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.

1. Incidence and Epidemiology
of Cardiovascular Disease:
A National (and International)
Success Story
Lee Goldman, M.D.
November, 2011

2. Disclosure Statement of Financial Interest
Within the past 12 months, I or my spouse/partner have had a financial
interest/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. 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. 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. 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. Absolute Number of Heart Disease Deaths
United States: 1900-2007
Deaths in Thousands
Years
Roger VL et al. Circulation 2011;123:e18-e209.

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. 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. 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. Age Adjusted 30 Day Mortality After MI
Yeh et al. N Engl J Med 2010;362:2162

11. The Potential Contribution of Changing Drug Usage on the 30-Day
Mortality Reduction for Acute Myocardial Infarction from 1975 to 1995
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Data from Heidenreich et al. Am J Med 2001; 110:171

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. 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. 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. 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. 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. 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. 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. 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. Explaining the Decline
Summary of 2 Studies
Risk Factors 44-51%
Treatment 41-47%