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(Circulation. 2006;113:2285-2292.)
© 2006 American Heart Association, Inc.

Epidemiology

Secular Trends in Deaths From Cardiovascular Diseases

A 25-Year Community Study

Yariv Gerber, PhD; Steven J. Jacobsen, MD, PhD; Robert L. Frye, MD; Susan A. Weston, MS; Jill M. Killian, BS; Véronique L. Roger, MD, MPH

From the Division of Cardiovascular Diseases (Y.G., R.L.F., V.L.R.) and Department of Health Sciences Research (Y.G., S.J.J., S.A.W., J.M.K., V.L.R.), Mayo Clinic College of Medicine, Rochester, Minn.

Correspondence to Dr Véronique L. Roger, Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail roger.veronique{at}mayo.edu

Received September 22, 2005; revision received March 15, 2006; accepted March 21, 2006.

Background— Although age-adjusted cardiovascular disease (CVD) mortality has declined over the past decades, controversies remain about whether this trend was similar across locations of death and disease categories and about the existence of age and sex disparities.

Methods and Results— We examined CVD mortality trends in Olmsted County, Minnesota, between 1979 and 2003 using the categories defined by the American Heart Association, including coronary heart disease (CHD), non-CHD diseases of the heart, and noncardiac circulatory diseases. Data on demographics, cause, and location of death of all 6378 residents who died of CVD were analyzed. Although decreases in the age-adjusted rates occurred in all groups, the magnitude of the decline varied widely. Lesser annual declines were noted in out-of-hospital than in-hospital deaths (1.8% versus 4.8%; P<0.001), in older than in younger persons (1.5% at age 85 years versus 3.9% for those 74 years of age; P<0.001), and in women relative to men (2.5% versus 3.3%; P=0.007). Furthermore, although CHD showed a marked annual decrease (3.3%), more modest decrements were found for non-CHD diseases of the heart (2.1%) and noncardiac circulatory diseases (2.4%) (P=0.02 and P=0.04 for the comparison with CHD decline, respectively).

Conclusions— Over the past 25 years, CVD mortality declined markedly in the community, but there were large disparities in the magnitude of the decline, resulting in a shift in the distribution toward out-of-hospital and non-CHD deaths. Further reduction in CVD mortality will require strategies directed at elderly persons and women, in whom out-of-hospital rates have improved only minimally.

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