Autopsies of individuals in one
“Over the past century, the rate of death due to heart disease in the
A total of 3,237
“Over the full period (1981 to 2004), 8.2 percent of the 425 individuals had high-grade disease, and 83 percent had evidence of any disease,” the authors write. High-grade disease was defined as a grade of three or higher in the left main artery or a grade four or higher in any other single artery. Analyses adjusted to consider the individuals’ age and sex revealed declines over the entire period for high-grade disease, any disease and the average grade of disease. However, “declines in the grade of coronary disease ended after 1995 and possibly reversed after 2000.”
“Our finding that temporal declines in the grade of coronary artery disease at autopsy have ended, together with suggestive evidence that declines have recently reversed, provides some of the first data to support increasing concerns that declines in heart disease mortality may not continue,” the authors conclude. “The extent to which recent trends are attributable to the epidemics of obesity and diabetes mellitus awaits further investigation.”
In the context of other recent studies about increasing rates of childhood obesity, “the study by Nemetz et al underscores the importance of focusing prevention efforts on lifestyle factors among younger generations, including continued efforts to decrease smoking and encouraging healthy diets and moderate physical activity, before clinical symptoms of coronary artery disease have an opportunity to be expressed,” write S. Jay Olshansky, Ph.D., and Victoria Persky, M.D., of the University of Illinois at Chicago, in an accompanying editorial.2
“This limited examination of the autopsies of Olmsted County residents may be representative only of this unique segment of the American population, but the results are alarming enough to alert public health officials to begin monitoring younger cohorts for early signs of coronary artery disease with much greater vigilance,” they conclude.
1. Arch Intern Med. 2008; 168:264-270.
2. Arch Intern Med. 2008; 168:261.