Marked decline of coronary heart disease mortality in 35-44-year-old white men in Allegheny County, Pennsylvania.
Marked decline of coronary heart disease mortality in 35-44-year-old white men in Allegheny County, Pennsylvania.
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宾夕法尼亚州阿勒格尼县 35-44 岁白人男性的冠心病死亡率显着下降。
DOI：
10.1161/01.cir.80.2.261
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发表时间：
1989
期刊：
影响因子：
37.8
通讯作者：
Ives,DG
中科院分区：
文献类型：
--
作者：
Kuller,LH;Traven,ND;Rutan,GH;Perper,JA;Ives,DG
研究了1970-1986年间35-44岁白人男性冠心病(CHD)死亡率的趋势。1216例患者获得了死亡证明。所有死亡都是验尸官认证的自然死亡和非验尸官认证的血管疾病和糖尿病死亡。尸检数据、验尸官报告、医院记录、医生报告和告密者被用来验证诊断。审查者拒绝了805份CHD证明中的73份，但他们确认了54例死亡证明上未被证明为CHD的病例。冠心病死亡率从1970-1972年的90.6/10万/年下降到1985-1986年的40.3/10万/年。大约三分之二的下降与猝死的下降有关，其中41.6%的下降与突发冠心病死亡有关。糖尿病患者在确认的冠心病死亡中的比例从1970-1972年的6.5%大幅上升到1985-1986年的23.0%。在这项研究的17年中，糖尿病患者的冠心病死亡率显然没有下降。我们得出结论，初级预防在35-44岁年龄组中对冠心病的下降起到了重要作用。更好的诊断和治疗，特别是心绞痛和心肌梗塞后患者的诊断和治疗，也可能是重要的。在进一步的预防策略中，控制糖尿病患者的冠心病必须是高度优先的。
Trends in coronary heart disease (CHD) mortality were examined among 35-44-year-old white men during 1970-1986. Death certificates were obtained for 1,216 cases. All were coroner-certified natural deaths and noncoroner-certified deaths due to vascular diseases and diabetes mellitus. Autopsy data, coroner's reports, hospital records, physician's reports, and informants were used to validate diagnoses. The reviewers rejected 73 of 805 CHD certifications, but they validated 54 cases not certified as CHD on the death certificate as CHD. The CHD mortality rate fell from 90.6/100,000/year in 1970-1972 to 40.3/100,000/year in 1985-1986. Approximately two thirds of the decline was related to a decline in sudden deaths including 41.6% due to incident sudden CHD death. The proportion of diabetics among validated CHD deaths rose dramatically from 6.5% in 1970-1972 to 23.0% in 1985-1986. The CHD mortality rate among diabetics apparently did not decline during the 17 years of the study. We conclude that primary prevention has contributed substantially to the CHD decline in the 35-44-year age group. Better diagnoses and treatment, especially of angina pectoris and of patients after a myocardial infarction, may also have been important. Control of CHD in diabetics must take high priority in further prevention strategies.