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Korperliches Training ist eine klinisch bewahrte, kosteneffektive, primare Intervention zur Pravention und Behandlung zahlreicher chronischer Erkrankungen. Ergebnisse einer Meta-Analyse zur Primarpravention zeigen, dass unabhangig von Alter und Geschlecht eine signifikante inverse Beziehung zwischen der Bewegungsintensitat und der Gesamtsterblichkeit besteht. Bei Gesunden ist die relative Intensitat, nicht aber die Dauer der Belastung mit einer Senkung sowohl der Gesamt- wie auch der KHK-Mortalitat verbunden, bei alteren Menschen eine hohere Trainingsintensitat mit einem groseren positiven Effekt auf die KHK-Inzidenz assoziiert. Intervalltraining ist gekennzeichnet durch einen Wechsel von Belastungs- und Erholungsphasen. Diese Form des Trainings ermoglicht, in den Belastungsphasen wiederholt uber einen definierten Zeitraum eine hohe Intensitat aufrechtzuerhalten. Es wird oft als angenehmer empfunden und ermoglicht, ein effektives Training in kurzerer Zeitdauer zu absolvieren. Dies ist bedeutsam vor dem Hintergrund, dass „Zeitmangel“ die meistgenannte Barriere bei der Adharenz an korperliche Aktivitat ist. Bereits in den 1990er-Jahren wurden im Setting der kardiologischen Rehabilitation erste Erfahrungen mit Intervalltraining bei Patienten gesammelt. Bisherige Untersuchungen zeigen ubereinstimmend, dass hohe Trainingsintensitaten auch von Patienten mit hohem kardiovaskularem Risiko bzw. manifesten, stabilen und medikamentos adaquat therapierten Herzkreislauferkrankungen gut toleriert werden und nicht mit einem erhohten Risiko fur den individuellen Patienten einhergehen. Bei zukunftigen rehabilitationswissenschaftlichen und anwendungsbezogenen Untersuchungen des Intervalltrainings sollte differenzierter der Impetus auf Einhaltung der vorgebenden Protokolle, d.h. des Gesamt-Energieumsatzes) gelegt werden, um fur spezifische Patientengruppen differenzierte Empfehlungen geben zu konnen. Exercise is a clinically proven, cost-effective, primary intervention for the prevention and treatment of a wide variety of chronic conditions. The results of a meta-analysis on primary prevention show that there is a significant inverse relationship between exercise intensity and overall mortality regardless of age and gender. In healthy individuals, the relative intensity, but not the duration of exercise, is associated with a reduction in both total and (coronary heart disease) CHD mortality. In older people, a higher training intensity is associated with a greater positive effect on CHD incidence. Interval training is characterized by alternating stress and recovery phases. This form of training makes it possible to maintain a high intensity repeatedly over a defined period of time during the stress phases. It is often perceived as more pleasant and enables effective training to be completed in a shorter period of time. This is significant in light of the fact that “lack of time” is the most frequently mentioned barrier to adherence to physical activity. As early as the 1990s, initial experience with interval training was gained in patients in the setting of cardiac rehabilitation. Previous studies consistently show that high training intensities are also well tolerated by patients with a high cardiovascular risk or manifest, stable and medically adequately treated cardiovascular diseases and are not associated with an increased risk for the individual patient. In future rehabilitation and application-related studies of interval training, the impetus should be more differentiated on compliance with the prescribed protocols (i.e. the total energy expenditure), in order to be able to give differentiated recommendations for specific patient groups.

Background and aim The association of serum cholesterol levels with the occurrence of coronary heart disease (CHD) mortality during a follow-up of 50 years was rarely investigated previously. Thus, we took advantage of results at hand in 10 pooled cohorts of men aged 40–59 years from the Seven Countries Study (9063 individuals and 2057 CHD fatal events) and we assessed this. Methods and results Cox proportional hazards models were run with CHD fatal events (as dependent variable) and cholesterol levels (as independent variables) at years 0, 10, and 25 (in 5 cohorts). Cumulative events during subsequent decades (cumulative approach: CA) and separately in each subsequent decade (partitioned approach: PA) were analyzed. The ecological correlation of average baseline serum cholesterol levels with CHD mortality was very high (R = 0.97). Serum cholesterol and CHD mortality for 50 years were associated at the individual level, and the association estimated by the Cox's coefficients (and related hazards ratios) was initially strong in both CA and PA, but slightly declined during later decades. Hazards ratios (for a difference of 40 mg/dl) ranged from 1.39 to 1.20 for CA and from 1.39 to 0.80 for PA. Coefficients were larger for CA than for PA and the decline was more evident for the latter. Partitioned coefficient became negative and significant in the last decade (from year 40–50). Coefficients derived from cholesterol levels measured at year 10 of follow-up showed similar trends but their magnitude was smaller. Conclusion Thus, the relationship of serum cholesterol levels with CHD mortality remained relatively stable during at least 40 years after a single cholesterol measurement at baseline in middle-aged men.

BACKGROUND:The Coronary Artery Calcium Data and Reporting System (CAC-DRS), which takes into account the Agatston score category (A) and the number of calcified vessels (N) has not yet been validated in terms of its prognostic significance. METHODS:We included 54,678 patients from the CAC Consortium, a large retrospective clinical cohort of asymptomatic individuals free of baseline cardiovascular disease (CVD). CAC-DRS groups were derived from routine, cardiac-gated CAC scans. Cox proportional hazards regression models, adjusted for traditional CVD risk factors, were used to assess the association between CAC-DRS groups and CHD, CVD, and all-cause mortality. CAC-DRS was then compared to CAC score groups and regional CAC distribution using area under the curve (AUC) analysis. RESULTS:The study population had a mean age of 54.2 ± 10.7, 34.4% female, and mean ASCVD score 7.3% ± 9.0. Over a mean follow-up of 12 ± 4 years, a total of 2,469 deaths (including 398 CHD deaths and 762 CVD deaths) were recorded. There was a graded risk for CHD, CVD and all-cause mortality with increasing CAC-DRS groups ranging from an all-cause mortality rate of 1.2 per 1,000 person-years for A0 to 15.4 per 1,000 person-years for A3/N4. In multivariable-adjusted models, those with CAC-DRS A3/N4 had significantly higher risk for CHD mortality (HR 5.9 (95% CI 3.6-9.9), CVD mortality (HR4.0 (95% CI 2.8-5.7), and all-cause mortality a (HR 2.5 (95% CI 2.1-3.0) compared to CAC-DRS A0. CAC-DRS had higher AUC than CAC score groups (0.762 vs 0.754, P

The first investigation of dietary intake in the Mediterranean region was undertaken at the initiative of the government of Greece in 1948. Plant foods (cereals, pulses, nuts, potatoes, vegetables and fruits) accounted for 61 % of total energy intake (TEI), animal foods (meat, eggs, fish and dairy products) for 7 % of TEI and olive oil was the main oil used. In 1950s, Ancel Keys undertook studies in USA, Italy, Spain, England, Japan, Australia and Canada leading him to hypothesise that a link could exist between diet, plasma cholesterol and CHD. Between 1958 and 1964, Keys and co-workers carried out the Seven Countries Study, which enrolled men aged 40–59 years in one of sixteen cohorts from seven countries (Finland, Greece, Italy, Yugoslavia, Japan, USA and Italy). After 15-, 25- and 50-year follow-up, a strong positive relation was observed between saturated fat intake and CHD mortality, and a negative one with Mediterranean Dietary Index. In 1975, Keys and his wife published a book entitled: ‘How to eat well and stay well. The Mediterranean way’, which popularised Mediterranean Diet (MedDiet). After 45-year follow-up, longevity without CHD death was 12·9 years higher in Crete than in Finland. Protecting effect of MedDiet towards CHD incidence and risk is now confirmed by Prevencion con Dieta Mediterranea study and by cohorts’ studies gathered in several recent meta-analyses. MedDiet is sustainable and recognised by UNESCO as an intangible cultural heritage, which is the most beautiful homage that can be paid to Ancel Keys and all his co-workers.

Background and aims In the 1960s and 1970s, Finland, mortality due to coronary heart disease (CHD) was over 30% higher among Finns residing in the east of the country compared with those residing in the west. Today, CHD mortality remains 20% higher among eastern Finns. The higher incidence of CHD mortality among eastern Finns has largely been explained by higher risk factor levels. Using a unique longitudinal cohort, we aimed to determine if participants who resided in eastern Finland during childhood had higher CHD risk factors in adulthood and from childhood to adulthood. Methods The study population included 2063 participants of the Cardiovascular Risk in Young Finns Study, born during the period 1962–1977, with risk factor data available from baseline (1980) when participants were aged 3–18 years, and had risk factor data collected again in adulthood (2011) when aged 34–49 years. Results Adult CHD risk factor profile was similar for those who resided in eastern or western Finland in childhood. Over life-course from 1980 to 2011, those subjects with childhood residency in eastern Finland had, on average, higher systolic (p = 0.006) and diastolic (p = 0.0009) blood pressures, total (p = 0.01) and LDL-cholesterol (p = 0.01), triglycerides (p = 0.04), apoB (p = 0.02), and serum glucose (p Conclusions Our sample of adult Finns aged 34–49 years had a similar CHD risk factor profile irrespective of whether they resided in eastern or western Finland during their childhood. However, when considering participants risk factor profiles over a 31-year period, those who resided in eastern Finland in childhood were associated with a less favorable CHD risk factor profile than those who resided in western Finland in childhood. The observed differences suggest that future CHD mortality might remain higher in eastern Finland compared with western Finland.

ObjectiveAn industry levy on sugar-sweetened beverages (SSB) was implemented in the UK in 2018. One year later, Brexit is likely to change the UK trade regime with potential implications for sugar price. We modelled the effect of potential changes in sugar price due to Brexit on SSB levy impacts upon CHD mortality and inequalities.DesignWe modelled a baseline SSB levy scenario; an SSB levy under ‘soft’ Brexit, where the UK establishes a free trading agreement with the EU; and an SSB levy under ‘hard’ Brexit, in which World Trade Organization tariffs are applied. We used the previously validated IMPACT Food Policy model and probabilistic sensitivity analysis to estimate the effect of each scenario on CHD deaths prevented or postponed and life-years gained, stratified by age, sex and socio-economic circumstance, in 2021.SettingEngland.SubjectsAdults aged 25 years or older.ResultsThe SSB levy was associated with approximately 370 (95 % uncertainty interval 220, 560) fewer CHD deaths and 4490 (2690, 6710) life-years gained in 2021. Associated reductions in CHD mortality were 4 and 8 % greater under ‘soft’ and ‘hard’ Brexit scenarios, respectively. The SSB levy was associated with approximately 110 (50, 190) fewer CHD deaths in the most deprived quintile compared with 60 (20, 100) in the most affluent, under ‘hard’ Brexit.ConclusionsOur study found the SSB levy resilient to potential effects of Brexit upon sugar price. Even under ‘hard’ Brexit, the SSB levy would yield benefits for CHD mortality and inequalities. Brexit negotiations should deliver a fiscal and regulatory environment which promotes population health.

Background: Congenital heart disease (CHD) accounts for ≈40% of deaths in US children with birth defects. Previous US data from 1999 to 2006 demonstrated an overall decrease in CHD mortality. Our study aimed to assess current trends in US mortality related to CHD from infancy to adulthood over the past 19 years and determine differences by sex and race/ethnicity. Methods: We conducted an analysis of death certificates from 1999 to 2017 to calculate annual CHD mortality by age at death, race/ethnicity, and sex. Population estimates used as denominators in mortality rate calculations for infants were based on National Center for Health Statistics live birth data. Mortality rates in individuals ≥1 year of age used US Census Bureau bridged-race population estimates as denominators. We used joinpoint regression to characterize temporal trends in all-cause mortality, mortality resulting directly attributable to and related to CHD by age, race/ethnicity, and sex. Results: There were 47.7 million deaths with 1 in 814 deaths attributable to CHD (n=58 599). Although all-cause mortality decreased 16.4% across all ages, mortality resulting from CHD declined 39.4% overall. The mean annual decrease in CHD mortality was 2.6%, with the largest decrease for those >65 years of age. The age-adjusted mortality rate decreased from 1.37 to 0.83 per 100 000. Males had higher mortality attributable to CHD than females throughout the study, although both sexes declined at a similar rate (≈40% overall), with a 3% to 4% annual decrease between 1999 and 2009, followed by a slower annual decrease of 1.4% through 2017. Mortality resulting from CHD significantly declined among all races/ethnicities studied, although disparities in mortality persisted for non-Hispanic Blacks versus non-Hispanic Whites (mean annual decrease 2.3% versus 2.6%, respectively; age-adjusted mortality rate 1.67 to 1.05 versus 1.35 to 0.80 per 100 000, respectively). Conclusions: Although overall US mortality attributable to CHD has decreased over the past 19 years, disparities in mortality persist for males in comparison with females and for non-Hispanic Blacks in comparison with non-Hispanic Whites. Determining factors that contribute to these disparities such as access to quality care, timely diagnosis, and maintenance of insurance will be important moving into the next decade.

For decades has been discussed on cardio-protective factors associated with drinking water, Si, Mg, etc. This study is assessing Finnish regional cropland Mg/ Ca values (by total, “tot” and 6 separate soil types) from periods 1966-70 (“68”) and 1986-90 (“88”), soil-type proportions (Prp) of mineral soils (min), e.g. moraines (mor) and sands, groundwater (gw) Si and (Mg/Ca), male (M) CHD mortality, ratios of human CHD and other cardiac mortality to total mortality [(CHD/Tot) and (Card.o/Tot)] in 19 regions. Preferring Si.gw median (Si.gw.md) to Si.gw.mean is explained.

BackgroundCongenital heart disease (CHD) accounts for approximately 40% percent of deaths in United States (US) children with birth defects. Previous US data from 1999-2006 demonstrated an overall decrease in CHD mortality. The objective of our study was to assess current trends in US mortality related to CHD from infancy to adulthood over the last 19 years and determine differences by sex and race/ethnicity.MethodsWe conducted an analysis of death certificates from 1999-2017 to calculate annual CHD mortality by age at death, race/ethnicity, and sex. Population estimates used as denominators in mortality rate calculation for infants were based on National Center for Health Statistics live birth data. Mortality rates in individuals>1 year of age utilized US Census Bureau bridged-race estimates as denominators for population estimates. We characterized temporal trends in all-cause mortality, mortality resulting directly due to and related to CHD by age, race/ethnicity, and sex using joinpoint regression.ResultsThere were 47.7 million deaths with 1 in 814 deaths due to CHD (n=58,599). While all-cause mortality decreased 16.4% across all ages, mortality resulting from CHD declined 39.4% overall. The mean annual decrease in CHD mortality was 2.6%, with the largest decrease for those age >65years. The age-adjusted mortality rate decreased from 1.37 to 0.83 per 100,000. Males had higher mortality due to CHD than females throughout the study, although both sexes declined at a similar rate (∼40% overall), with a 3-4% annual decrease between 1999 and 2009, followed by a slower annual decrease of 1.4% through 2017. Mortality resulting from CHD significantly declined among all race/ethnicities studied, although disparities in mortality persisted for non-Hispanic Blacks versus non-Hispanic Whites (mean annual decrease 2.3% versus 2.6%, respectively; age-adjusted mortality rate 1.67 to 1.05 versus 1.35 to 0.80 per 100,000, respectively).ConclusionsWhile overall US mortality due to CHD has decreased over the last 19 years, disparities in mortality persist for males compared to females and for non-Hispanic Blacks compared to non-Hispanic Whites. Determining factors that contribute to these disparities such as access to quality care, timely diagnosis, and maintenance of insurance will be important moving into the next decade.

We examined potential associations of sport club participation during adolescence and sports-related physical activity during adulthood with mortality from cardiovascular diseases (CVD) in a Japanese population. Between 1988 and 1990, 29,526 men and 41,043 women aged 40–79 years responded to a questionnaire including questions about the frequency of sports participation at baseline and sport club participation during junior/senior high school. Subjects were followed-up until the end of 2009, and 4230 cardiovascular deaths (870 CHD, 1859 stroke) were identified. Cox proportional-hazard regression models were used to estimate hazard ratios (HR). During the first-two thirds of the follow-up – where the proportional hazards assumption was met – the multivariate-adjusted HR (95% confidence interval) for total CVD mortality was 0.77 (0.61–0.98) among men and 0.82 (0.61–1.10) among women who were physically active at baseline (≥5 h/week versus 1–2 h/week). The corresponding HRs for coronary heart disease (CHD) mortality were 0.65 (0.39–1.07) and 0.40 (0.17–0.91), respectively. The combined associations of sports participation during adulthood and adolescence were also examined. Among men who participated in sports for ≥5 h/week at baseline, the multivariate-adjusted HR for those who also engaged in sport club activities during adolescence was 0.89 (0.61–1.30) for total CVD mortality and 0.24 (0.08–0.71) for CHD mortality when compared to non-participants. Among women, no statistically significant differences were found between sport club participants and non-participants. In conclusion, participating in sport clubs during adolescence might lead to a more pronounced risk-reduction for CHD mortality among men who also participate in sport activities during adulthood.

Objective To determine whether self-reported religiosity is associated with decreased coronary mortality risk in middle-aged men when rates are adjusted for known confounders. Design The Israeli Ischemic Heart Disease (IIHD) Project (n=10,232) was chosen by stratified sampling of civil servants and municipal male employees, men aged 40–65 in 1963. Subjects were seen upon enrollment (1963) and at two follow-up visits (1965 and 1968). Extent of religiosity according to belief and practice collected in 1965 on a scale from 1 to 5. Religiosity was defined as follow: (1) The most-strict observance of religious rules “Haredim”. (2) “Religious” (3) “Traditional” (4) “Secular” (5) The part of the latter who declared themselves to be “nonbelievers” were categorized as “agnostic”. Main outcome measure Coronary heart disease (CHD) death, determined from death certificates in 23 years of follow-up Results Among 9245 participants, 1098 died from CHD during 23 years follow up. Ever smoking, Body mass index (BMI) and socioeconomic status were significantly lower while age and diabetes were higher according to increasing religiosity. Religiosity was inversely related to CHD mortality. Demographic, anthropometric characteristics according to religion, and odds ratio (OR), 95% confidence interval (95% CI), for CHD mortality, (using agnostic as a reference group) are presented in table 1. Characteristics according to religion Religiosity Haredim (n=2103) Religious (n=1528) Traditional (n=1782) Secular (n=2085) Agnostic (n=1747) P for trend Age years (SD) 50.2 (6.9) 48.8 (6.6) 48.4 (6.7) 48.8 (6.6) 45.9 (6.8) Conclusion Religiosity was associated with lower CHD death in employed middle aged Israeli men followed up prospectively for 23 years.

BackgroundCardiovascular disease (CVD) is the main cause of death in most industrialised countries, including those in Europe. The mortality rates due to coronary heart disease (CHD), one of the most serious CVD conditions, have been decreasing in most European countries during the last decades. However, whether the trends over time in CHD mortality rates differ depending on neighbourhood deprivation has rarely been investigated.MethodsFor each year of the study period, 1988–2012, in Sweden, age-standardised mortality rates were calculated for three different types of neighbourhoods, characterised by a Neighbourhood Deprivation Index. Joinpoint regression was used to investigate potential changes in age-standardised mortality rates by neighbourhood deprivation and over time.ResultsOver the study period, age-standardised mortality rates due to CHD were consistently the highest in the deprived neighbourhoods and the lowest in the affluent neighbourhoods. We observed a statistically significant overall decline, ranging from 67% to 59%, in the age-standardised CHD mortality rates for each level of neighbourhood deprivation. Furthermore, the decline for the affluent neighbourhoods was significantly higher compared with the decline in the deprived neighbourhoods.ConclusionAge-standardised CHD mortality rates decreased significantly in Sweden between 1988 and 2012. This decline was more pronounced in the affluent neighbourhoods, which indicates that the improvements in prevention and treatment of CHD have not benefited individuals residing in deprived neighbourhoods to an equal extent. Knowledge of time trends in CHD mortality by level of neighbourhood deprivation may help guide decision-makers in the development of appropriate healthcare policies for deprived neighbourhoods.

Background Heart disease (HD) is the leading cause of death among Mississippians. However, trends in mortality rates for HD subtypes in Mississippi have not been adequately described. This study examined trends in mortality rates for HD subtypes among adults in Mississippi from 1980 through 2013. Methods We used Mississippi Vital Statistics data to calculate age-specific mortality rates for HD subtypes for Mississippians age 35 and older. Cases were identified via underlying cause of death codes from the International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10). We used Joinpoint software to calculate the average annual percent change (AAPC) in mortality rates for HD subtypes by race, sex, and age group. Results Overall, the age-adjusted coronary heart disease (CHD) mortality rate among Mississippi adults decreased by 62.7% between 1980 and 2013, with an AAPC of −3.0% (95% CI −3.7 to −2.3), while the age-adjusted heart failure mortality rate increased by 66.7%, with an AAPC of 1.4% (95% CI 0.5 to 2.3). Trends varied across HD subtypes: Annual rates of hypertensive HD mortality increased significantly for men, for individuals age 35 to 54, and for individuals age 75 and older. CHD mortality experienced a significant annual decrease among all race, sex, and age subgroups, while heart failure increased significantly among women, whites, and individuals age 75 and older. Conclusions From 1980 to 2013, CHD mortality decreased significantly while heart failure mortality increased significantly among adult Mississippians. However, HD subtype trends differed by race, sex, and age group.

Although air pollutants are associated with both mortality and incidence of coronary heart disease (CHD), further research is needed to determine the relative harm of each type of air pollutant. A systematic review to study the strength of association between an air pollutant and risks of CHD mortality and incidence was performed, 48 relevant cohort and time-series studies that reported the relationship between air pollutants and risks of CHD mortality and incidence were identified and subgroup analyses for PM10 and PM2.5 by age, sex, geographical location, economic development, and study design. The results showed that: particular matter 10 (particular matter ≤ 10 μm in aerodynamic diameter, PM10) and particular matter2.5 (particular matter ≤ 2.5 μm in aerodynamic diameter, PM2.5) could increase the risk of CHD mortality more than other gaseous pollutants, although most air pollutants could significantly increase the risk of CHD mortality and incidence. The risk of CHD mortality increased 12% (9...

Ca and dairy product intakes may be inversely associated with all-cause and cause-specific mortality, and non-Ca components of dairy products, such as insulin-like growth factor-1, may be independently associated with mortality. We investigated associations of Ca and dairy product intakes with all-cause, all-cancer, colorectal cancer (CRC) and CHD mortality among 35 221 55- to 69-year-old women in the prospective Iowa Women’s Health Study, who were cancer-free in 1986. We assessed diet using a Willett FFQ, and associations using multivariable Cox proportional hazards regression. We estimated residuals from linear regression models of dairy products with dietary Ca to investigate total and specific dairy products independent of their Ca content. Through 2012, 18 687 participants died, including 4665 from cancer (including 574 from CRC) and 3603 from CHD. For those in the highest relative to the lowest quintiles of intake, the multivariable-adjusted hazard ratios (HR) and 95 % CI for total Ca (dietary plus supplemental) were 0·88 (0·83, 0·93; P trend=0·001) for all-cause mortality, 0·91 (0·81, 1·02; P trend=0·34) for all-cancer mortality, 0·60 (0·43, 0·83; P trend=0·002) for CRC mortality and 0·73 (0·64, 0·83; P trend

Background This study aimed to assess the trends in the prevalence of electrocardiographic (ECG) abnormalities from 1986 to 2015 and impact of ECG abnormalities on risk of death from cardiovascular diseases (CVD) in the Lithuanian population aged 40–64 years. Methods Data from four surveys carried out in Kaunas city and five randomly selected municipalities of Lithuania were analysed. A resting ECG was recorded and CVD risk factors were measured in each survey. ECG abnormalities were evaluated using Minnesota Code (MC). Trends in age-standardized prevalence of ECG abnormalities were estimated for both sexes. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HR) for coronary heart disease (CHD) and CVD mortality. Net reclassification index (NRI), integrated discrimination improvement and other indices were used for evaluation of improvement in the prediction of CVD and CHD mortality risk after addition of ECG abnormalities variable to Cox models. Results From1986 to 2008, the decrease in the prevalence of Q-QS MC was observed in both genders. The prevalence of high R waves increased in men, while the prevalence of ST segment and T wave abnormalities as well as arrhythmias decreased in women. Ischemic changes and possible MI were associated with a 2.5-fold and 4.4-fold higher risk of death from CVD in men and 1.51-fold and 2.56-fold higher mortality risk from CVD in women as compared to individuals with marginal or no ECG abnormalities. The addition of ECG abnormalities to traditional CVD risk factors improved Cox regression models performance. According to NRI, 18.6% of men were correctly reclassified in CVD mortality prediction model and 25.2% of men - in CHD mortality prediction model. Conclusions the decreasing trends in the prevalence of ischemia on ECG in women and increasing trends in the prevalence of left VH in men were observed. ECG abnormalities were associated with higher risk of CVD mortality. The addition of ECG abnormalities to the prediction models modestly improved the prediction of CVD mortality beyond traditional CVD risk factors. The use of ECG as routine screening to identify high risk individuals for more intensive preventive interventions warrants further research.

Background and objectives: Congenital Heart Disease (CHD) is the most common class of major congenital malformations. It is also the leading cause of mortality from birth defects. We used the Global Burden of Disease (GBD) 2017 study results to explore the burden of CHD in five countries of the Magrebian region. Methods: We estimated the most comprehensive of CHD mortality, prevalence, and disability among children (0–1 year), all ages and age standardized for the Magrebian countries from 1990 to 2017. The burden of disease related to CHD was calculated using the GBD comparative risk assessment approach. Results: CHD caused 4.622,87 (95% UI 3.801,24-7.580,28) all age deaths in Maghreb in 2017, a 50% decline from 1990, 661,02 (95% UI 310,96-933,58) rate per 100.000, among children (0-1 year) CHD deaths, a 42.4% decline from 1990 and 19,37 (95% UI 11,88-45,68) in age standardized CHD deaths a 40.6% decline from 1990. Leading to a 21.6% decrease from 1990 to 2017 in the number of people living with CHD to 727.01 (95% UI 631,28-1.098,29), causing a total of 397.060,97 (220.367,12-685.127,98) years lived with disability. Conclusion: This is the first study to estimate trends in CHD burden for the Maghreb from 1990 to 2017. These findings highlight the large inequities in CHD in the region and can serve as a starting point for policy changes leading to improved screening, treatment, and data collection. We call for Maghreb countries to invest more resources in prevention and health promotion efforts to reduce this burden.

AIMS The main objective of our study was to evaluate the associations between different categories of bundle branch blocks (BBBs) and mortality and to consider possible impact of QRS prolongation in these associations. METHODS This analysis included 15 408 participants (mean age 54 years, 55.2% women, and 26.9% blacks) from the Atherosclerosis Risk in Communities study. We used Cox regression to examine associations between left BBB (LBBB), right BBB (RBBB) and indetermined type of ventricular conduction defect [intraventricular conduction defect (IVCD)] with coronary heart disease (CHD) death and all-cause mortality. RESULTS During a mean 21 years of follow-up, 4767 deaths occurred; of these, 728 were CHD deaths. Compared to No-BBB, LBBB and IVCD were strongly associated with increased CHD death (hazard ratios 4.11 and 3.18, respectively; P

Background: Previous studies have shown sex-specific differences in all-cause and CHD mortality in type 2 diabetes. We performed a systematic review and meta-analysis to provide a global picture of the estimated influence of type 2 diabetes on the risk of all-cause and CHD mortality in women versus men. Methods: We systematically searched PubMed, Embase, and Web of Science for studies published from their starting dates to 7 Aug 2018. The sex-specific hazard ratios (HRs) and their pooled ratio (women vs. men) of all-cause and CHD mortality associated with type 2 diabetes were obtained through an inverse-variance weighted random-effects meta-analysis. Subgroup analyses were used to explore potential sources of heterogeneity. Findings: The 35 analyzed prospective cohort studies included 2,314,292 individuals, among whom 254,038 all-cause deaths occurred. The pooled women vs. men ratio of the HRs for all-cause and CHD mortality were 1.17 (95% CI 1.12-1.23, I2=81.6%) and 1.97 (95% CI 1.49-2.61, I2=86.4%), respectively. The pooled estimate of the HR for all-cause mortality was approximately 1.30 in articles in which the duration of follow-up longer than 10 years, and 1.10 in articles in which the duration of follow-up less than 10 years. The pooled HRs for all-cause mortality in patients with type 2 diabetes was 2.33 (95% CI 2.02-2.69) in women and 1.91 (95% CI 1.72-2.12) in men, compared with their healthy counterparts. Interpretations: Women with type 2 diabetes have an approximately 17% and 97% greater additional risk of all-cause and CHD mortality than their men counterparts. Funding Statement: The study is supported by Natural Science Foundation of Zhejiang Province, K.C. Wong Magna Fund in Ningbo University, China Postdoctoral Science Foundation funded project, Jiangsu Postdoctoral Science Foundation funded project, Ningbo Scientific Innovation Team for Environmental Hazardous Factor Control and Prevention. Declaration of Interests: The authors declare no competing interest.

AimTo quantify the contribution of changes in different risk factors population levels and treatment uptake on the decline in CHD mortality in Denmark from 1991 to 2007 in different socioeconomic groups.DesignWe used IMPACTSEC, a previously validated policy model using data from different population registries.ParticipantsAll adults aged 25–84 years living in Denmark in 1991 and 2007.Main outcome measureDeaths prevented or postponed (DPP).ResultsThere were approximately 11,000 fewer CHD deaths in Denmark in 2007 than would be expected if the 1991 mortality rates had persisted. Higher mortality rates were observed in the lowest socioeconomic quintile. The highest absolute reduction in CHD mortality was seen in this group but the highest relative reduction was in the most affluent socioeconomic quintile. Overall, the IMPACTSEC model explained nearly two thirds of the decline in. Improved treatments accounted for approximately 25% with the least relative mortality reduction in the most deprived quintile. Risk factor improvements accounted for approximately 40% of the mortality decrease with similar gains across all socio-economic groups. The 36% gap in explaining all DPPs may reflect inaccurate data or risk factors not quantified in the current model.ConclusionsAccording to the IMPACTSEC model, the largest contribution to the CHD mortality decline in Denmark from 1991 to 2007 was from improvements in risk factors, with similar gains across all socio-economic groups. However, we found a clear socioeconomic trend for the treatment contribution favouring the most affluent groups.

Background : The Seven Countries Study in the 1960s showed very low mortality from coronary heart disease (CHD) in Japan, which was attributed to very low levels of total cholesterol. Studies of migrant Japanese to the USA in the 1970s documented increase in CHD rates, thus CHD mortality in Japan was expected to increase as their lifestyle became Westernized, yet CHD mortality has continued to decline since 1970. This study describes trends in CHD mortality and its risk factors since 1980 in Japan, contrasting those in other selected developed countries. Methods : We selected Australia, Canada, France, Japan, Spain, Sweden, the UK and the USA. CHD mortality between 1980 and 2007 was obtained from WHO Statistical Information System. National data on traditional risk factors during the same period were obtained from literature and national surveys. Results : Age-adjusted CHD mortality continuously declined between 1980 and 2007 in all these countries. The decline was accompanied by a constant fall in total cholesterol except Japan where total cholesterol continuously rose. In the birth cohort of individuals currently aged 50–69 years, levels of total cholesterol have been higher in Japan than in the USA, yet CHD mortality in Japan remained the lowest: >67% lower in men and > 75% lower in women compared with the USA. The direction and magnitude of changes in other risk factors were generally similar between Japan and the other countries. Conclusions : Decline in CHD mortality despite a continuous rise in total cholesterol is unique. The observation may suggest some protective factors unique to Japanese.

To investigate the predictive value of T-wave inversion (TWI) on routine electrocardiogram (ECG) for mortality in the general population with various risk groups in a prospective population-based follow-up study. Subjects. ECGs of a random population-based sample of 1814 men aged 42-60 years without coronary heart disease (CHD) at baseline.During an average follow-up of 21 years, 685 deaths occurred. Of these deaths 174 were due to CHD and 278 to cardiovascular disease (CVD). There were 57 subjects with TWI. After adjusting for age, TWI was associated with an increased CHD mortality (relative risk (RR) 4.10, 95% CI 2.26-7.41), CVD mortality (RR 3.47, 95% CI 2.09-5.78), and all-cause mortality (RR 2.07, 95% CI 1.37-3.12). After further adjustment for conventional risk factors, TWI remained statistically significant, predicting CHD mortality (RR 2.62, 95% CI 1.57-4.36), CVD mortality (RR 2.18, 95% CI 1.40-3.38), and all-cause mortality (RR 1.41, 95% CI 1.00-2.01), respectively.TWI is a strong predictor for CHD, CVD, and all-cause mortality in the general population. The respective risks of CHD and CVD among men with TWI were also increased among men with high blood pressure, LDL cholesterol, and obesity.

In this work a Mathematical model is proposed to study the relationship between sh consumption and coronary heart disease (CHD) mortality in Morocco. The aim of this study is to investigate CHD mortality depending on various sh consumption levels by proposing dierent scenarios. The mathematical model is based on ordinary dierential equations system. The dynamics of a population at risk of CHD, the dynamics of sh population living along the Moroccan coasts, the relationship between CHD mortality and the quantities consumed from the total caught in Morocco are studied. Furthermore, simulation is carried out with different scenarios depending on the total sh harvested and total sh consumed. This model highlights the negative correlation between CHD mortality and sh consumption. Mathematics Subject Classication: 92B05

Background Cardiovascular disease mortality rates are well-known to be lower in women than men and to increase with age. Whether these sex and age effects have changed over recent decades, and how much they differ by country, is unclear. Method From the WHO Mortality Database, we obtained age- and sex-specific CHD and stroke mortality rates for the world's most populous countries with data available between 1980 and 2010. We calculated age, country, and period-specific men-to-women mortality CHD and stroke mortality rate ratios for 26 countries and compared the differences between and within countries over time. Results Coronary heart disease (CHD) and stroke mortality decreased substantially between 1980 and 2010 in most countries, in both sexes. Mostly there was an attenuation of the effect of ageing over calendar time, more so in men than in women. CHD mortality was higher in men than in women throughout adulthood, but the magnitude of the difference varied by age. Men-to-women CHD mortality rate ratios were 4- 5 in middle age and 2 thereafter. Stroke mortality was more similar between sexes, with men-to-women stroke mortality rate ratios of around 1.5 to 2 until old age. Conclusion While CHD and stroke mortality rates declined considerably between 1980 and 2010 in both sexes, there was some indication for stronger age-specific reductions in CHD in men than women. Mortality from CHD and stroke remains higher among men than women until old age across a range of economically, socially, and culturally diverse countries.

Until the past century, mortality trends from coronary heart disease (CHD) and cerebrovascular disease (CVD) were less favorable in Latin than in North America. We calculated age-standardized mortality rates using data from the World Health Organization database over the period 1980 to 2013. To identify significant changes in trends, we performed joinpoint analysis. Since the early 2000's, CHD mortality rates decreased by about 35% in the USA and Canada in both genders; similar decreases were observed in some Latin American countries (i.e., Ecuador, Puerto Rico, and Chile), whereas the decreases were smaller in the other countries. In 2011 to 2013, the highest rates were in Venezuela (114.4/100,000 men) and Colombia (86.1/100,000 men) and the lowest ones (apart from Ecuador) in Panama, Chile, and Argentina (from 41 to 46/100,000 men and 18 to 19/100,000 women). For CVD mortality, a decrease by about 30% was observed in Argentina, Panama, and Uruguay plus Colombia for women, in addition to the USA and Canada. Smaller declines were observed in the other Latin American countries (from 23% in Colombian men to 5% in Venezuelan men). Throughout the period, rates in Latin America remained appreciably higher than those in North America. The highest CVD rates were observed in Brazil (51.6/100,000 men) and the lowest ones in Canada (12.9/100,000 women). In conclusion, trends in CHD and CVD mortality continue to be less favorable in Latin America than in Canada and the USA. The marked excess of CVD mortality is partly or largely attributable to inadequate control of dyslipidemia and hypertension.

This study presents a cost-effectiveness analysis of salt reduction policies to lower coronary heart disease in Syria. Costs and benefits of a health promotion campaign about salt reduction (HP); labeling of salt content on packaged foods (L); reformulation of salt content within packaged foods (R); and combinations of the three were estimated over a 10-year time frame. Policies were deemed cost-effective if their cost-effectiveness ratios were below the region’s established threshold of $38,997 purchasing power parity (PPP). Sensitivity analysis was conducted to account for the uncertainty in the reduction of salt intake. HP, L, and R + HP + L were cost-saving using the best estimates. The remaining policies were cost-effective (CERs: R = $5,453 PPP/LYG; R + HP = $2,201 PPP/LYG; R + L = $2,125 PPP/LYG). R + HP + L provided the largest benefit with net savings using the best and maximum estimates, while R + L was cost-effective with the lowest marginal cost using the minimum estimates. This study demonstrated that all policies were cost-saving or cost effective, with the combination of reformulation plus labeling and a comprehensive policy involving all three approaches being the most promising salt reduction strategies to reduce CHD mortality in Syria.

There are few multicity studies to address the effect of short-term effect of particulate matter air pollution on daily Coronary Heart Disease (CHD) mortality in developing countries, much fewer to further discuss its threshold and seasonal effect. This study investigates the season-varying association between particulate matter less than or equal to 10 μm in aerodynamic diameter (PM10) and daily CHD mortality in seven cities of China. Time series threshold Poisson regression model is specified to estimate the health effect for four cities with the threshold effect, and conventional linear Poisson model is used to analyze the effect for three cities without threshold. We apply the Bayesian hierarchical model to pool the city-specific estimates into overall level. On average, a 10μg/m3 increase of the moving average concentrations of current-day and previous-day PM10 is associated with an increase of 0.81% (95% Posterior Interval, PI: -0.04%, 1.67%) in daily CHD mortality for all the cities as a whole. The associations are smaller than reported in developed countries or regions with lower polluted level, which is consistent to the findings in the literature. The hazardous effect are higher in hot summer and cold winter (1.15% and 0.89%) but lower in relative warm spring and fall (0.85% and 0.69%). In summary, we found significant associations between short-term exposure to PM10 and CHD mortality in China. The sensitivity analyses in the study support the robustness of our results.

We have come a long way in the past 50 years toward reducing death and disability from cardiovascular diseases (CVDs). And yet, as articulated by Wilmot et al in this edition of Circulation ,1 we still have a long way to go, especially for young women and some racial/ethnic groups. These new findings highlight the value of looking “behind the curtain” at health data, in particular, teasing apart age- and sex-related outcomes. Article see p 997 Wilmot et al now build on our understanding of CVD mortality by highlighting recent trends in subpopulations, including young women, and those trends are troubling. These investigators examined mortality data for US men and women ≥25 years between 1979 and 2011 using US National Vital Statistics data that focused on coronary heart disease (CHD).1,2 International Classification of Diseases, 9th Revision and International Classification of Diseases, 10th Revision codes were used to determine the underlying cause of CHD deaths. Analyses of mortality data within 3 age groups ( 65 years) during 3 decades (1979–1989, 1990–1999, and 2000–2011) yielded an initial assessment of mortality trends. Regression modeling then further evaluated trends in the estimated annual percentage change in CHD mortality across the entire time period, permitting calculation of statistically significant differences in estimated annual percentage change from year to year. On one hand, the news is good. The impressive (68%) decline in age-adjusted CHD mortality rate for both men and women across the overall study period is nothing short of remarkable and validates progressive improvements in CVD prevention and treatment. Overall, since 2002, older men and women (>65 years of age) continue to experience large reductions in CHD mortality, which drives this overall mortality decline. Yet, disaggregating the data and recalculating mortality rates by age, sex, race, and …

Coronary heart disease (CHD) continues to be a major global cause of death and morbidity. Tremendous resources have been invested in diagnosing CHD and predicting CHD mortality and morbidity. Although Framingham and other risk scores have contributed importantly to risk stratification of patients

There are substantial geographic variations in coronary heart disease (CHD) mortality rates in England that may in part be due to differences in climate and air pollution. An ecological cross-sectional multi-level analysis of male and female CHD mortality rates in all wards in England (1999-2004) was conducted to estimate the relative strength of the association between CHD mortality rates and three aspects of the physical environment - temperature, hours of sunshine and air quality. Models were adjusted for deprivation, and index measuring the healthiness of the lifestyle of populations, and urbanicity. In the fully adjusted model, air quality was not significantly associated with CHD mortality rates, but temperature and sunshine were both significantly negatively associated (p

Background Information is scarce about the geographic variation in time trends of mortality from coronary heart disease (CHD). We aimed to describe trends in death rates, absolute number of deaths and years of life lost (YLL) due to CHD among men and women in Portugal, by region, from 1981 to 2012. Methods The age-standardized mortality rates from CHD were estimated by sex and region. We used joinpoint regression analysis to calculate the annual percent change (APC) in mortality and to identify points of significant change in the trend. The YLL due to premature mortality for CHD were computed using the Global Burden of Disease method. Results The age-adjusted mortality from CHD decreased between 1981 and 2012, both in men and women, but with significantly different APC by region. Smaller declines in rates were observed in Alentejo (men: APC 1993–2012: −2.4%; women: APC 1991–2012: −2.4%). The greatest decline was observed in Madeira between 2003 and 2012, in men (APC: −7.6%) and women (APC: −9.7%). The decline in rates in Algarve started only after 2003, whereas it was consistent from 1981 in the North and started in the 1990s in most other regions. A decrease in the number of deaths was only observed after 2000. The YLL from CHD decreased from 1981 to 2012, mainly after 2000. Conclusions In Portugal, between 1981 and 2012, relative declines of CHD mortality indicators were different by geographic region. Consistent decreases in mortality rates were only observed in the Centre, Lisbon and North, the most populated and urbanized regions.

This manuscript reviewed racial/ethnic differences in dyslipidemia, including prevalence of dyslipidemia, its relation to CHD and stroke mortality rates, response to lipid-lowering agents, and lifestyle modification. In particular, among all racial/ethnic groups, Asian Indians, Filipinos and Hispanics are at higher risk for dyslipidemia, which is consistent with the higher coronary heart disease (CHD) mortality rates in these groups. In addition, compared to other racial/ethnic groups, statins may have a higher efficacy for Asians. Studies suggest lower starting dosage in Asians, but the data are mixed. Genetic differences in statin metabolism can in part explain this racial/ethnic difference in statin sensitivity and adverse effects. Furthermore, lifestyle modification is recommended as part of dyslipidemia control and management. Both African Americans and Hispanics have more sedentary behavior and less favorable diet profile. Hispanic subgroups (i.e. Mexican, Puerto Rican, etc.) and Asian (i.e. Chinese, South Asian, etc.) subgroups should be disaggregated for lifestyle interventions due to cultural differences among the subgroups. Further studies are needed to better understand racial/ethnic-specific risk factors contributing to the observed differences in dyslipidemia, CHD, and stroke. Culturally-tailored prevention and intervention should be provided to the minority populations with elevated risk for dyslipidemia and considerably more research is needed to determine the best approaches to helping specific subgroups.

Background: Saturated fat (SFA), ω‐6 (n‐6) polyunsaturated fat (PUFA), and trans fat (TFA) influence risk of coronary heart disease (CHD), but attributable CHD mortalities by country, age, sex, and time are unclear. Methods and Results: National intakes of SFA, n‐6 PUFA, and TFA were estimated using a Bayesian hierarchical model based on country‐specific dietary surveys; food availability data; and, for TFA, industry reports on fats/oils and packaged foods. Etiologic effects of dietary fats on CHD mortality were derived from meta‐analyses of prospective cohorts and CHD mortality rates from the 2010 Global Burden of Diseases study. Absolute and proportional attributable CHD mortality were computed using a comparative risk assessment framework. In 2010, nonoptimal intakes of n‐6 PUFA, SFA, and TFA were estimated to result in 711 800 (95% uncertainty interval [UI] 680 700–745 000), 250 900 (95% UI 236 900–265 800), and 537 200 (95% UI 517 600–557 000) CHD deaths per year worldwide, accounting for 10.3% (95% UI 9.9%–10.6%), 3.6%, (95% UI 3.5%–3.6%) and 7.7% (95% UI 7.6%–7.9%) of global CHD mortality. Tropical oil–consuming countries were estimated to have the highest proportional n‐6 PUFA– and SFA‐attributable CHD mortality, whereas Egypt, Pakistan, and Canada were estimated to have the highest proportional TFA‐attributable CHD mortality. From 1990 to 2010 globally, the estimated proportional CHD mortality decreased by 9% for insufficient n‐6 PUFA and by 21% for higher SFA, whereas it increased by 4% for higher TFA, with the latter driven by increases in low‐ and middle‐income countries. Conclusions: Nonoptimal intakes of n‐6 PUFA, TFA, and SFA each contribute to significant estimated CHD mortality, with important heterogeneity across countries that informs nation‐specific clinical, public health, and policy priorities., peer-reviewed

The aim of this review is to summarize the incidence, prevalence, trend in mortality, and general prognosis of coronary heart disease (CHD) and a related condition, acute coronary syndrome (ACS). Although CHD mortality has gradually declined over the last decades in western countries, this condition still causes about one-third of all deaths in people older than 35 years. This evidence, along with the fact that mortality from CHD is expected to continue increasing in developing countries, illustrates the need for implementing effective primary prevention approaches worldwide and identifying risk groups and areas for possible improvement. FIS PI12/00914 Fondos FEDER No data JCR 2016 0.889 SJR (2016) Q1, 698/2886 Medicine (miscellaneous) No data IDR 2016 UEM

There are few multicity studies to address the effect of short-term effect of particulate matter air pollution on daily Coronary Heart Disease (CHD) mortality in developing countries, much fewer to further discuss its threshold and seasonal effect. This study investigates the season-varying association between particulate matter less than or equal to 10 ?m in aerodynamic diameter (PM10) and daily CHD mortality in seven cities of China. Time series threshold Poisson regression model is specified to estimate the health effect for four cities with the threshold effect, and conventional linear Poisson model is used to analyze the effect for three cities without threshold. We apply the Bayesian hierarchical model to pool the city-specific estimates into overall level. On average, a 10?g/m3 increase of the moving average concentrations of current-day and previous-day PM10 is associated with an increase of 0.81% (95% Posterior Interval, PI: -0.04%, 1.67%) in daily CHD mortality for all the cities as a whole. The associations are smaller than reported in developed countries or regions with lower polluted level, which is consistent to the findings in the literature. The hazardous effect are higher in hot summer and cold winter (1.15% and 0.89%) but lower in relative warm spring and fall (0.85% and 0.69%). In summary, we found significant associations between short-term exposure to PM10 and CHD mortality in China. The sensitivity analyses in the study support the robustness of our results.

OBJECTIVES We analyzed all-cause and coronary mortality data of the Turkish Adult Risk Factor Study cohort in Marmara and Central Anatolia regions, surveyed in 2011, and overall performance of long-term (21 years) follow-up of participants. STUDY DESIGN A total of 1,588 participants with an age range of 45 to 74 years were surveyed. Information on the mode of death was obtained from first-degree relatives and/or personnel of local health offices. Information on survivors was obtained from history, physical examination, and 12-lead electrocardiograms. Loss to follow-up was defined as the lack of physical examination for at least eight years. RESULTS Of the surveyed participants, 854 were examined, information on health status was obtained in 606 subjects, 46 individuals (28 men, 18 women) were ascertained to have died, and 82 subjects were lost to follow-up. A total of 2,800 person-years were added to follow-up. Nineteen deaths were attributed to coronary heart disease (CHD) and five deaths to cerebrovascular events. Overall mortality was estimated as 10.9 per 1000 person-years. In the age bracket of 45-74 years, overall annual all-cause mortality and CHD mortality were 12.8 and 5.5 per mille, respectively. Based on the total loss to follow-up (31.2%) during the past two decades, an annual loss to follow-up may be derived as 19.3 for every 1000 participants. This loss was nearly twice as high in participants living in big cities compared to those in smaller towns and rural areas. CONCLUSION A trend to slight reduction in coronary mortality, though not in overall mortality, before the age 75 years is noted in Turks. Annual loss to follow-up amounts to 2% of the participants.

Bjorck L, Capewell S, Bennett K, Lappas G, Rosengren A (Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; University of Liverpool, Liverpool, United Kingdom; Trinity College and St. James’s Hospital, Dublin, Ireland). Increasing evidence-based treatments to reduce coronary heart disease mortality in Sweden: quantifying the potential gains. J Intern Med 2011; 269: 452–467. Objectives. Between 1986 and 2002, coronary heart disease (CHD) mortality in Sweden fell by more than 50%. Approximately one-third (4800 fewer deaths) of this decline in age-adjusted CHD mortality could be attributed to treatments in patients with CHD and primary prevention medications. High treatment levels were achieved in some cases, but in others, only 50–80% of eligible patients received appropriate therapy. We therefore examined to what extent increasing the use of specific treatments in eligible patients might have reduced CHD mortality rates in Sweden. Design and methods. We used the previously validated IMPACT CHD model to combine data on CHD patient numbers, medical and surgical uptake levels and treatment effectiveness. We estimated the number of deaths prevented or postponed for 2002 (baseline scenario) and for an alternative scenario (if at least 60% of eligible patients were treated). Results. If treatments were increased to consistently cover at least 60% of eligible patients, approximately 8900 deaths could have been postponed or prevented, representing a potential gain of approximately 4100 fewer deaths than actually occurred in 2002. Approximately 45% of the 4100 gain would have come from primary prevention with statins, 23% from acute coronary syndrome treatments, 15% from secondary prevention therapies and 15% from treatments for heart failure. Conclusion. Increasing the proportion of eligible patients with CHD who receive evidence-based treatment could have resulted in approximately 4100 fewer deaths in 2002, almost doubling the actual mortality reduction. These findings further emphasize the importance of aggressively identifying and treating patients with CHD and high-risk individuals.

Objectives. The aim of this prospective cohort, multicentre study was to assess the effect of coadministrating ezetimibe 10 mg/day with an ongoing statin on the estimated risk for Cardiovascular (CVD) mortality in patients with persistently elevated LDL-C after statin monotherapy.Methods. The Systematic Coronary Risk Evaluation (SCORE) function was used to estimate the 10-year risk for cardiovascular mortality at baseline and 6 weeks. Primary outcome measures were absolute and percent changes in estimated Coronary Heart Disease (CHD) Mortality Risk, and general CVD Mortality Risk (Total CVD Mortality Risk).Results. 825 patients were included in the analysis. Mean (SD) age was 62 (10.5) years and 62.3% were males. The mean (SD) estimated Total CVD Mortality Risk decreased from 0.068 (0.059) at baseline to 0.053 (0.046) at 6 weeks (RR = 0.77; 95% CI:0.689–0.867), while the estimated CHD Mortality Risk decreased from 0.047 (0.040) at baseline to 0.034 (0.029) at 6 weeks (RR = 0.72; 95% CI:0.624–0.826).Conclusions. Co-administration of ezetimibe with a statin is effective in significantly reducing the estimated risk for cardiovascular mortality as measured by the SCORE model.

To analyse the frequency of unrecognized and/or unregistered fatal and nonfatal cases of acute coronary heart disease (CHD) and to estimate the unrecognized / unregistered cases influence on the acute CHD morbidity and mortality rate. Materials and methods. The unrecognized in medical documents acute CHD cases were actively revealed among 285 736 population according to the Study Design. Results. The portion of unrecognized cases in qualified acute CHD morbidity rate was 20.78% among males and 24.48% - among females, and 89.43% unrecognized cases had fatal outcome. In the issue of unrecognized cases revealing the acute CHD morbidity rate was increased by 26.24% among males and by 32.41% - among females, and the acute CHD mortality rate was increased in 2.13 and 2.28 times accordingly. Conclusion. The study results indicated the low acute CHD detectability in clinical practice and underestimate of acute CHD as cause of death.