Trends in heart failure mortality in England and Wales since 1950

BACKGROUND: This study aims to analyse trends in heart failure mortality for England and Wales from 1950 to 2003. METHODS: A retrospective observational study was conducted using death certificate and population data from the Office for National Statistics. RESULTS: Unadjusted heart failure deaths rose by a factor of more than four between 1950 and 1974 and then fell by a quarter by 2003. When standardised for changes in the age, sex and size of the population, there was a tripling in mortality rate from 1950 to the mid-1970s and since then, a sustained decline in mortality rate of 50% by 2003. The unadjusted female heart failure death rate has been between 1.5-2 times that of males since the early 1970s, but this is much less marked when the differences in the age distribution and sizes of the male and female populations are taken into account. Heart failure mortality trends are similar to those of coronary heart disease (CHD), but the peak is about 10 years earlier, and the male/female ratios are reversed. There is a continuing rise in deaths from both heart failure and CHD in the very elderly (>85 years). CONCLUSION: Unlike hospital trends, deaths from heart failure in the community in England and Wales show a decline since the early 1970s, in spite of an ageing population. This may reflect genuine changes in heart failure incidence, or parallel changes in CHD.     

Variation of the platelet glycoprotein IIIa PI(A1/A2) allele frequencies in the three ethnic groups of Singapore

Background: Polymorphisms of the glycoprotein IIIa receptor have been shown to be associated with differences in platelet aggregability. The PI^A2 variant of the polymorphism has been reported to be an inherited risk factor for acute coronary events. Although the allele frequency of this polymorphism is well documented in Caucasian populations, studies involving Asian Indians, Malays and Chinese are lacking. We studied 706 random male individuals to determine the genotypic distribution of this polymorphism in Singapore. Methods: Male subjects included in this study were drawn from those undergoing routine annual medical examinations offered by their employers. Venous blood was obtained from these patients after an overnight fast and from which genomic DNA was extracted. Genotyping was carried out by polymerase chain reaction (PCR) followed by digestion with restriction enzyme NciI. Personal and family medical history of the subjects were also taken. Results: The genotype distribution of the individuals studied was in accordance to a population at Hardy Weinberg equilibrium. The frequency of the PI^A2 allele was 0.1, 0.01 and 0.01 in the Indians, Malays and Chinese, respectively. The differences in frequencies of the PI^A2 variant are significant among different ethnic groups (P<0.001 for Indians vs. Chinese and Indians vs. Malays). Conclusions: We observed a significantly higher frequency of the PI^A2 allele among Indians relative to the Chinese and Malays in Singapore. The effect of this genotype may partially explain the higher rate of ischaemic heart disease seen among Indians compared to the Chinese and Malay ethnic groups.     

2014 Global geographic analysis of mortality from ischaemic heart disease by country,age and income: Statistics from World Health Organisation and United Nations

Background

Ischaemic heart disease (IHD) is the leading cause of death worldwide and its prevention is a public health priority.

Method

We analysed worldwide IHD mortality data from the World Health Organisation as of February 2014 by country, age and income. Age-standardised mortality rates by country were calculated. We constructed a cartogram which is an algorithmically transformed world map that conveys numbers of deaths in the form of spatial area.

Results

Of the countries that provided mortality data, Russia, the United States of America and Ukraine contributed the largest numbers of deaths. India and China were estimated to have even larger numbers of deaths. Death rates from IHD increase rapidly with age. Crude mortality rates appear to be stable whilst age-standardised mortality rates are falling. Over half of the world's countries (113/216) have provided IHD mortality data for 2008 or later. Of these, 13 countries provided data in 2012. No countries have yet provided 2013 data. Of the 103 remaining countries, 24 provided data in 2007 or earlier, and 79 have never provided data in the ICD9 or ICD10 format.

Conclusions

In the countries for which there are good longitudinal data, predominantly European countries, recent years have shown a continuing decline in age-standardised IHD mortality. However, the progressive aging of populations has kept crude IHD mortality high. It is not known whether the pattern is consistent globally because many countries have not provided regular annual data including wealthy countries such as the United Arab Emirates and large countries such as India and China.     

Atrial fibrillation, ischaemic heart disease, and the risk of death in patients with heart failure.

AIMS: Atrial fibrillation (AF) is a risk factor for death in patients with a myocardial infarction, but highly variable results are reported in patients with heart failure. We studied the prognostic impact of AF in heart failure patients with and without ischaemic heart disease. METHODS AND RESULTS: During a period of 2 years, 3587 patients admitted to hospital because of heart failure were included in this study. All patients were examined by echocardiography and the presence of AF was recorded. Follow-up was available for 8 years. Twenty four percent of those discharged alive from hospital had AF. After 4 and 8 years of follow-up, mortality was higher in patients with AF than in patients without, 56 vs. 52% and 77 vs. 73%, respectively. Cox multivariable regression analysis showed a small but significant importance of AF for long-term mortality [hazard ratio (HR) 1.12, 95% confidence limits (CI), 1.02-1.23, P=0.018]. There was a significant interaction between the importance of AF and the presence of ischaemic heart disease (P=0.034). In patients with AF at the time of discharge and ischaemic heart disease, HR was 1.25 (95% CI: 1.09-1.42) and P<0.001; in patients with AF at discharge and without ischaemic heart disease, HR was 1.01 (95% CI: 0.88-1.16) and P=0.88. CONCLUSION: AF is associated with increased risk of death only in patients with ischaemic heart disease. This finding may explain the variable results of studies of the prognosis associated with AF in heart failure.     

Mortality from ischaemic heart disease by country,region, and age: Statistics from World Health Organisation and United Nations

Background

Ischaemic heart disease (IHD) is the leading cause of death worldwide. The World Health Organisation (WHO) collects mortality data coded using the International Statistical Classification of Diseases (ICD) code.

Methods

We analysed IHD deaths world-wide between 1995 and 2009 and used the UN population database to calculate age-specific and directly and indirectly age-standardised IHD mortality rates by country and region.

Results

IHD is the single largest cause of death worldwide, causing 7,249,000 deaths in 2008, 12.7% of total global mortality. There is more than 20-fold variation in IHD mortality rates between countries. Highest IHD mortality rates are in Eastern Europe and Central Asian countries; lowest rates in high income countries. For the working-age population, IHD mortality rates are markedly higher in low-and-middle income countries than in high income countries.Over the last 25 years, age-standardised IHD mortality has fallen by more than half in high income countries, but the trend is flat or increasing in some low-and-middle income countries. Low-and-middle income countries now account for more than 80% of global IHD deaths.

Conclusions

The global burden of IHD deaths has shifted to low-and-middle income countries as lifestyles approach those of high income countries. In high income countries, population ageing maintains IHD as the leading cause of death. Nevertheless, the progressive decline in age-standardised IHD mortality in high income countries shows that increasing IHD mortality is not inevitable. The 20-fold mortality difference between countries, and the temporal trends, may hold vital clues for handling IHD epidemic which is migratory, and still burgeoning.     

Changes in all-cause and cardiovascular disease mortality in three different Finnish population cohorts with and without diabetes

Background

We aimed to assess changes in cardiovascular (CVD) and all-cause mortality among diabetic and non-diabetic individuals between three large study cohorts with baseline assessments of 10 years apart and followed up for 10 years.

Methods

Six population surveys were carried out in 1972, 1977, 1982, 1987, 1992 and 1997 in Finland. For the analyses we combined the 1972 and 1977 cohorts (cohort 1), the 1982 and 1987 cohorts (cohort 2) and similarly also the 1992 and 1997 cohorts (cohort 3).

Results

Age-adjusted hazard ratio (HR) of all-cause mortality and CVD in men without diabetes showed that both had a statistically significant decreased risk of all-cause mortality compared to the first cohort. No statistically significant changes in all-cause mortality were observed in men and women with diabetes between the latter two cohorts compared with the first after controlling for several covariates. In both men and women without diabetes, cohort 2 (men, HR = 0.65; 95% CI 0.51–0.82; women, HR = 0.54; 95% CI 0.32–0.89) and cohort 3 (men, HR = 0.32; 95% CI 0.22–0.47; women, HR = 0.31; 95% CI 0.14–0.68) showed a statistically significant decreased risk of CVD mortality compared to cohort 1. Age-adjusted HRs in regard to CVD mortality in men (HR = 0.22; 95% CI 0.07–0.69) and women (HR = 0.22; 95% CI 0.05–0.99) with diabetes of cohort 3 were statistically significantly lower than in cohort 1.

Conclusions

There seems to be a decrease in CVD mortality in people with diabetes indicating that treatment of diabetes and cardiovascular risk factors in diabetes patients may have improved during the last decade.     

Lens opacity and mortality in diabetes

A population-based cohort of 294 diabetic patients were examined for the presence of lens opacities and followed up for a median of 6 years. Only two patients were lost to follow-up but there were 73 deaths, 49 in the 108 patients with opacities and 24 in the 184 patients without (odds ratio 2.4, 95% Cl 1.5-3.9). Lens opacities were a powerful predictor of death and the effect was independent of other prognostic factors. The presence of cataract identifies a high risk sub-group of elderly diabetic patients.     

Diabetes mellitus and risk of fatal ischaemic heart disease by gender: 18 years follow-up of 74,914 individuals in the HUNT 1 Study.

AIM: To study long-term mortality from ischaemic heart disease (IHD) in subjects with and without diabetes and how the association between diabetes and fatal IHD is influenced by gender and established cardiovascular disease (CVD). METHODS AND RESULTS: In 1984-86, all inhabitants aged 20 years or older in Nord-Tr?ndelag County, Norway were invited to the HUNT Study. A total of 74,914 participated in our study, 2100 of them with prevalent diabetes. During 18 years of follow-up, 19,967 persons died. Among people without diabetes or CVD at baseline, men had twice (HR 2.20, CI 2.00-2.41) the rate of fatal IHD compared with women. With diabetes present, the gender gap was substantially reduced (HR 1.25, CI 0.9-1.72), and if both diabetes and CVD were present, IHD mortality in men and women was identical (HR 1.1, CI 0.79-1.64). Gender specific analyses showed a stronger association of diabetes with IHD mortality in women (HR 2.71, CI 2.33-3.16) compared with men (HR 1.98, CI 1.70-2.30, test for interaction, P < 0.01). CONCLUSION: Diabetes is a stronger predictor for IHD mortality in women than in men, and diabetes attenuates the usual gender gap in IHD mortality. With both diabetes and established CVD present, the gender gap is fully attenuated.     

The association between mortality from ischaemic heart disease and mortality from leading chronic diseases.

AIMS: Coronary risk factors raise the risk of other chronic disorders. We therefore tested the hypothesis that the geographic distribution of ischaemic heart disease mortality is associated with that of other chronic diseases with which it shares risk factors. METHODS AND RESULTS: For the 50 provinces of Spain, we collected mortality data for the period 1980-1995 from the national vital statistics. We calculated age-adjusted mortality rates for the leading causes of death in quintiles of provincial distribution of ischaemic heart disease mortality, and correlation coefficients with respect to provincial ischaemic heart disease mortality. As expected, because they share risk factors with ischaemic heart disease, mortality from cerebrovascular disease, malignant tumours, lung cancer, respiratory diseases, chronic obstructive pulmonary disease, diseases of the digestive system, cirrhosis of the liver and all causes, increase with the rise from lower to higher quintiles of ischaemic heart disease mortality. Ischaemic heart disease mortality registered correlations over 0.5 (P<0.001) with mortality from many of the above diseases in the periods 1980-1984 and 1991-1995. Expectations were similarly borne out for disorders not sharing risk factors with ischaemic heart disease, in that mortality from prostate and breast cancer, injury and poisoning, traffic accidents and ill-defined causes in most cases did not show a provincial association with ischaemic heart disease mortality. In general, these results were observed for both sexes and across all age groups. CONCLUSION: Ischaemic heart disease mortality is associated with mortality from chronic diseases which share coronary risk factors, across provinces of Spain over the period 1980-1995. This suggests that the geographic variation in such chronic diseases is due to common factors, potentially susceptible to similar preventive interventions.     

Use of the UKPDS Outcomes Model to predict all-cause mortality in U.S. adults with type 2 diabetes mellitus: comparison of predicted versus observed mortality

Aims

The applicability of the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model is unknown in populations with type 2 diabetes mellitus (T2DM) outside the United Kingdom. We compared all-cause mortality predicted from the UKPDS model with observed mortality among T2DM subjects in the U.S.

Methods

We studied participants with T2DM from the National Health and Nutrition Examination Survey 1988-1994 with characteristics comparable to the UKPDS cohort. The 10-year observed all-cause mortality was compared to the UKPDS model-predicted mortality. The Lifetable method was used to estimate the probability of mortality for 10 years following diagnosis.

Results

Among 156 subjects with characteristics comparable to the UKPDS cohort, mean age was 49.6 years, age at T2DM diagnosis was 47.1 years, and T2DM duration averaged 2.6 years, with follow-up for 10.4 years. The UKPDS model-predicted 10-year mortality was 15.7%, similar to the observed mortality of 14.2%. Corresponding 10-year predicted versus observed mortality was 32.7% versus 32.4% including subjects >age 65, 17.0% versus 19.3% including individuals with pre-existing CVD, and 31.1% versus 20.9% including individuals with diabetes duration ≥6 years.

Conclusion

All-cause mortality predicted by the UKPDS model was comparable to observed mortality in U.S. NHANES participants with characteristics similar to the UKPDS.     

Comparison of trends in prostate-cancer mortality in England and Wales and the USA

Although trends in prostate-cancer screening and disease incidence differ substantially between the USA and England and Wales, trends in mortality are very similar.     

Impact of diabetes mellitus on mortality rates and outcomes in myocardial infarction

BackgroundDiabetes mellitus (DM) represents a major cardiovascular risk factor for increased risk of coronary artery disease and myocardial infarction (MI). DM is also associated with a poorer clinical outcome in MI.Materials and methodsThe nationwide German inpatient population treated between 2005 and 2016 was used for statistical analyses. Hospitalized MI patients were stratified by the presence of DM and investigated for the impact of DM on in-hospital events.ResultsIn total, 3,307,703 hospitalizations for acute MI (37.6% female patients, 56.8% aged ≥ 70 years) treated in Germany during 2005–2016 were included in this analysis. Of these patients, 410,737 (12.4%) died while in hospital. Overall, 1,007,326 (30.5%) MI cases were coded for DM. While the rate of MI patients with DM increased slightly over time, from 29.8% in 2005 to 30.7% in 2016 (β = 7.04, 95% CI: 4.13–9.94; P < 0.001), their in-hospital mortality decreased from 15.2% to 11.5% (β = -0.36, 95% CI: -0.38 to -0.34; P < 0.001). Rates of in-hospital death (13.2% vs 12.1%; P < 0.001) and recurrent MI (0.8% vs 0.6%; P < 0.001) were higher in MI patients with vs without DM. Also, in MI patients with DM, significantly lower use of coronary artery angiography (51.5% vs 56.8%; P < 0.001) and interventional revascularization (37.6% vs 43.9%; P < 0.001) was noted.ConclusionAlthough in-hospital mortality of patients with MI decreased in both diabetes and non-diabetes patients, in-hospital deaths were still higher in diabetes patients, thereby revealing the impact of this metabolic disorder on cardiovascular outcomes.     

Breastfeeding and cardiovascular mortality: the Boyd Orr cohort and a systematic review with meta-analysis.

AIMS: To investigate the association of breastfeeding with all-cause, cardiovascular, and ischaemic heart disease mortality. METHODS AND RESULTS: A long-term follow-up of 4999 children originally surveyed from 1937 to 1939 was undertaken (Boyd Orr cohort). Four thousand three hundred and seventy-nine subjects (88%) were traced in adulthood and 3555 (71%) had complete data on all covariates. The results were combined with a meta-analysis of the published literature. In the Boyd Orr study, there was little evidence that breastfeeding was associated with all-cause (hazard ratio: 1.04 [95% CI: 0.90-1.20]), cardiovascular (1.04 [0.83-1.30]), or ischaemic heart disease (1.02 [0.77-1.36]) mortality, compared with bottle-feeding. Meta-analyses of observational studies showed little evidence of an association of breastfeeding with all-cause (pooled rate ratio: 1.01 [95% CI: 0.91-1.13]) or cardiovascular (1.06 [0.94-1.20]) mortality. There was a moderate-to-high degree of between-study heterogeneity for the association between breastfeeding and ischaemic heart disease mortality (I2 value-indicating the degree of between-study variation attributable to heterogeneity-66%), and estimates were consistent with both an important beneficial or adverse effect of breastfeeding. CONCLUSION: There is little consistent evidence that breastfeeding influences subsequent all-cause or cardiovascular disease mortality. Results from other well-designed cohorts may clarify residual uncertainty.     

Contribution of changes in incidence and mortality to trends in the prevalence of coronary heart disease in the UK: 1996 2005.

Aims: To assess how trends in the incidence of coronary heart disease (CHD) and mortality rates among people with CHD have affected the prevalence of CHD in the UK. METHODS AND RESULTS: A time trend analysis using computerized general practice clinical records of people aged 35 years and over was performed. From 1996 to 2005, age-standardized incidence of CHD decreased by 2.2% in men and 2.3% in women per year (average percentage change). Age-standardized all-cause mortality among those with CHD decreased by 4.5% in men and 3.4% in women per year (average percentage change). Age-standardized prevalence increased by 1.3% in men and 1.7% in women per year (average percentage change). Although the decline in incidence had some impact on limiting the increase in prevalence, its effect was offset by the increase in prevalence occurring as a result of improved survival among people with CHD. CONCLUSION: The results suggest that increasing prevalence is largely due to decreasing mortality among people with CHD. Further increases in prevalence are likely even if the incidence of CHD continues to fall.     

Income and heart disease mortality trends in Sao Paulo,Brazil, 1996 to 2010

Background

Reductions in heart disease mortality rates are variable according to socioeconomic status.

Methods

We performed a time trend analysis of all heart diseases (all circulatory diseases, except rheumatic, cerebrovascular, and aortic diseases) comparing three different household income levels (high, middle, and low) in the city of Sao Paulo from 1996 to 2010.

Results

A total of 197,770 deaths were attributed to heart diseases; 62% of them were due to coronary diseases. The rate of death due to heart diseases declined for the city as a whole. The annual percent change (APC) and 95% confidence intervals for men living in the high, middle and low income areas were − 4.1 (− 4.5 to − 3.8), − 3.0 (− 3.5 to − 2.6), and − 2.5 (− 2.8 to − 2.1), respectively. The decline in death rate was greatest among men in the wealthiest area. The trend rates of women living in the high-income area had one joinpoint; APC was − 4.4 (− 4.8 to − 3.9) from 1996–2005 and − 2.6 (− 3.8 to − 1.4) from 2005–2010. Middle and low income areas had an APC of − 3.6 (− 4.1 to − 3.1) and − 3.0 (− 3.2 to − 2.7) from 1996–2010, respectively. During the last 5 years of observation, there was a gradient of the decline of the risk of death, faster for people living in the wealthiest area and slower for people living in the more deprived neighborhoods.

Conclusion

Reduction in deaths due to heart diseases is greatest for men and women living in the wealthiest neighborhoods.