Coronary heart disease attack rate, incidence and mortality 1975-1994 in Goteborg, Sweden

MATERIAL AND METHODS: Data from the Göteborg myocardial infarction register wereused to investigate trends in attack rate, incidence of non-fatalmyocardial infarction and mortality from coronary heart diseasein persons aged 64 and below during the period 1975–1994. RESULTS: Myocardial infarction was defined according to strict criteriawhich remained the same throughout the study period. Attackrate and incidence were 3–5 times higher among men thanwomen. The ratio of recurrent infarcts out of all attacks increasedwith increasing age and was 14%, 20% and 24% for men aged 35–44,45–54, and 55–64, respectively. Corresponding ratesfor women were 8%, 14%, and 22%, respectively. Both attack rateand incidence decreased significantly by 2·1–3·9%per year during the study period for most age groups. The 28-dayfatality rate (hospitalized as well as non-hospitalized cases)tended to decline, but significantly so only in the oldest men.The same was true for 28-day fatality among hospitalized patients.The majority of all coronary heart disease deaths occurred outsidehospital in people unaware they had coronary heart disease.Mortality from coronary heart disease decreased by 2·0–68%per year during the study period. In-hospital treatment of myocardialinfarction with intravenous beta-blockers followed by oral treatment,nitroglycerin and thrombolytics increased during the study period.Coronary surgery and angioplasty were used in less than 5% ofpatients during the study period, but increased substantiallyin 1994. CONCLUSION: Coronary heart disease and mortality in ages below 65 yearsare now decreasing in Sweden. Decreasing short-term mortalityis almost certainly due to more efficient treatment in hospital,but as the majority of coronary heart disease deaths occur outsidehospital and in people unaware they have coronary heart disease,primary prevention is still very important.     

Coronary revascularization improves long-term prognosis in diabetic and nondiabetic end-stage renal disease.

To test the hypothesis that coronary revascularization improves long-term prognosis in patients with hemodialysis, 80 of 121 patients (66%) on maintenance hemodialysis who had undergone initial coronary angiography had bypass surgery, catheter angioplasty, or both between 1983 and 1999. Multivessel disease was more frequent (p=0.01) and the duration of hemodialysis therapy was shorter (p=0.01) in patients with diabetes (n=61), than in nondiabetic patients (n=60). Of the patients who underwent revascularization, complete revascularization was achieved in 75% of those with diabetic nephropathy (30/40) and 83% in a similar number of nondiabetic patients (33/40). The 5-year survival rate from initiation of hemodialysis was 79% in diabetic and 96% in non-diabetic patients (p<0.01), exceeding published Japanese (53% vs 70%) and US (26% vs 60%) survival rates. When survival was studied from the date of revascularization, predictors of outcome were age and achievement of complete revascularization. Surprisingly, diabetes was not a predictor of survival outcome. Complete revascularization improves long-term survival in both diabetic and nondiabetic patients.     

Coronary artery disease among asymptomatic diabetic and nondiabetic patients undergoing coronary computed tomography angiography

OBJECTIVES: The aim of this study was to determine the prevalence and severity of coronary artery disease (CAD) and the plaque composition in asymptomatic diabetic and nondiabetic patients undergoing coronary computed tomography angiography (CCTA). BACKGROUND: CAD is the major cause of death among patients with diabetes. The true prevalence of CAD in asymptomatic diabetic patients, however, remains unknown. MATERIALS AND METHODS: A total of 328 consecutive patients (each with at least one risk factor or abnormal stress-test results) were referred for cardiac evaluation, 42 with diabetes and 286 without diabetes, all asymptomatic for cardiac-related symptoms. Groups were matched for age, sex, and CAD risk factors. CAD was defined as coronary atherosclerosis, with obstructive or nonobstructive lesions. CCTA was performed and findings compared between patients with diabetes and those without. RESULTS: CAD was present in 39 (93%) diabetic patients and in 211 (73%) nondiabetic patients (P=0.006). Obstructive CAD was more common in diabetic patients than in nondiabetic patients (29 vs. 6.6%, respectively; P<0.0001). In diabetic patients, more coronary segments with atherosclerosis per patient were detected (5.5 segments/patient vs. 2.8 segments/patient in nondiabetics; P<0.0001). The total Agatston score was significantly higher in diabetic patients vs. nondiabetic patients (370+/-96 and 79.9+/-16, respectively; P<0.0001). CONCLUSION: Our results indicate a high prevalence (93%) of CAD in asymptomatic diabetic patients with either nonobstructive or obstructive lesions. CCTA may be a useful imaging modality for selecting patients at high risk who would benefit most from further evaluation for subclinical ischemia.     

The incidence of rheumatic heart disease among diabetic patients

The usual frequency of acute infectious diseases as they occurred in a group of 1530 patients coming under my observation is recorded. Special care was exercised in obtaining a correct history of these patients.In the diabetics studied here, a history of rheumatic fever prior to the diabetes, was obtained with the same frequency as in nondiabetics. In 350 diabetics, we found that 37 gave a history of having had rheumatic fever at some time prior to their diabetes. In 37 nondiabetics, the expected number of cases of valvular disease of the heart would be about 18 or 19. In 37 diabetics who had suffered rheumatic fever, only one case of valvular disease of the heart was discovered.In the light of our present knowledge, only one explanation can be offered for this extraordinary find, and that is, individuals with certain hereditary constitutional traits have tendencies to certain diseases and at the same time, immunities to other diseases or their complications.     

Coronary heart disease mortality among Arab and Jewish residents of Jerusalem

Information on coronary heart disease (CHD) in the Palestinian population is sparse. We compared mortality rates in the largely Palestinian Arab population of Jerusalem with the Jewish population of the district between 1984 and 1997 based on official Israeli statistics. CHD mortality and all-cause mortality rates were significantly higher among Arab residents than among Jewish residents aged 35-74 years. Whether the excess CHD mortality reflects increased incidence of events, higher case fatality, or both remains to be established. Possible explanations include a higher prevalence of conventional risk factors such as diabetes, obesity, and smoking in Palestinians, stress effects related to the complex political situation and socioeconomic inequalities, and suspected differences in medical care.     

Trends in heart disease death rates in diabetic and nondiabetic Pima Indians

BACKGROUND: Secular trends over 34 years (1965-1998) in overall and cause-specific mortality were examined in 4,623 Pima Indians >or=35 years old. METHODS: The underlying and contributing causes of the 1,363 deaths were determined from a review of all available clinical records; 540 of the deaths occurred in the 2,528 nondiabetic participants and 823 in the 2,095 participants who had diabetes during all or part of the study period. Age/sex-adjusted death rates were calculated across four 8.5-year time intervals. RESULTS: In the nondiabetic participants, the rate of death from natural causes declined gradually over time (20.4, 17.3, 17.3, and 16.0 deaths per 1,000 persons/year; P=.11); deaths from ischemic heart disease (IHD) were uncommon (n=22), and the rate did not change appreciably, remaining as the fifth leading natural cause of death. In the diabetic participants, the rate of death from natural causes was unchanged over time, but the rate of death from IHD (n=141) increased nearly twofold (3.3, 4.2, 6.4, and 6.4 deaths per 1,000 persons/year; P<.01), becoming the leading cause of death in the third and fourth time intervals. CONCLUSIONS: The rate of death from IHD remained stable in nondiabetic Pima Indians but increased among those with diabetes. This finding suggests that, in the absence of diabetes, the underlying susceptibility to IHD in this population has not changed.     

Coronary artery disease in diabetic and nondiabetic patients: a clinical and angiographic comparison

A comparison of data from 58 diabetic and 58 nondiabetic patients with arteriographic evidence of coronary artery disease showed that diabetic patients had a significantly greater frequency of major stenoses in the intermediate coronary artery segments but no significant differences in the proximal or distal segments. Thus, the diabetic patients did have more severe coronary disease, but the diabetic group did not have "more distal" disease as represented by the number of major or minor lesions in the distal segments. The diabetic patients had a significantly greater frequency of electrocardiographic intraventricular conduction defects and manifestations of left ventricular dysfunction. There was no significant difference in the severity of coronary artery disease between the diabetic patients with manifestations of myocardial decompensation and the diabetic patients without such manifestations, suggesting that the increased frequency of myocardial dysfunction in diabetic patients may be related to factors other than the greater severity of coronary artery disease.     

Admission blood glucose level and mortality among hospitalized nondiabetic patients with heart failure

BACKGROUND: The significance of admission blood glucose level in nondiabetic patients with heart failure (HF) is unknown. We examined the possible association between admission glucose levels and outcome in a large cohort of hospitalized patients with HF. METHODS: We analyzed the data of 4102 patients with HF, who were hospitalized during a prospective national survey. The present study focuses on a subgroup of 1122 nondiabetic patients with acute HF who were admitted because of acute HF or exacerbation of chronic HF. RESULTS: In-hospital mortality was twice as high in patients with admission blood glucose levels in the third tertile (7.2%) compared with the first (3%) and second (4%) tertiles (P = .02). Furthermore, mortality risk was correlated with admission glucose levels; each 18-mg/dL (1-mmol/L) increase in glucose level was associated with a 31% increased risk of in-hospital mortality (adjusted odds ratio, 1.31; 95% confidence interval, 1.10-1.57; P = .003) and a 12% increase in 60-day mortality (adjusted hazard ratio, 1.12; 95% confidence interval, 1.01-1.25; P = .04). Admission blood glucose levels remained an independent predictor of in-hospital and 60-day mortality even after the exclusion of 315 patients (28%) with acute myocardial infarction and HF. The 6- and 12-month mortality rates were similar in patients with and without abnormal admission blood glucose levels. CONCLUSIONS: Elevated admission blood glucose levels are associated with increased in-hospital and 60-day mortality, but not 6-month or 1-year mortality, in nondiabetic patients hospitalized because of HF.     

Coronary heart disease mortality trends and related factors in Australia

Coronary heart disease (CHD) has been the greatest single cause of mortality in Australia over the past 30 years. For most age and sex groups CHD mortality rates peaked in 1965-67. Since that time, rates have decreased by nearly 40% and are currently the lowest for 30 years. CHD mortality rates are highest in the eastern areas of Australia, among those who were born in Australia, and among lower socio-economic groups. Changes in CHD mortality have been accompanied by changes in life-style (particularly recent decreases in the prevalence of cigarette smoking, large reductions in tar content of cigarettes and a large change in preference for margarine over butter) and changes in treatment (especially in the control of hypertension and surgical interventions). Concurrent studies of the incidence and case fatality rates in two population centres (Perth and Newcastle) coupled with periodic surveys of changes in treatment and population risk factor levels are being undertaken over a 10-year period to try to understand the current and future trends in CHD mortality.     

Coronary heart disease mortality trends and related factors in Norway

The coronary heart disease (CHD) mortality rates for men aged 35-44 years decreased by 25% from 1966-70 to 1976-80. In older age groups only a modest decline was observed. The decrease in CHD mortality is probably due to a decrease in incidence. The reason for the decline is not known, but some changes in health-related behaviour have occurred in Norway, probably already starting in the 1960s. There was an increase in meat, sugar and total fat consumption and a decrease in the intake of cereals both before and after the Second World War. These trends seem to have slowed down and in a recent survey 44% of the population reported changes towards a low fat diet. The percentage of non-smokers is increasing, particularly since 1975-76. Physical activity in leisure time has increased since the mid-70s but there are social gradients with the most active subjects being recruited from the higher social strata. The improved medical care of CHD patients is not thought to have had a major impact upon the decline in the mortality rates. The most probable explanation for the changes is an increase of non-smokers and a turn towards a less coronary prone diet.     

Coronary heart disease mortality trends and related factors in Spain

Coronary heart disease (CHD) mortality rate in Spain is relatively low, but showed an annual increase of 6.2% for men and of 4.2% for women between 1968 and 1977. There are marked differences in CHD mortality rate between regions. Although there is little data available on the prevalence and trends of CHD risk factors, these data seem to suggest a relatively high level of the main risk factors and a tendency toward adverse development. Socioeconomic and sociocultural changes due to a fast industrial development followed by an economic crisis with high rates of unemployment may produce an unpredictable change in CHD trends in the next years.     

Coronary heart disease mortality and coronary risk factors in Argentina

A marked increase in the coronary heart disease (CHD) mortality of working-age (35-64 years) men and women occurred in Argentina in the 1960s and 1970s. CHD is the leading cause of death in men. In 1978, Argentine men had also one of the highest CHD mortality rates (603.9/100,000) in international mortality statistics and Argentine women (155.2/100,000) were also at the top of these statistics. Stroke mortality has also increased in the younger age-group of men and women over the last decade. The high CHD and stroke mortality rates are compatible with a high prevalence of cardiovascular risk factors. Several surveys have demonstrated that mean serum total cholesterol levels are high, the prevalence of smokers is increasing and the proportion of adequately treated hypertensive patients is low. These results suggest that measures should be introduced to change the Argentine way of life to try to initiate a decline in cardiovascular mortality.     

Coronary heart disease mortality, morbidity, and risk factor trends in New Zealand

Coronary heart disease (CHD) mortality rates declined by 22 and 13% for European men and women respectively between 1968 and 1981. Data from two methodologically identical population-based registers indicate that in the period 1974-1981 there was no change in either the event rates or case fatality rates of definite myocardial infarction. In the same period there was a significant 17% decline in the sudden death event rates. These declines have been associated with a decrease in the consumption of dairy products, a reduction in self-reported cigarette smoking habits, improved control of hypertension, and possibly by reductions in serum cholesterol levels and an increase in habitual physical activity in the community. There have also been improvements in the medical management of patients with CHD although this appears to be of secondary importance in contributing to the decline in CHD mortality.     

Coronary heart disease, cancer and mortality in male middle-aged light smokers.

We examined the effect of light smoking in relation to incidence of coronary heart disease (CHD) in a general population sample consisting of 6879 men aged 47-55 years and free of previous myocardial infarction (MI) at baseline. After a follow-up of mean duration 11.8 years, 11.0% of men smoking 1-4 cigarettes daily (n = 228) had suffered a major CHD event, compared to 3.7% of non-smokers (n = 2049) [adjusted odds ratio 2.8 (1.7-4.7)]. No further increase in risk was observed in men who smoked more. There was an increasing risk of death from cancer with the number of cigarettes smoked per day. Mortality was increased in all categories of cigarette smokers, particularly among the very heavy smokers, who had a mortality risk of 22% compared to 6% among nonsmokers [adjusted odds ratio 4.4 (2.7-7.1)]. Data from an examination 4 years later considered only those men who stated that their smoking habits were identical on both occasions (n = 3981). Among these subjects the incidence of CHD after a mean period of 7.1 years was 10.6% in men smoking 1-4 cigarettes per day, compared to 2.6% in nonsmokers [adjusted O.R. 4.6 (2.1-10.1)]. No dose-response effect was observed. Even very light cigarette smoking considerably increases the risk of CHD in middle-aged men.     

The incidence of heart failure among nondiabetic patients with and without impaired fasting glucose

ObjectiveThe purpose of this study was to elucidate the relationship between fasting plasma glucose (FPG), development of diabetes, and incident heart failure (HF) in a large, community sample of nondiabetic subjects.Research Design and MethodsFrom Kaiser Permanente Northwest medical records, we identified 10,113 subjects with an FPG level of 100–125 mg/dl in 1997 or 1998 who were free of diabetes and HF and matched them to an equal number of subjects with an FPG level of <100 mg/dl on sex and 5-year age groups. Subjects were followed until a new diagnosis of HF was entered into the medical record, death, termination of health plan membership, or December 31, 2005, whichever came first.ResultsAfter controlling for known HF risk factors, each 10 mg/dl increase in FPG was independently associated with an 8% increase in the risk of HF over a mean follow-up of 79 months [hazard ratio (HR)=1.08, 95% confidence interval (CI) 1.03–1.13, P=.003]. However, in a subsequent analysis that included only those HF cases that occurred prior to diabetes onset and censored follow-up at the time of diabetes development, FPG was not a significant predictor of HF risk (HR=1.01, 95% CI 0.96–1.07, P=.621). Age, male sex, body mass index, smoking, and cardiovascular disease were highly predictive of HF incidence.ConclusionsAlthough the risk of HF is increased among subjects with higher FPG, the increased risk is explained by greater likelihood of developing diabetes. Risk factors other than FPG are much stronger independent predictors of incident HF.     

Coronary heart disease in young Type 1 (insulin-dependent) diabetic patients with and without diabetic nephropathy: incidence and risk factors

Summary Fifty-nine Type 1 (insulin-dependent) diabetic patients with (group I) and 59 patients without nephropathy (group II) pair-matched according to sex (30 males and 29 females), age (33 years, range 15–48) and diabetes duration (19 years, range 6–42) were followed for a period of 10 years from about 5 years before to 5 years after onset of proteinuria. The cumulative incidence of coronary heart disease was estimated, and blood pressure and serum cholesterol were followed. Within six years after onset of proteinuria the cumulative incidence of coronary heart disease was increased eight-fold in group I (40%) compared with group II (5%), (p<0.001). Blood pressure was higher in group I compared with group II from before onset of proteinuria (135/86±17/9 mmHg vs 129/80±15/8 mmHg, p<0.001), and serum cholesterol elevated from onset of proteinuria in group I (6.3±1.2 mmol/l) vs. group II (5.5±1.0 mmol/l), (p<0.005). Patients in group I who developed coronary heart disease had similar age (36 years, range 21–51, vs 38 years, range 21–53), sex (50% males vs. 52% males), smoking frequency (50% vs 49%), diabetes duration (22 years, range 9–39, vs 24 years, range 10–42) and serum creatinine (110 mol/l, range 69–284, vs 108 mol, range 72–1024) compared with patients not developing coronary heart disease. However, the patients with coronary heart disease had higher blood pressure (135/87mmHg±16/9 vs 128/82±15/7, p<0.05) and serum cholesterol (7.3 mmol/l+ 1.2 vs 6.4 mmol/l±0.9, p<0.05) than patients without coronary heart disease. Thus, patients developing clinical nephropathy have a highly increased incidence of coronary heart disease compared with patients not developing nephropathy. Patients who developed coronary heart disease were characterized by higher blood pressure and serum cholesterol.