Incidence and Epidemiology of Cardiovascular Disease:

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Presentation by Lee Goldman, MD, at TCT 2011 conference. Goldman is dean of the faculties of health sciences and medicine and executive vice president of Columbia University Medical Center. For more information, go to http://cumc.columbia.edu/newsroom or call 212-305-3900.

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Incidence and Epidemiology of Cardiovascular Disease:

  1. 1. Incidence and Epidemiology of Cardiovascular Disease:A National (and International) Success Story Lee Goldman, M.D. November, 2011
  2. 2. Disclosure Statement of Financial InterestWithin the past 12 months, I or my spouse/partner have had a financialinterest/arrangement or affiliation with the organization(s) listed below. Affiliation/Financial Relationship Company • Grant/Research Support • NIH • Consulting Fees/Honoraria • None • Major Stock Shareholder/Equity • None • Royalty Income • Elsevier (Cecil Textbook of Medicine) • Ownership/Founder • None • Intellectual Property Rights • None • Other Financial Benefit • None
  3. 3. Disclosure Statement of Financial Interest I, Lee Goldman, M.D., DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.
  4. 4. Change in Age Adjusted Death Rates Non-CVD Stroke Non-CVD CHD Adapted from 2009 Chartbook on Cardiovascular, Lung and Blood Diseases, NIH 2009:23
  5. 5. Annual Percent Change in Age-Adjusted CHD Death Rates in U.S. Time Period Annual % Change 1950-1960 + 0.7 1960-1970 - 0.1 1970-1980 - 3.1 1980-1990 - 3.1 1990-1998 - 2.8 1999-2006 - 5.1 Adapted from 2009 Chartbook on Cardiovascular, Lung and Blood Diseases, NIH 2009:34
  6. 6. Absolute Number of Heart Disease Deaths United States: 1900-2007 Deaths in Thousands Years Roger VL et al. Circulation 2011;123:e18-e209.
  7. 7. Hospital Discharges for Coronary Heart Disease by Sex, United States: 1970-2007 Discharges in Thousands Males Females Years Roger VL et al. Circulation 2011;123:e18-e209.
  8. 8. CHD Death Rates per 150,000 Men* Ages 35-74 Russia 706 Hungary 385 Scotland 195 U.S. 153 Canada 130 Urban China 108 France 58 Japan 48 * Rates in women are consistently about 30-40% as high as in men Roger VL et al. Circulation 2011;123:e18-e209.
  9. 9. Annual Percent Decline in CHD Death Rates in 7 European Countries 1980-2005 Denmark 4% Finland 3% France 3% Netherlands 4% Norway 3% Sweden 4% U.K. 3% Amiri M et al. J Epidemiol Community Health 2011; 65:676-681.
  10. 10. Age Adjusted 30 Day Mortality After MI Yeh et al. N Engl J Med 2010;362:2162
  11. 11. The Potential Contribution of Changing Drug Usage on the 30-DayMortality Reduction for Acute Myocardial Infarction from 1975 to 1995 35 30 25 20 15 10 5 0 A s es G oc A 1º in rin e H is do s In ker th ain Li tor B PT C C B ar s at ro spi PT ly A ep itr bi c C bo Th A hi er N A -Bl m O E C Data from Heidenreich et al. Am J Med 2001; 110:171
  12. 12. Beneficial Therapies for Myocardial Ischemia Approximate % mortality Therapy Setting reduction Aspirin CHD 31% Beta-blockers Post MI 27% ACE-inhibitors CHF or LVEF 26% Aggressive Rx ACS 26% CABG/PCI Stable CHD varies Cardiac rehab Post-MI 25%
  13. 13. Hypertension in the U.S. U.S. Population Age 20-74 with SBP ≥140 or DBP ≥90 1961 31% 1973 33% 1978 26% 1991 15% 2000 15% 2007 15% Gregg et al. JAMA 2005;293:1868-1874 and subsequent NHANES surveys
  14. 14. Cholesterol Levels in the U.S. U.S. population age 20-74 with total cholesterol ≥240 mg/dL 1961 34% 1973 28% 1978 27% 1991 19% 2000 17% 2004 16% 2007 15% Adapted from National Center for Health Statistics, Health, United States, 2008:314-16
  15. 15. Smoking in the U.S.U.S. population age 20-74 that smokes 1973 39% 1978 36% 1991 29% 2000 26% 2007 25% Gregg et al. JAMA 2005;293:1868-74 and subsequent NHANES surveys
  16. 16. Obesity in the U.S. U.S. population age 20-74 with BMI >30 1961 15% 1973 14% 1978 15% 1991 23% 2000 31% 2004 33% 2007 35%But blood pressure and especially cholesterol levels have gone down in the obese, apparently related to use of medications. Gregg et al. JAMA 2005;293:1868-74 and subsequent NHANES surveys
  17. 17. Diabetes in the U.S.U.S. Population Age 20-74 with Diabetes diagnosed all 1961 2% 1973 3% 1978 4% 5% 1991 5% 7% 2000 5% 8% 2007 7% 10% Gregg et al. JAMA 2005;293:1868-74 and subsequent NHANES surveys
  18. 18. Explaining the Decline in U.S. CHD Mortality Decreased Deaths Increased Deaths ▼ Cholesterol 24% ▼ Smoking 12% ▼ Blood Pressure 20% ▲ Physical Activity 5% ▲ BMI 8% ▲ Diabetes 10% 61% 18% = 44% Acute MI/ACS 10% Heart Failure 9% Medical Rx CHD 11% CHD, CABG/PCI 5% Other 12% 47% = 47% Ford ES et al. N Engl J Med 2007; 356-2388-2398
  19. 19. Explaining the Decline in U.S. CHD Mortality 1° 2° TotalCholesterol 15% 17% 32% Smoking 3% 3% 6% Blood Pressure 6% 7% 13%Total risk factor 24% 27% 51% MI case-fatality rate - 14% 14%Medical/surgical Rx CAD - 27% 27%Total 2° med/surg 41%Total 24% 68% 92%
  20. 20. Explaining the DeclineSummary of 2 Studies Risk Factors 44-51% Treatment 41-47%

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