CORONARY DISEASE MORBIDITY AND MORTALITY IN A POPULATION

Mayo Clinic Coll Of Medicine, Rochester, Rochester MN

Investigators

Linked publications & trials

Abstract

DESCRIPTION: (Adapted from Investigator's Abstract) Cardiovascular disease remains the leading cause of death in the U.S. Despite an encouraging decline in age-adjusted coronary heart disease (CHD) mortality, prevalent CHD continues to represent a major health burden, particularly in the elderly population. Most community surveillance programs, however, cannot fully characterize this problem because they are restricted to an upper age limit of 74 years and thus do not include the events occurring in an increasingly growing part of the population. Observational studies have questioned the existence of a change over time in the prevalence of anatomic coronary disease either at post-mortem examination or at coronary angiography. This remains to be further examined in a population-based setting. In addition, the natural history of myocardial infarction (MI) in the reperfusion area is unknown; in particular, there are no population-based data on the incidence of post-MI heart failure. The investigators propose to study the entire population of Olmsted County, Minnesota, including all age categories, to examine the secular trends in CHD mortality, MI incidence, and natural history, including MI severity, case fatality and post-MI morbidity. In addition, because of the uniquely high autopsy rate in Olmsted County, the time trends in the prevalence of CHD at post-mortem will be examined. The investigators point out that the Olmsted County population constitutes a valuable resource for ascertainment of MI incidence, morbidity and case fatality rate. In particular, since all inpatient and outpatient medical encounters are present in a single medical record unit, this study will have the capabilities of measuring the incidence of post-MI heart failure and its hypothesized change over time. The records of all Olmsted County residents with a hospital discharge diagnosis of MI between 1979 and 1999 will be reviewed, and standard epidemiologic MI validation criteria will be applied; post-MI outcome over time will be determined, including post-MI heart failure, angina, 30 day case fatality and long-term survival. In parallel with the analysis of time trends in CHD mortality, the autopsy reports will be reviewed to examine whether the prevalence of coronary disease at autopsy has changed over time. The investigators state that these studies will provide an assessment of the clinical and anatomical manifestations of CHD, including the outcome of acute MI, over a time period characterized by intensified primary prevention efforts and major changes in the treatment of acute CHD.