CME: Coronary Heart Disease: Stagnation in Young Adults & Women

CME: Coronary Heart Disease: Stagnation in Young Adults & Women

Recent reports have shown that coronary heart disease (CHD) continues to be a leading cause of death among Americans despite a remarkable decline in cardiovascular deaths related to the disease over the past several decades. CHD mortality rates fell by as much as 52% in men and 49% in women between 1980 and 2002, according to some research. However, other data suggests that these beneficial trends may not have been experienced by all demographic groups. “A 2007 study showed that there was a dramatic slowing in the average annual rate of decline of CHD mortality among adults aged 35 to 54,” explains Viola Vaccarino, MD, PhD. “Younger women appeared to be a particularly vulnerable patient group in this analysis.”   Examining Long-Term Trends For a study published in Circulation, Dr. Vaccarino and colleagues examined CHD mortality rates in the United States by age and sex from 1979 to 2011. “It’s important to assess long-term trends in CHD mortality to monitor our progress and see if more work is needed,” says Dr. Vaccarino.  The study group calculated age-specific CHD mortality rates and compared estimated annual percentage changes (EAPC) during three approximate decades of data: 1979–1989, 1990–1999, and 2000–2011. The authors then used regression modeling to assess EAPC trends over time. According to the results, the EAPC from 1979 to 2011 was lower in people younger than 55 years of age than in older groups in the two most recent decades. In contrast, CHD mortality rates declined steeply after 2000 for both women and men who were aged 65 and older.   Younger Women at Particular Risk The study also revealed...
Coronary Heart Disease: Stagnation in Young Adults & Women

Coronary Heart Disease: Stagnation in Young Adults & Women

Recent reports have shown that coronary heart disease (CHD) continues to be a leading cause of death among Americans despite a remarkable decline in cardiovascular deaths related to the disease over the past several decades. CHD mortality rates fell by as much as 52% in men and 49% in women between 1980 and 2002, according to some research. However, other data suggests that these beneficial trends may not have been experienced by all demographic groups. “A 2007 study showed that there was a dramatic slowing in the average annual rate of decline of CHD mortality among adults aged 35 to 54,” explains Viola Vaccarino, MD, PhD. “Younger women appeared to be a particularly vulnerable patient group in this analysis.”   Examining Long-Term Trends For a study published in Circulation, Dr. Vaccarino and colleagues examined CHD mortality rates in the United States by age and sex from 1979 to 2011. “It’s important to assess long-term trends in CHD mortality to monitor our progress and see if more work is needed,” says Dr. Vaccarino.  The study group calculated age-specific CHD mortality rates and compared estimated annual percentage changes (EAPC) during three approximate decades of data: 1979–1989, 1990–1999, and 2000–2011. The authors then used regression modeling to assess EAPC trends over time. According to the results, the EAPC from 1979 to 2011 was lower in people younger than 55 years of age than in older groups in the two most recent decades. In contrast, CHD mortality rates declined steeply after 2000 for both women and men who were aged 65 and older.   Younger Women at Particular Risk The study also revealed...

Evaluating & Managing Patients With Congenital Heart Disease

Survivors of congenital heart disease (CHD) are at greater risk for neurodevelopmental issues from both biological and environmental risk factors when compared with heart-healthy children. As survival rates in CHD have improved, the focus of clinical research has transitioned from striving for short-term survival to enhancing long-term morbidity. How common is neurodevelopmental impairment? View figure. A New Scientific Statement on CHD In the July 30, 2012 online issue of Circulation, my colleagues and I from the American Heart Association (AHA) released a scientific statement reviewing factors that increase risk for developmental disorders in those with CHD. The statement provides an algorithm for treating these developmental disabilities and stratifies risk; age-based management of CHD patients is also reviewed. The statement also discusses the impact of developmental disorders on quality of life for these individuals. A key recommendation is that children born with CHD should receive early evaluation for related neurodevelopmental disorders. High-risk patients should be referred for further developmental and medical evaluation. Developmental disorders can be identified and managed with continuous surveillance, appropriate screening, early evaluation, periodic reevaluation, and continuous, comprehensive treatment coordinated by a central care provider. Other recommendations include: Establishing a “medical home” to coordinate care between various specialists. Reassessing risk of developmental disorders each time the medical home is visited. Referring high-risk patients with CHD for early interventions before developmental disorders are formally diagnosed. Conducting periodic re-evaluations throughout infancy and childhood at 1 to 2 years, 3 to 5 years, and 11 to 12 years of age for developmental disorders in children with CHD deemed high risk. Considering potential benefits from higher-education or vocational counseling when high-risk...

Few STEMI Patients Take Preventive Therapies

Despite the apparently high prevalence of cardiovascular risk factors among patients hospitalized for STEMI without known coronary heart disease (CHD), preventive therapy appears to be low, according findings from to a cohort analysis. Only 24.1% of patients in the analysis were on aspirin, 16.1% were on a statin, and 7.8% were on both. The authors noted that 70% of their STEMI population did not have known CHD before their event, and slightly more than 40% of those events would be considered premature. Abstract: American Heart Journal, July 18, 2012...
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