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Coronary heart disease trends in four United States communities. The Atherosclerosis Risk in Communities (ARIC) study
W D Rosamond1, A R Folsom, L E Chambless
1Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC 27514, USA. wayne_rosamond@unc.edu
Insights
Coronary heart disease (CHD) mortality and recurrent myocardial infarction rates declined significantly between 1987 and 1996 in the ARIC Study. Improved survival after myocardial infarction was observed, particularly reductions in sudden death.
Area of Science:
- Cardiovascular epidemiology
- Public health surveillance
- Clinical outcomes research
Background:
- Coronary heart disease (CHD) remains a significant public health concern.
- Understanding temporal trends in CHD mortality and morbidity is crucial for effective prevention and treatment strategies.
- The Atherosclerosis Risk in Communities (ARIC) Study provides a valuable dataset for examining these trends in diverse populations.
Purpose of the Study:
- To analyze trends in CHD mortality rates from 1987 to 1996.
- To assess changes in the incidence of first and recurrent hospitalized myocardial infarction (MI).
- To evaluate survival rates following MI within the ARIC Study cohort.
Main Methods:
- Retrospective community surveillance was employed to monitor CHD deaths and hospital admissions.
- Data included all residents aged 35-74 across four diverse US communities.
- Surveillance covered in-hospital and out-of-hospital CHD deaths and MI events.
Main Results:
- Age-adjusted CHD mortality rates decreased by 3.2% annually in men and 3.8% in women, with most decline between 1987-1991.
- Significant improvements in case-fatality rates post-MI were observed.
- Recurrent MI event rates declined significantly, though incident MI rates showed no significant change overall, except for an increase in Black individuals.
Conclusions:
- Declines in CHD mortality are likely attributable to factors reducing recurrent MI and improving survival, including decreased sudden cardiac death.
- These findings highlight the impact of interventions and evolving medical practices on cardiovascular outcomes.
- Continued monitoring of CHD trends is essential, with attention to specific demographic groups.
Objective:
The objective of this paper is to report trends in mortality due to coronary heart disease (CHD), rates of first and recurrent hospitalized myocardial infarction, and survival after myocardial infarction in the Atherosclerosis Risk in Communities (ARIC) Study from 1987 through 1996.
Method:
The ARIC study used retrospective community surveillance to monitor admissions to acute care hospitals and deaths due to CHD (both in- and out-of-hospital) among all residents 35-74 years of age. The surveillance areas included over 360 000 men and women in four communities: Forsyth County, North Carolina; the city of Jackson, Mississippi; eight northern suburbs of Minneapolis, Minnesota; and Washington County, Maryland.
Results:
The annual age-adjusted mortality rate of CHD fell 3.2% (95% CI: 2.0, 4.3) among men and 3.8% (95% CI: 1.9, 5.6) among women. The greater part of the decline took place between 1987 and 1991. Significant declines were observed for both in-hospital and out-of-hospital CHD death. Significant improvements in case-fatality were also observed. Recurrent hospitalized myocardial infarction event rate fell an average of 1.9% per year among men (95% CI: 0.7, 3.1) and 2.1% (95% CI: 0.3, 3.9) among women. Average annual per cent change in incident hospitalized myocardial infarction was not statistically significant, except in blacks where there was evidence of an increase over time.
Conclusion:
Factors associated with the occurrence of recurrent hospitalized myocardial infarction, as well as those creating a better chance of survival after an event (including reductions in sudden death), were likely the prominent components in the recent decline in CHD mortality in ARIC communities.