po37format - DEATH FROM CARDIOVASCULAR DISEASE THE...

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D EATH F ROM C ARDIOVASCULAR D ISEASE : T HE M AGNITUDE OF THE P ROBLEM The death rate due to cardiovascular disease increased each decade in the United States until the 1970's. Since then, there has been a dramatic decline in the death rates from myocardial ischemia and its complications. Although the reasons for this are not well understood, they are likely due, in part, to improved detection and treatment of hypertension, a toward a more prudent diet, and improvements in the medical and surgical care for cardiovascular disease. There is a general overall increase in heath awareness in our society, more emphasis on disease prevention, and a growing interest in exercise, or "fitness." Despite these advances, the problem of premature death due to cardiovascular disease is formidable - more Americans die of cardiovascular disease than from any other cause (Table 1). In 1984 there were an estimated 2,047,000 deaths in the United States. Just under half (48%) of these were cardiovascular disease deaths, two-thirds of which were caused by underlying coronary and ischemic heart disease. Table 1. Estimated Leading Causes of Death in the United States, 1985. Cause Number Diseases of the heart and blood vessels 991,332 Cancer 457,670 Accidents 92,070 Chronic obstructive pulmonary disease 74,420 Pneumonia and influenza 66,630 All other causes 401,878 Source: National Center for Health Statistics, U.S. Public Health Service, DHHS For patients with acute myocardial infarction who reach the hospital, mortality from coronary disease has also substantially declined. This is due, in part, to the immediate resuscitation efforts possible in coronary care areas of hospitals and a reduction in the incidence of ventricular fibrillation by early antiarrhythmic drug therapy. The recent results of trials employing thrombolytic therapy and/or percutaneous transluminal angioplasty hold promise for further reducing mortality from acute ischemic heart disease. S UDDEN C ARDIAC D EATH There are two major clinical syndromes that result in death from ischemic heart disease that occur without discrimination: sudden arrhythmic death due to cardiac arrest death due to myocardial failure Although sudden arrhythmic death occurs most often in patients with previously recognized ischemic heart disease, unexpected cardiac arrest is the first manifestation of underlying heart disease in up to 20% of patients.
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