COMMUNITY SURVEILLANCE OF CHD AND SUDDEN DEATH (MHS)

明尼苏达州心脏调查(MHS)是为数不多的以人群为基础的纵向研究之一，旨在监测和解释冠心病(CHD)死亡率和发病率的趋势；冠心病是美国死亡和残疾的主要原因。它包括一个定义明确的大社区，明尼苏达州的明尼阿波利斯/圣保罗(双子城)大都市区，人口230万(1990年人口普查)。近二十年来，MHS在以下方面做出了贡献：1)了解冠心病死亡率下降的原因，包括冠心病危险因素的发病率、住院发病率、病死率和人群水平；2)在分类和诊断技术不断变化的时代，疾病监测的方法。在上一次赠款期间，卫生部发病率和死亡率监测发现：1)男性和女性的年龄调整的冠心病死亡率在1995年继续下降；2)在1990年代‘S’的上半年，住院的急性心肌梗死患者的存活率继续提高；3)在1990‘’S的时期，院外心脏性猝死的下降较为温和，导致院外的冠心病死亡率比院内的冠心病死亡率高；4)住院的急性心肌梗死的比率下降，包括‘S’年代男女的事件和复发事件；(5)急性心肌梗死的事件严重程度有轻微的变化；6)在确诊的急性心肌梗死住院后，两年内的病死率有了显著的改善；以及7)在急性心肌梗死期间住院时间大幅减少的情况下，适当的药物、诊断程序和治疗程序的使用显著增加。在这一应用中，我们建议继续在以下领域进行有效的MHS数据收集：1)在2002年继续监测冠心病死亡率；2)通过监测2000年住院的急性心肌梗死来监测急性心肌梗死的发生和存活趋势；3)评估新的、高度敏感和特异的生物标记物(肌钙蛋白)的广泛使用对急性心肌梗死诊断的影响；以及4)通过对受害者进行尸检来评估院外心脏性猝死(SCD)，利用现代解剖学、组织学、毒理学和基于访谈的数据来更好地描述这种致命状况。

The Minnesota Heart Survey (MHS) is among the few population- based longitudinal studies to monitor and explain trends in coronary heart disease (CHD) mortality and morbidity; the leading cause of death and disability in the United States. It encompasses a large and well defined community, the Minneapolis/St. Paul (Twin Cities) metropolitan area of Minnesota, comprising a population of 2.3 million (1990 census). For almost two decades, MHS has made contributions to: 1) understanding the components of the decline of coronary heart disease mortality including incidence rate, hospitalized attack rate, case fatality, and population levels of CHD risk factors; and 2) the methodology of disease surveillance in a time when classification and diagnostic technologies are constantly changing. In the last grant period, MHS morbidity and mortality surveillance has found: 1) a continued decline in age-adjusted CHD death rates through 1995 for both men and women; 2) continued improved survival of hospitalized AMI patients in the first half of the 1990's; 3) more modest declines of out-of-hospital sudden cardiac death during the 1990's resulting in an increasing preponderance of out-of-hospital compared to in-hospital CHD mortality; 4) declining rates of hospitalized AMI including incident and recurrent events for both men and women in the 1990's; 5) a modest change in event severity for AMI; 6) dramatic improvements in two year case fatality after validated hospitalized AMI; and 7) significant increases in the use of appropriate medications, diagnostic procedures and therapeutic procedures during AMI in the setting of dramatic declines in length of hospital stay. In this application, we propose to continue efficient MHS data collection in the following domains: 1) continue surveillance of coronary heart disease mortality through the year 2002; 2) monitoring trends in AMI occurrence and survival by surveillance of hospitalized AMI in the year 2000; 3) evaluation of the effect on AMI diagnosis of the widespread use of new, highly sensitive and specific biomarkers (troponins); and 4) evaluation of out-of- hospital sudden cardiac death (SCD) through an autopsy in a population sample of victims utilizing modern anatomical, histological, toxicologic and interview-based data to better characterize this fatal condition.