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监测和解释冠心病（CHD）死亡率和发病率趋势的纵向研究之一；是美国死亡和残疾的主要原因。它包含了一个大而明确的社区，明尼阿波利斯/St。保罗（双子城）明尼苏达州的大都市区，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组成部分，包括发病率、住院发作率、病死率和冠心病危险因素的人群水平；2)在分类和诊断技术不断变化的时代，疾病监测的方法。在上一次拨款期间，卫生部对发病率和死亡率的监测发现：1)到1995年，男性和女性经年龄调整的冠心病死亡率持续下降；2) 20世纪90年代前半期住院AMI患者的生存率持续提高；3) 20世纪90年代院外心脏性猝死的下降较为温和，导致院外冠心病死亡率高于院内冠心病死亡率；4) 20世纪90年代男性和女性急性心肌梗死住院率（包括发病率和复发率）下降；5) AMI事件严重程度的适度变化；6) AMI住院后两年病死率显著提高；7)在急性心肌梗死期间，在住院时间急剧缩短的情况下，适当的药物、诊断程序和治疗程序的使用显著增加。在此应用中，我们建议在以下领域继续有效地收集MHS数据：1)在2002年继续监测冠心病死亡率；2) 2000年住院AMI监测监测AMI发生和生存趋势；3)评价新型高敏感特异性生物标志物（肌钙蛋白）的广泛应用对AMI诊断的影响；4)利用现代解剖学、组织学、毒理学和基于访谈的数据，通过对受害者群体样本进行尸检来评估院外心脏性猝死（SCD），以更好地表征这种致命疾病。

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.