. 34. Unal B, Critchley JA, Capewell S. Modelling the decline in coronary heart disease deaths in England and Wales, 1981–2000: comparing contributions from primary prevention and secondary prevention BMJ 2005;331:614-617.[Abstract/Free Full Text]
Related Articles
-
Inside This Issue of JACC
J. Am. Coll. Cardiol. 2007 50: A32.
[Full Text]
[PDF]
-
Time to End the Mixed—and Often Incorrect—Messages About Prevention and Treatment of Atherosclerotic Cardiovascular Disease
- Philip Greenland and Donald Lloyd-Jones
J. Am. Coll. Cardiol. 2007 50: 2133-2135.
[Full Text]
[PDF]
This article has been cited by other articles:
|
|
|
|
 
B. Lubiszewska, M. Kruk, G. Broda, E. Ksiezycka, W. Piotrowski, P. Kurjata, T. Zielinski, and R. Ploski
The impact of early menopause on risk of coronary artery disease (PREmature Coronary Artery Disease In Women - PRECADIW case-control study)
European Journal of Cardiovascular Prevention & Rehabilitation,
February 1, 2012;
19(1):
95 - 101.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. P. Vamos, C. Millett, C. Parsons, P. Aylin, A. Majeed, and A. Bottle
Nationwide Study on Trends in Hospital Admissions for Major Cardiovascular Events and Procedures Among People With and Without Diabetes in England, 2004-2009
Diabetes Care,
February 1, 2012;
35(2):
265 - 272.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Writing Group Members, V. L. Roger, A. S. Go, D. M. Lloyd-Jones, E. J. Benjamin, J. D. Berry, W. B. Borden, D. M. Bravata, S. Dai, E. S. Ford, et al.
Heart Disease and Stroke Statistics--2012 Update: A Report From the American Heart Association
Circulation,
January 3, 2012;
125(1):
e2 - e220.
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. R. S. Fernandes and J. A. C. Lima
Functional Coronary Imaging with Magnetic Resonance: A "Renaissance"?
Radiology,
December 1, 2011;
261(3):
685 - 687.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Mosca, E. Barrett-Connor, and N. Kass Wenger
Sex/Gender Differences in Cardiovascular Disease Prevention: What a Difference a Decade Makes
Circulation,
November 8, 2011;
124(19):
2145 - 2154.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. P. Gale, B. A. Cattle, A. Woolston, P. D. Baxter, T. H. West, A. D. Simms, J. Blaxill, D. C. Greenwood, K. A. A. Fox, and R. M. West
Resolving inequalities in care? Reduced mortality in the elderly after acute coronary syndromes. The Myocardial Ischaemia National Audit Project 2003-2010
Eur. Heart J.,
October 18, 2011;
(2011)
ehr381v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. W. Y. Lee and S. L. T. Law
Ten-year cardiovascular risk in the general public of Hong Kong
Heart Asia,
September 10, 2011;
3(1):
111 - 114.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. W. Hotchkiss, C. Davies, L. Gray, C. Bromley, S. Capewell, and A. H. Leyland
Trends in adult cardiovascular disease risk factors and their socio-economic patterning in the Scottish population 1995-2008: cross-sectional surveys
BMJ Open,
September 2, 2011;
1(1):
e000176 - e000176.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. G. Steg and S. H. Dorman
The evolving nature of coronary artery disease
Eur. Heart J. Suppl.,
September 1, 2011;
13(suppl_C):
C14 - C18.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A.-S. Sonne Holm, G. Stentebjerg Olsen, A. Borglykke, and T. Jorgensen
Estimating the proportion of Danes at high risk of fatal cardiovascular disease
Scand J Public Health,
August 1, 2011;
39(6):
571 - 576.
[Abstract]
[PDF]
|
|
|
|
|
|
|
E. N. Reither, S. J. Olshansky, and Y. Yang
New Forecasting Methodology Indicates More Disease And Earlier Mortality Ahead For Today's Younger Americans
Health Aff.,
August 1, 2011;
30(8):
1562 - 1568.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Vaartjes, M. O'Flaherty, D. E. Grobbee, M. L. Bots, and S. Capewell
Coronary heart disease mortality trends in the Netherlands 1972-2007
Heart,
April 1, 2011;
97(7):
569 - 573.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Vaccarino, L. Badimon, R. Corti, C. de Wit, M. Dorobantu, A. Hall, A. Koller, M. Marzilli, A. Pries, R. Bugiardini, et al.
Ischaemic heart disease in women: are there sex differences in pathophysiology and risk factors?: Position Paper from the Working Group on Coronary Pathophysiology and Microcirculation of the European Society of Cardiology
Cardiovasc Res,
April 1, 2011;
90(1):
9 - 17.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Briffa, L. Nedkoff, A. Peeters, A. Tonkin, J. Hung, S. C. Ridout, and M. Knuiman
Discordant age and sex-specific trends in the incidence of a first coronary heart disease event in Western Australia from 1996 to 2007
Heart,
March 1, 2011;
97(5):
400 - 404.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. L. Roger, A. S. Go, D. M. Lloyd-Jones, R. J. Adams, J. D. Berry, T. M. Brown, M. R. Carnethon, S. Dai, G. de Simone, E. S. Ford, et al.
Heart Disease and Stroke Statistics--2011 Update: A Report From the American Heart Association
Circulation,
February 1, 2011;
123(4):
e18 - e209.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Knight
Diseases and Disorders Associated with Excess Body Weight
Ann. Clin. Lab. Sci.,
January 1, 2011;
41(2):
107 - 121.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. G. Briffa, M. S. Hobbs, A. Tonkin, F. M. Sanfilippo, S. Hickling, S. C. Ridout, and M. Knuiman
Population Trends of Recurrent Coronary Heart Disease Event Rates Remain High
Circ Cardiovasc Qual Outcomes,
January 1, 2011;
4(1):
107 - 113.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Giannarelli, B. Ibanez, G. Cimmino, J. M. Garcia Ruiz, F. Faita, E. Bianchini, M. U. Zafar, V. Fuster, M. J. Garcia, and J. J. Badimon
Contrast-Enhanced Ultrasound Imaging Detects Intraplaque Neovascularization in an Experimental Model of Atherosclerosis
J. Am. Coll. Cardiol. Img.,
December 1, 2010;
3(12):
1256 - 1264.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Capewell and D. M. Lloyd-Jones
Optimal Cardiovascular Prevention Strategies for the 21st Century
JAMA,
November 10, 2010;
304(18):
2057 - 2058.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Kones
Low-Fat Versus Low-Carbohydrate Diets, Weight Loss, Vascular Health, and Prevention of Coronary Artery Disease: The Evidence, the Reality, the Challenge, and the Hope
Nutr Clin Pract,
October 1, 2010;
25(5):
528 - 541.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Assmann, P. Cullen, and H. Schulte
Non-LDL-related dyslipidaemia and coronary risk: a case-control study
Diabetes and Vascular Disease Research,
July 1, 2010;
7(3):
204 - 212.
[Abstract]
[PDF]
|
|
|
|
|
|
|
C. J. Lavie, R. V. Milani, H. O. Ventura, and A. Romero-Corral
Body Composition and Heart Failure Prevalence and Prognosis: Getting to the Fat of the Matter in the "Obesity Paradox"
Mayo Clin. Proc.,
July 1, 2010;
85(7):
605 - 608.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Sims, R. Maxwell, L. Bauld, and A. Gilmore
Short term impact of smoke-free legislation in England: retrospective analysis of hospital admissions for myocardial infarction
BMJ,
June 8, 2010;
340(jun08_1):
c2161 - c2161.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. J. Sutton, J. Marsden, C. L. Watkins, M. J. Leathley, and P. Dey
Changing stroke mortality trends in middle-aged people: an age-period-cohort analysis of routine mortality data in persons aged 40 to 69 in England
J Epidemiol Community Health,
June 1, 2010;
64(6):
523 - 529.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. M. Lloyd-Jones
Cardiovascular Risk Prediction: Basic Concepts, Current Status, and Future Directions
Circulation,
April 20, 2010;
121(15):
1768 - 1777.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. J. Gersh, K. Sliwa, B. M. Mayosi, and S. Yusuf
Novel therapeutic concepts * The epidemic of cardiovascular disease in the developing world: global implications
Eur. Heart J.,
March 2, 2010;
31(6):
642 - 648.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. K. Wenger
The Female Heart Is Vulnerable to Cardiovascular Disease: Emerging Prevention Evidence for Women Must Inform Emerging Prevention Strategies for Women
Circ Cardiovasc Qual Outcomes,
March 1, 2010;
3(2):
118 - 119.
[Full Text]
[PDF]
|
|
|
|
|
|
|
WRITING GROUP MEMBERS, D. Lloyd-Jones, R. J. Adams, T. M. Brown, M. Carnethon, S. Dai, G. De Simone, T. B. Ferguson, E. Ford, K. Furie, et al.
Heart Disease and Stroke Statistics--2010 Update: A Report From the American Heart Association
Circulation,
February 23, 2010;
121(7):
e46 - e215.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. M. Lloyd-Jones, Y. Hong, D. Labarthe, D. Mozaffarian, L. J. Appel, L. Van Horn, K. Greenlund, S. Daniels, G. Nichol, G. F. Tomaselli, et al.
Defining and Setting National Goals for Cardiovascular Health Promotion and Disease Reduction: The American Heart Association's Strategic Impact Goal Through 2020 and Beyond
Circulation,
February 2, 2010;
121(4):
586 - 613.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. K. Marma, J. D. Berry, H. Ning, S. D. Persell, and D. M. Lloyd-Jones
Distribution of 10-Year and Lifetime Predicted Risks for Cardiovascular Disease in US Adults: Findings From the National Health and Nutrition Examination Survey 2003 to 2006
Circ Cardiovasc Qual Outcomes,
January 1, 2010;
3(1):
8 - 14.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. A. Henderson and L. Lee
Chapter 1 The epidemiology and pathophysiology of coronary artery disease
Oxford Textbook of Interventional Cardiology,
January 1, 2010;
1(1):
med-9780199569083-chapter - med-9780199569083-chapter.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
B. E. Alvarado, S. Harper, R. W. Platt, G. D. Smith, and J. Lynch
Would Achieving Healthy People 2010's Targets Reduce Both Population Levels and Social Disparities in Heart Disease?
Circ Cardiovasc Qual Outcomes,
November 1, 2009;
2(6):
598 - 606.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Vaccarino, L. Parsons, E. D. Peterson, W. J. Rogers, C. I. Kiefe, and J. Canto
Sex Differences in Mortality After Acute Myocardial Infarction: Changes From 1994 to 2006
Arch Intern Med,
October 26, 2009;
169(19):
1767 - 1774.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. J. Shaw, R. Bugiardini, and C. N. B. Merz
Women and Ischemic Heart Disease: Evolving Knowledge
J. Am. Coll. Cardiol.,
October 20, 2009;
54(17):
1561 - 1575.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. M. van Dam and W. C. Willett
Unmet Potential for Cardiovascular Disease Prevention in the United States
Circulation,
September 29, 2009;
120(13):
1171 - 1173.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. A. Kaufmann
Ultrasound molecular imaging of atherosclerosis
Cardiovasc Res,
September 1, 2009;
83(4):
617 - 625.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Rosengren
Declining cardiovascular mortality and increasing obesity: a paradox
Can. Med. Assoc. J.,
August 4, 2009;
181(3-4):
127 - 128.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. H Leyland and J. W Lynch
Why has mortality from coronary heart disease in young adults levelled off?
BMJ,
July 14, 2009;
339(jul14_3):
b2515 - b2515.
[Full Text]
|
|
|
|
|
|
|
M. O'Flaherty, J. Bishop, A. Redpath, T. McLaughlin, D. Murphy, J. Chalmers, and S. Capewell
Coronary heart disease mortality among young adults in Scotland in relation to social inequalities: time trend study
BMJ,
July 14, 2009;
339(jul14_3):
b2613 - b2613.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R.M. Reynolds, B. Ilyas, J.F. Price, F.G.R. Fowkes, D.E. Newby, D.J. Webb, and B.R. Walker
Circulating plasma cortisol concentrations are not associated with coronary artery disease or peripheral vascular disease
QJM,
July 1, 2009;
102(7):
469 - 475.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Capewell and M. O'Flaherty
Trends in cardiovascular disease: Are we winning the war?
Can. Med. Assoc. J.,
June 23, 2009;
180(13):
1285 - 1286.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. V. Tu, L. Nardi, J. Fang, J. Liu, L. Khalid, H. Johansen, and for the Canadian Cardiovascular Outcomes Research
National trends in rates of death and hospital admissions related to acute myocardial infarction, heart failure and stroke, 1994-2004
Can. Med. Assoc. J.,
June 23, 2009;
180(13):
E118 - E125.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. J. Lavie, R. V. Milani, and H. O. Ventura
Obesity and Cardiovascular Disease: Risk Factor, Paradox, and Impact of Weight Loss
J. Am. Coll. Cardiol.,
May 26, 2009;
53(21):
1925 - 1932.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M Mirzaei, A S Truswell, R Taylor, and S R Leeder
Coronary heart disease epidemics: not all the same
Heart,
May 1, 2009;
95(9):
740 - 746.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Sanz, P. R. Moreno, and V. Fuster
The Year in Atherothrombosis
J. Am. Coll. Cardiol.,
April 14, 2009;
53(15):
1326 - 1337.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. J. Gardner
Building a Healthier World, Free of Cardiovascular Diseases and Stroke: Presidential Address at the American Heart Association 2008 Scientific Sessions
Circulation,
April 7, 2009;
119(13):
1838 - 1841.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Cook
Hypercholesterolemia Among Children: When Is It High, and When Is It Really High?
Circulation,
March 3, 2009;
119(8):
1075 - 1077.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. S. Gidding, A. H. Lichtenstein, M. S. Faith, A. Karpyn, J. A. Mennella, B. Popkin, J. Rowe, L. Van Horn, and L. Whitsel
Implementing American Heart Association Pediatric and Adult Nutrition Guidelines: A Scientific Statement From the American Heart Association Nutrition Committee of the Council on Nutrition, Physical Activity and Metabolism, Council on Cardiovascular Disease in the Young, Council on Arteriosclerosis, Thrombosis and Vascular Biology, Council on Cardiovascular Nursing, Council on Epidemiology and Prevention, and Council for High Blood Pressure Research
Circulation,
March 3, 2009;
119(8):
1161 - 1175.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Mora
Aspirin Therapy in Women: Back to the ABCs
Circ Cardiovasc Qual Outcomes,
March 1, 2009;
2(2):
63 - 64.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. C. Gulliford and J. Charlton
Is Relative Mortality of Type 2 Diabetes Mellitus Decreasing?
Am. J. Epidemiol.,
February 15, 2009;
169(4):
455 - 461.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
WRITING GROUP MEMBERS, D. Lloyd-Jones, R. Adams, M. Carnethon, G. De Simone, T. B. Ferguson, K. Flegal, E. Ford, K. Furie, A. Go, et al.
Heart Disease and Stroke Statistics--2009 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Circulation,
January 27, 2009;
119(3):
e21 - e181.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. O'Hara, K. Bennett, M. O'Flaherty, and S. Jennings
Pace of change in coronary heart disease mortality in Finland, Ireland and the United Kingdom from 1985 to 2006
Eur J Public Health,
December 1, 2008;
18(6):
581 - 585.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J.-C. Fruchart, F. M Sacks, M. P Hermans, G. Assmann, W V. Brown, R. Ceska, M J. Chapman, P. M Dodson, P. Fioretto, H. N Ginsberg, et al.
The Residual Risk Reduction Initiative: a call to action to reduce residual vascular risk in dyslipidaemic patients
Diabetes and Vascular Disease Research,
November 1, 2008;
5(4):
319 - 335.
[Abstract]
[PDF]
|
|
|
|
|
|
|
S. Capewell and M. O'Flaherty
What explains declining coronary mortality? Lessons and warnings
Heart,
September 1, 2008;
94(9):
1105 - 1108.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. E. Litwin
Which Measures of Obesity Best Predict Cardiovascular Risk?
J. Am. Coll. Cardiol.,
August 19, 2008;
52(8):
616 - 619.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Stang
Quotations From Anticipated Coronary Heart Disease Mortality Trends
J. Am. Coll. Cardiol.,
August 5, 2008;
52(6):
498 - 498.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. S. Bassuk and J. E. Manson
Lifestyle and Risk of Cardiovascular Disease and Type 2 Diabetes in Women: A Review of the Epidemiologic Evidence
American Journal of Lifestyle Medicine,
June 1, 2008;
2(3):
191 - 213.
[Abstract]
[PDF]
|
|
|
|
|
|
|
A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, P. Clopton, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, J. D. Knoke, W. Y.W. Lew, J. A.C. Lima, et al.
Highlights of the Year in JACC 2007
J. Am. Coll. Cardiol.,
January 29, 2008;
51(4):
490 - 512.
[Full Text]
[PDF]
|
|
|
|
|
|
|
On the Rise: Waistlines . . . and Coronary Death Rates
Journal Watch Women's Health,
December 20, 2007;
2007(1220):
2 - 2.
[Full Text]
|
|
|
|
|
|
|
Are We Losing the War Against Heart Disease?
Journal Watch Cardiology,
November 28, 2007;
2007(1128):
1 - 1.
[Full Text]
|
|
|
|
|
|
|
P. Greenland and D. Lloyd-Jones
Time to End the Mixed and Often Incorrect Messages About Prevention and Treatment of Atherosclerotic Cardiovascular Disease
J. Am. Coll. Cardiol.,
November 27, 2007;
50(22):
2133 - 2135.
[Full Text]
[PDF]
|
|
|
|
Top
Abstract
Methods