Article

The decline in ischemic heart disease mortality: prospective evidence from the Alameda County Study.

Human Population Laboratory, California Department of Health Services, Berkeley 94704.
American Journal of Epidemiology (Impact Factor: 4.98). 07/1988; 127(6):1131-42.
Source: PubMed

ABSTRACT The contribution of secular changes in the distribution of ischemic heart disease risk factors and medical care utilization to the decline in ischemic heart disease mortality was investigated using data collected on the nine-year ischemic heart disease mortality experience of two cohorts selected to be representative of Alameda County, California, in 1965 and 1974. With adjustment for age, sex, race, and baseline ischemic heart disease conditions and symptoms, there was a 45% decline in the nine-year odds of ischemic heart disease mortality between the two cohorts (1965/1974, odds ratio (OR) = 1.82, p = 0.0001). Further adjustment for cohort differences in the following ischemic heart disease risk factors did not explain the decline: smoking status, leisure-time physical activity, self-assessed physical activity, alcohol consumption, body mass index, or social network participation; neither did adjustment for measures of education, utilization of preventive medical care, availability of a regular physician or clinic, health insurance coverage, number of physician visits during the last 12 months, or occupation. There was no change in the estimated ischemic heart disease decline when all adjustment variables were included in a logistic model (1965/1974, OR = 1.81, p = 0.0002). These variables do not appear to explain the large decline in nine-year ischemic heart disease mortality between these two cohorts.

0 Followers
 · 
67 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Coronary heart disease (CHD) mortality has declined in the past few decades; however, it is unclear whether the reduction in CHD deaths has been similar across urbanization levels and in specific racial groups. We describe the pattern and magnitude of urban-rural variations in CHD mortality in the U.S. Using data from the National Center for Health Statistics, we examined trends in death rates from CHD from 1999 to 2009 among people aged 35-84 years, in each geographic region (Northeast, Midwest, West, and South) and in specific racial-urbanization groups, including black and white people in large and medium metropolitan (urban) areas and in non-metropolitan (rural) areas. We also examined deaths from early-onset CHD in females aged <65 years and males aged <55 years. From 1999 to 2009, there was a 40% decline in age-adjusted CHD mortality. The trend was similar in black and white people but was more pronounced in urban than in rural areas, resulting in a crossover in 2007, when rural areas began showing a higher CHD mortality than urban areas. White people in large metropolitan areas had the largest decline (43%). Throughout the study period, CHD mortality remained higher in black people than in white people, and, in the South, it remained higher in rural than in urban areas. For early-onset CHD, the mortality decline was more modest (30%), but overall trends by urbanization and region were similar. Favorable national trends in CHD mortality conceal persisting disparities for some regions and population subgroups (e.g., rural areas and black people).
    Public Health Reports 01/2014; 129(1):19-29. · 1.64 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Atherosclerosis and osteoporosis are currently considered unrelated diseases. Osteoporosis involves bone calcium (Ca) loss and predominantly affects females after menopause. Atherosclerosis is an illness predominantly affecting males, and is primarily characterized by abnormal lipid metabolism. However, pathological calcification of the arterial wall is an underlying feature of atherosclerosis. Ca homeostasis is thus important in atherosclerosis as well as in osteoporosis. Men also develop osteoporosis although at a later age than women, and, as osteoporosis progresses in women, there is an accompanying calcification of arteries leading to increased incidence of atherosclerosis in aging women. Thus, during old age, both atherosclerosis and osteoporosis are prevalent in both males and females. The dramatic increase in atherosclerosis among women as they develop osteoporosis suggests that the two illnesses may be more closely related than previously realized. The use of vitamin D as a food supplement coincides with epidemic onsets of atherosclerosis and osteoporosis, and excess vitamin D induces both conditions in humans and laboratory animals. These observations suggest a role for chronic vitamin D excess in the etiology of the two illnesses. Magnesium (Mg) deficiency, nicotine, and high dietary cholesterol are contributing factors that accentuate adverse effects of vitamin D.
    Journal of the American College of Nutrition 11/1992; 11(5):567-83. DOI:10.1080/07315724.1992.10718263 · 1.68 Impact Factor
  • Source