Temporal trends in the incidence of coronary disease
Temporal trends in the incidence of coronary disease
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DOI：
10.1016/j.amjmed.2004.04.008
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发表时间：
2004-08-15
影响因子：
5.9
通讯作者：
Roger, VL
中科院分区：
文献类型：
--
作者：
Arciero, TJ;Jacobsen, SJ;Roger, VL
目的：冠心病死亡率有所下降，但心肌梗塞的发病率变化不大。心肌梗塞的发病率是否反映了整体冠心病的发病率尚不清楚。本研究旨在确定冠心病的发病率是否随着时间的推移而下降。 方法：我们利用明尼苏达州奥姆斯特德县患者的医疗记录，确定了 1979 年至 1998 年间明显的冠心病（心肌梗塞、猝死、血管造影诊断的冠心病、其他分类下未识别的不稳定心绞痛）的事件病例。用泊松回归分析长期趋势。结果：1979年至1998年间，发生冠心病病例5772例（心肌梗死：1991例；猝死：1056例；血管造影诊断冠心病：2514例；不稳定型心绞痛：211例）。经年龄和性别调整后的心肌梗塞发病率在这二十年中下降了 6%，在第二个十年中下降了 3%，而心肌梗塞和猝死的发病率合计在前二十年下降了 17%，在第二个十年下降了 9%。在第二个十年中，血管造影术的使用有所增加，并成为冠心病发病率的衡量标准。在第二个十年中，所有冠状动脉疾病的发病率趋势与心肌梗塞以及心肌梗塞和猝死的总和的发病率趋势相似，下降了 9%（P = 0.06）。在研究期间，通过血管造影诊断出的冠心病病例有所增加。结论：我们观察到的趋势表明，心肌梗死和猝死构成了冠心病趋势的合适指标。冠心病发病率的下降支持了这样一种假设，即死亡率下降的部分原因是一级预防和二级预防，部分是由早期检测介导的。 (C) 2004 年，爱思唯尔公司
PURPOSE: Mortality due to coronary disease has declined, but the incidence of myocardial infarction has changed little. Whether the incidence of myocardial infarction reflects that of overall coronary disease is unknown. This study was designed to determine whether the incidence of coronary disease has declined over time.METHODS: We ascertained incident cases of overt coronary disease (myocardial infarction, sudden death, angiographically diagnosed coronary disease, unstable angina not identified under other rubrics) between 1979 and 1998, using medical records of patients in Olmsted County, Minnesota. Secular trends were analyzed with Poisson regression.RESULTS: Between 1979 and 1998, there were 5772 incident cases of coronary disease (myocardial infarction: 1991; sudden death: 1056; angiographically diagnosed coronary disease: 2514; unstable angina: 211). The age- and sex-adjusted incidence of myocardial infarction declined 6% during these two decades and 3% in the second decade, whereas the incidence of myocardial infarction and sudden death combined declined 17% in the first two decades and 9% in the second decade. Use of angiography increased and served as a measure of coronary disease incidence in the second decade. During the second decade, trends in the incidence of all coronary diseases paralleled those of myocardial infarction and of myocardial infarction and sudden death combined, declining 9% (P = 0.06). Cases of coronary disease diagnosed angiographically increased during the period studied.CONCLUSION: The trends that we observed suggest that myocardial infarction and sudden death constitute suitable indicators of trends in coronary disease. The decline in incident coronary disease cases supports the hypothesis that the decline in mortality is explained in part by primary prevention and secondary prevention partially mediated by earlier detection. (C) 2004 by Elsevier Inc.