Decline in Cardiovascular Mortality: Possible Causes and Implications.
Decline in Cardiovascular Mortality: Possible Causes and Implications.
复制标题
心血管死亡率下降：可能的原因和影响。
DOI：
10.1161/circresaha.116.309115
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发表时间：
2017-01-20
影响因子：
20.1
通讯作者：
Gordon D
中科院分区：
文献类型：
--
作者：
Mensah GA;Wei GS;Sorlie PD;Fine LJ;Rosenberg Y;Kaufmann PG;Mussolino ME;Hsu LL;Addou E;Engelgau MM;Gordon D
如果说传染病的控制是世纪上半叶公共卫生的成功故事，那么冠心病和中风死亡率的下降则是世纪最后40年的成功故事。在20世纪70年代中期首次报道时，CHD和中风的这种下降的早期阶段是意想不到的和有争议的，随着美国人口老龄化，60年来逐渐增加。然而，在1978年，国家心脏、肺和血液研究所（NHLBI）召开的一次会议的与会者得出结论，至少在美国，冠心病和中风死亡率最近确实出现了显著下降。到2000年，按年龄调整的死亡率已降至1960年代基线的三分之一左右。模型表明，这种显著下降是由预防和治疗的快速进展推动的，包括吸烟的急剧下降，高血压治疗和控制的改善，他汀类药物的广泛使用以降低循环胆固醇水平，以及急性冠状动脉综合征中血栓溶解和支架的开发和及时使用以限制或预防梗死。然而，尽管在预防和治疗方面的知识和进展有了巨大增长，但对这种下降仍存在许多问题。事实上，有证据表明，在某些人口群体中，下降的速度可能已经减缓，甚至可能显示出逆转的早期迹象。NHLBI通过信息请求，正在征求意见，这些意见可以为原始里程碑会议40周年或接近40周年的后续会议提供信息，以便在之前和未来的背景下进一步探索心血管死亡率的这些趋势。
If the control of infectious diseases was the public health success story of the first half of the 20th century, then the decline in mortality from coronary heart disease (CHD) and stroke has been the success story of the century’s last 4 decades. The early phase of this decline in CHD and stroke was unexpected and controversial when first reported in the mid-1970s, having followed 60 years of gradual increase as the U.S. population aged. However, in 1978 the participants in a conference convened by the National Heart, Lung, and Blood Institute (NHLBI) concluded that a significant recent downtick in CHD and stroke mortality rates had definitely occurred, at least in the U.S. Since 1978, a sharp decline in mortality rates from CHD and stroke has become unmistakable throughout the industrialized world, with age-adjusted mortality rates having declined to about one-third of their 1960s baseline by 2000. Models have shown that this remarkable decline has been fueled by rapid progress in both prevention and treatment, including precipitous declines in cigarette smoking, improvements in hypertension treatment and control, widespread use of statins to lower circulating cholesterol levels, and the development and timely use of thrombolysis and stents in acute coronary syndrome to limit or prevent infarction. However, despite the huge growth in knowledge and advances in prevention and treatment, there remain many questions about this decline. In fact, there is evidence that the rate of decline may have abated and may even be showing early signs of reversal in some population groups. The NHLBI, through a request for information, is soliciting input that could inform a follow-up conference on or near the 40th anniversary of the original landmark conference in order to further explore these trends in cardiovascular mortality in the context of what has come before and what may lie ahead.
影响因子：
4.5
作者：
Gouda HN;Critchley J;Powles J;Capewell S
通讯作者：
Capewell S