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Secular trends in coronary atherosclerosis--analysis in patients with valvular regurgitation
M Enriquez-Sarano1, E Klodas, K N Garratt
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Insights
Coronary artery disease prevalence remained stable in patients with valvular regurgitation from 1980-1989. This suggests the decline in coronary artery disease mortality may not stem from reduced atherosclerosis.
Area of Science:
- Cardiology
- Vascular Medicine
- Epidemiology
Background:
- Coronary artery disease (CAD) mortality declined in the US (1980-1989).
- This decline suggested a potential decrease in coronary atherosclerosis prevalence.
- The study investigated CAD in patients undergoing valve surgery.
Purpose of the Study:
- To examine trends in coronary atherosclerosis.
- To assess coronary artery disease prevalence and severity.
- To evaluate changes over a decade in patients with valvular regurgitation.
Main Methods:
- Coronary angiography data from 601 patients with nonischemic valvular regurgitation (1980-1989).
- Analysis of coronary artery disease prevalence, multivessel disease, and degree of stenosis.
- Statistical adjustment for age and sex.
Main Results:
- No significant change in coronary artery disease prevalence (35-37%).
- No significant change in multivessel disease prevalence (23-24%).
- No significant change in mean stenosis degree (P=0.07).
- Mean total cholesterol decreased (P=0.04).
Conclusions:
- Angiographic measures of coronary atherosclerosis did not change significantly.
- Findings contrast with the general population's declining CAD mortality.
- Reduced CAD mortality may not be linked to decreased atherosclerosis prevalence.
Background:
Between 1980 and 1989, mortality due to coronary artery disease decreased considerably in the United States, suggesting a possible decrease in the prevalence of coronary atherosclerosis. We examined this possibility in patients with valvular regurgitation who, often in the absence of angina, underwent coronary angiography before valve-replacement surgery.
Methods:
We studied 601 patients with isolated, nonischemic valvular regurgitation who were operated on between 1980 and 1989 and who had undergone preoperative coronary angiography. From the angiograms we determined the prevalence of clinically significant coronary artery disease and of multivessel disease, assessed the mean degree of stenosis, and analyzed the trends in the data over the years of the study.
Results:
The prevalence of coronary artery disease (35 percent in 1980-1981, 37 percent in 1982-1983, 34 percent in 1984-1985, 37 percent in 1986-1987, and 35 percent in 1988-1989; P = 0.97) did not change significantly during the study period. We found no significant change in the prevalence of multivessel disease (24 percent in 1980-1981 and 23 percent in 1988-1989, P = 0.99) or in the mean ( +/- SD) degree of stenosis (11 +/- 13 percent in 1980-1981 and 13 +/- 14 percent in 1988-1989, P = 0.07). When these measures of coronary atherosclerosis were adjusted for age and sex, there were still no significant changes over time (P = 0.39 for the prevalence of coronary artery disease, P = 0.81 for that of multivessel disease, and P = 0.57 for the mean degree of stenosis). The patients' mean total cholesterol level decreased from 219 +/- 48 mg per deciliter (5.66 +/- 1.24 mmol per liter) to 206 +/- 44 mg per deciliter (5.33 +/- 1.14 mmol per liter) between 1980 and 1989 (P = 0.04).
Conclusions:
From 1980 to 1989, no significant change was observed in angiographic measures of coronary atherosclerosis in patients with nonischemic valvular regurgitation, in contrast to the marked decrease in mortality due to coronary disease in the general population. These findings suggest that the well-documented reduction in mortality due to coronary disease may not be due to a reduction in the prevalence of coronary atherosclerosis.