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Adult _ Elderly Health - Cardiovascular Diseases (Lecture 6)

Adult _ Elderly Health - Cardiovascular Diseases (Lecture...

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Weekly August6, 1999 / 48(30);649-656 Achievements in Public Health, 1900-1999: Dec in Deaths from Heart Disease and Stroke -- Unit States, 1900-1999 Heart disease has been the leading cause of death in the United States since 1921, and stroke has b third leading cause since 1938 (1); together they account for approximately 40% of all deaths. Since adjusted death rates from cardiovascular disease (CVD) have declined 60%, representing one of the important public health achievements of the 20th century. This report summarizes the temporal trend advances in the understanding of risk factors for CVD, development of prevention interventions to red risks, and improvements in therapy for persons who develop CVD. Decline in CVD Death Rates Age-adjusted death rates per 100,000 persons (standardized to the 1940 U.S. population) for disease heart (i.e., coronary heart disease, hypertensive heart disease, and rheumatic heart disease) have de from a peak of 307.4 in 1950 to 134.6 in 1996, an overall decline of 56% (1) ( Figure 1 ). Age-adjusted rates for coronary heart disease (the major form of CVD contributing to mortality) continued to increa 1960s, then declined. In 1996, 621,000 fewer deaths occurred from coronary heart disease than wou been expected had the rate remained at its 1963 peak (1). Age-adjusted death rates for stroke have declined steadily since the beginning of the century. Since stroke rates have declined 70%, from 88.8 in 1950 to 26.5 in 1996. Total age-adjusted CVD death ra declined 60% since 1950 and accounted for approximately 73% of the decline in all causes of deaths same period (1). Disease Epidemiology Intensive investigation into the CVD epidemic largely began in the 1940s following World War II, altho causal hypotheses about CVD and recognition of geographic differences in disease rates occurred e Landmark epidemiologic investigations, including the cross-country comparisons of Ancel Keys (5) ( s and the Framingham Heart Study (6), established the major risk factors of high blood cholesterol, hig pressure, and smoking and dietary factors (particularly dietary cholesterol, fat, and sodium). The risk concept--that particular biologic, lifestyle, and social conditions were associated with increased risk fo -developed out of CVD epidemiology (3,4). In addition to the major risk factors (i.e., high blood pressu blood cholesterol, and smoking), other important factors include socioeconomic status, obesity, and p inactivity (7). Striking regional differences were noted particularly for stroke mortality, with the highest observed in the southeastern United States (1). Cross-national and cross-cultural studies highlighted importance of social, cultural, and environmental factors in the development of CVD. Coronary heart disease and stroke, the two major causes of CVD-related mortality, are not influenced same degree by the recognized risk factors. For example, elevated blood cholesterol is a major risk f Page 1 of 6 Achievements in Public Health, 1900-1999: Decline in Deaths from Heart Disease and ...
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