Department of Medicine, University of Arizona College of Medicine, Tucson.
Department of Medicine, University of Arizona College of Medicine, Tucson.
Am J Med. 2014 Sep;127(9):807-12. doi: 10.1016/j.amjmed.2014.04.015. Epub 2014 May 5.
Heart disease was an uncommon cause of death in the US at the beginning of the 20th century. By mid-century it had become the commonest cause. After peaking in the mid-1960s, the number of heart disease deaths began a marked decline that has persisted to the present. The increase in heart disease deaths from the early 20th century until the 1960s was due to an increase in the prevalence of coronary atherosclerosis with resultant coronary heart disease, as documented by autopsy studies. This increase was associated with an increase in smoking and dietary changes leading to an increase in serum cholesterol levels. In addition, the ability to diagnose acute myocardial infarction with the aid of the electrocardiogram increased the recognition of coronary heart disease before death. The substantial decrease in coronary heart disease deaths after the mid-1960s is best explained by the decreased incidence, and case fatality rate, of acute myocardial infarction and a decrease in out-of-hospital sudden coronary heart disease deaths. These decreases are very likely explained by a decrease in coronary atherosclerosis due to primary prevention, and a decrease in the progression of nonobstructive coronary atherosclerosis to obstructive coronary heart disease due to efforts of primary and secondary prevention. In addition, more effective treatment of patients hospitalized with acute myocardial infarction has led to a substantial decrease in deaths due to acute myocardial infarction. It is very likely that the 20th century was the only century in which heart disease was the most common cause of death in America.
心脏病在 20 世纪初的美国并不是常见死因。到了 20 世纪中叶，它已成为最常见的死因。在 20 世纪 60 年代中期达到峰值后，心脏病死亡人数开始显著下降，这一趋势一直持续到现在。从 20 世纪初到 60 年代，心脏病死亡人数的增加归因于冠状动脉粥样硬化（导致冠心病）的发病率增加，这一点在尸检研究中得到了证实。这种增加与吸烟增加和饮食变化有关，导致血清胆固醇水平升高。此外，心电图辅助诊断急性心肌梗死的能力提高了在死亡前对冠心病的识别。自 20 世纪 60 年代中期以来，冠心病死亡率的大幅下降，最好用急性心肌梗死的发病率和死亡率下降以及院外突发冠心病死亡人数下降来解释。这些下降极有可能是由于一级预防导致冠状动脉粥样硬化减少，以及由于一级和二级预防努力导致非阻塞性冠状动脉粥样硬化向阻塞性冠心病进展减少所导致的。此外，对急性心肌梗死住院患者的更有效治疗导致因急性心肌梗死导致的死亡人数大幅下降。很可能 20 世纪是心脏病成为美国最常见死因的唯一一个世纪。
