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Published on: August 9, 2024
Epidemiology of Coronary Artery Disease
John P Duggan1, Alex S Peters1, Gregory D Trachiotis2
1Department of Surgery, Walter Reed National Military Medical Center, 4494 Palmer Road North, Bethesda, MD 20814, USA.
Insights
Coronary artery disease (CAD) remains a leading cause of death despite declining mortality. Treatment advances like coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are seeing reduced use in the US.
Area of Science:
- Cardiovascular Medicine
- Public Health Epidemiology
Background:
- Coronary artery disease (CAD) persists as a major cause of death and economic burden in the US.
- While some CAD risk factors like smoking and hypertension are decreasing, others such as diabetes and obesity are rising.
- Despite advances in treatments like coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), their utilization has declined.
Purpose of the Study:
- To analyze trends in CAD mortality, risk factors, and treatment utilization in the US.
- To understand the evolving patient profile undergoing CABG.
- To assess the implications of these trends on cardiovascular care.
Main Methods:
- Review of epidemiologic studies on CAD risk factors.
- Analysis of national trends in CABG and PCI procedures.
- Examination of patient demographics and comorbidities for CABG recipients.
Main Results:
- CAD mortality has decreased, but it remains the leading cause of death in the US.
- The prevalence of certain CAD risk factors is increasing (e.g., diabetes, obesity).
- There has been a decade-long decline in CABG and PCI procedures, with CABG patients becoming older and sicker, yet mortality remains stable.
Conclusions:
- Contemporary CAD management focuses on prevention and evidence-based revascularization.
- The declining use of CABG and PCI warrants further investigation.
- Despite an aging and more comorbid CABG population, procedural mortality has not increased, suggesting improved surgical outcomes or patient selection.
Abstract:
Although the mortality of coronary artery disease (CAD) has declined over recent decades, CAD remains the leading cause of death in the United States (US) and presents a significant economic burden. Epidemiologic studies have identified numerous risk factors for CAD. Some risk factors-including smoking, hypertension, dyslipidemia, and physical inactivity-are decreasing within the US population while Others, including advanced age, diabetes, and obesity are increasing. The most significant historic advances in CAD therapy were the development of coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), and lipid-lowering medications. Contemporary management of CAD includes primary and secondary prevention via medical management and revascularization when appropriate based on best available evidence. Despite the increasing prevalence of CAD nationwide, there has been a steady decline in the number of CABGs and PCIs performed in the US for the past decade. Patients with CABG are becoming older and with more comorbid conditions, although mortality associated with CABG has remained steady.
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