McGovern P G, Pankow J S, Shahar E, Doliszny K M, Folsom A R, Blackburn H, Luepker R V
Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55454-1015, USA.
N Engl J Med. 1996 Apr 4;334(14):884-90. doi: 10.1056/NEJM199604043341403.
Mortality from coronary heart disease (CHD) has declined in the United States since the late 1960s. To understand the reasons for the decline during the period form 1985 to 1990, we examined trends in mortality and morbidity due to CHD, medical care, and risk factors for CHD in a large metropolitan population.
We identified all deaths from CHD in residents of the Minneapolis-St. Paul, Minnesota, metropolitan area who were 30 to 74 years old and classified the deaths according to whether they occurred in or out of the hospital. For 1985 and 1990, we obtained lists of patients in this age range who were discharged with a diagnosis of acute CHD from all area hospitals, and we selected the medical records of 50 percent of these patients for abstraction. Definite myocardial infarctions were identified with standardized diagnostic algorithm. The 1985 and 1990 cohorts of patients hospitalized for myocardial infarction were followed for at least three years to identify those who died from any cause. Trends in risk factors for CHD were investigated through surveys of 25-to-74-year-olds that were conducted in 1985 through 1987 and 1990 through 1992.
Between 1985 and 1990, mortality from CHD fell by 25 percent for both men and women, and the decline in in-hospital mortality (41 percent) exceeded the decline in out-of-hospital mortality (17 percent) among men. The rates of hospitalization for acute myocardial infarction declined slightly, by 5 to 10 percent, between 1985 and 1990. Survival among patients hospitalized for acute myocardial infarction increased substantially during that period. After adjustment for age and previous myocardial infarction, the relative risk of dying within three years of hospitalization for a myocardial infarction (for the 1990 cohort as compared with the 1985 cohort) was 0.76 for men (95 percent confidence interval, 0.65 to 0.89) and 0.84 for women (95 percent confidence interval, 0.71 to 1.00). Substantial increases in the use of thrombolytic therapy, heparin, aspirin, and coronary angioplasty paralleled the survival trends. In general, the risk-factor profile of the area population with respect to CHD also improved considerably during that time.
The recent decline in mortality due to CHD in the Minneapolis-St. Paul metropolitan area can be explained by both the declining incidence of myocardial infarction in the population and the improved survival of patients with myocardial infarction.
自20世纪60年代末以来，美国冠心病（CHD）死亡率呈下降趋势。为了解1985年至1990年期间死亡率下降的原因，我们研究了一个大型都市人口中冠心病导致的死亡率和发病率趋势、医疗护理情况以及冠心病危险因素。
我们确定了明尼阿波利斯 - 圣保罗、明尼苏达州大都市地区30至74岁居民中所有冠心病死亡病例，并根据死亡发生在医院内还是医院外进行分类。对于1985年和1990年，我们获取了该年龄范围内所有地区医院诊断为急性冠心病出院患者的名单，并抽取了其中50%患者的病历进行摘要分析。通过标准化诊断算法确定明确的心肌梗死病例。对1985年和1990年因心肌梗死住院的患者队列进行至少三年的随访，以确定任何原因导致死亡的患者。通过对1985年至1987年以及1990年至1992年期间25至74岁人群的调查，研究冠心病危险因素的趋势。
1985年至1990年期间，男性和女性的冠心病死亡率均下降了25%，男性住院死亡率的下降幅度（41%）超过了院外死亡率的下降幅度（17%）。1985年至1990年期间，急性心肌梗死的住院率略有下降，降幅为5%至10%。在此期间，因急性心肌梗死住院患者的生存率大幅提高。在调整年龄和既往心肌梗死后，心肌梗死住院三年内死亡的相对风险（1990年队列与1985年队列相比）男性为0.76（95%置信区间为0.65至0.89），女性为0.84（95%置信区间为0.71至1.00）。溶栓治疗、肝素、阿司匹林和冠状动脉成形术使用的大幅增加与生存趋势平行。总体而言，该地区人群冠心病的危险因素状况在此期间也有显著改善。
明尼阿波利斯 - 圣保罗大都市地区近期冠心病死亡率的下降可归因于人群中心肌梗死发病率的下降以及心肌梗死患者生存率的提高。
