Epidemiology

The Big Heart Disease Lie

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Cardiovascular disease is responsible for approximately 30% of all mortality worldwide, amounting to approximately 15 million deaths (Sueta et al., 1999). Furthermore, cardiovascular disease is the principal cause of mortality in all developed countries, responsible for 50% of all deaths, and is also emerging as a prominent public health problem in developing countries, representing approximately 16% of all deaths. In the United States cardiovascular disease is the most common cause of mortality in both men and women and accounts for almost 500,000 deaths/year. Additionally, 58,800,000 Americans have one or more types of cardiovascular disease according to current estimates (Table 1.1).

Coronary artery disease (CAD) has been recognized as the leading cause of death since the late 1940s. Hypertension, hypercholesterolemia, cigarette smoking, and diabetes mellitus were identified as key contributors to atherosclerosis and the development of cardiovascular risk. These risk factors are also related to cere-brovascular and peripheral vascular disease (Table 1.2).

The data support aggressive treatment of atherosclerosis in populations at risk. In patients with peripheral arterial disease (PAD), there is a high prevalence of myocardial infarction, stroke, and increased mortality. Lack of patient and physician awareness of peripheral vascular disease is associated with low atherosclerosis risk factor treatment intensity (Sueta et al., 1999). In this study of patients with known cardiovascular disease, only 35% had smoking behavior treated, 73% had lipid abnormalities treated, and 71% were on antiplatelet therapy. Recognition and treatment in patients with symptomatic or asymptomatic [ankle-brachial index (ABI) <0.9] PAD were significantly lower than the rates for patients with CAD.

VASCULAR SURGERY

Table 1.1. Cardiovascular Disease in the United States: 58.8 million Americans have one or more types of cardiovascular disease a minimal effect in improving walking distance in claudicants.

Table 1.1. Cardiovascular Disease in the United States: 58.8 million Americans have one or more types of cardiovascular disease

Type

Number (in millions)

Hypertension

50

Coronary artery disease

12

Stroke

4.4

Congestive heart failure

4.6

Peripheral arterial disease

8.4

Table 1.2. Selected risk factors for atherosclerosis Age

Diabetes

Smoking

Hyperlipidemia

Hypertension

Hyperhomocystinemia

Hyperfibrinogenemia

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