Less is more: the dynamic epidemiology of cardiovascular diseases

Abstract

839the results of data regarding the characteristics and outcomes of about half million CV patients between 2006 and 2014 in Poland, is both interesting and important. The main findings of the latter study include the following temporal trends: 1) no significant change in the annual number of hospital admissions for CVD; 2) a shorter length of in-hospital stay for CVD admissions; 3) a decrease in the overall readmission rate; and 4) stable, with some tendency towards a decrease, in-hospital and 12-month adjusted mortality rates. The authors suggested that these findings could possibly result from better access to cardiology services, improvement in diagnostic and therapeutic measures, and in primary and secondary prevention. These findings are consistent with and largely confirm recent reports from other countries.A significant limitation of this work is the absence of evaluation and report of temporal trends in patients' characteristics, especially CV risk factors and major comorbidity, and the potential effect of such changes on investigated outcomes. This limitation is major because, as previously mentioned, changes in risk factors are a significant driving force behind changes in CVD morbidity and mortality and a focus for intervention. 5,6A recent analysis of 79 modifiable risks divided into 3 broad groups of behavioral, environmental and occupational, and metabolic risk factors in 188 countries showed that together they accounted for 88.5% of global CVD deaths and nearly 88% of global CV DALYs. 6 Although data on trends in important CV risk factors are much more limited than on mortality or some of the other CV outcomes and are rarely based on population-based studies, 5 several prominently observed changes should be mentioned. First and foremost, life expectancy is rising and population is getting older in most countries. This results in CV patients with an increased prevalence of CV risk factors and comorbidity, hence greatly Noncommunicable diseases (NCD) have surpassed communicable disease as the world's major disease burden. 1,2 The leading causes of NCD, accounting for approximately half of the annual deaths, are cardiovascular diseases (CVDs) with 17.9 million mortalities throughout 2015. 3 Furthermore, globally, the top 2 causes of years of life loss and disability-adjusted life years (DALYs) are ischemic heart disease (IHD) and stroke (ischemic and hemorrhagic). 2,3 Following the latter trends, in 2011, the UN General Assembly adopted a declaration that set a target, for all nations, to reduce the risk of premature death from NCDs by 25% by the year 2025 (known as 25 by 25). As a result, the World Health Organization (WHO) and Global Cardiovascular Disease Taskforce disseminated information and approaches to reach the WHO 2025 targets, where control of risk factors plays a pivotal role. 4Considering the above, it is clear that global and local investigation and monitoring of secular trends in cardiovascular (CV) morbidity and its related outcomes are one of the cornerstones for developing evidence...

Trends of Cardiovascular Risk Factors in Patients With Acute Myocardial Infarction: Soroka Acute Myocardial Infarction II (SAMI II) Project

“…Throughout the past decades, a significant decline in the rate of ST-segment elevation acute myocardial infarction (STEMI) hospitalizations but not of non-STEMI (NSTEMI) was observed. 1 –5 Improvements in outcomes were also reported for patients with STEMI in particular. 1 –4,6 –9 It has been suggested that these changes are explained, at least partially, by temporal changes in the prevalence of cardiovascular risk factors (CVRFs) in AMI.…”

“…[1][2][3][4][6][7][8][9] It has been suggested that these changes are explained, at least partially, by temporal changes in the prevalence of cardiovascular risk factors (CVRFs) in AMI. 3,5 The burden of CVRFs was demonstrated in an analysis of over 120 000 patients with acute coronary syndrome (ACS) enrolled in 14 international randomized clinical trials that showed at least 1 of 4 conventional risk factors (smoking, diabetes mellitus [DM], dyslipidemia, and hypertension) was present in >80% of patients. 5,10 The Framingham risk score (FRS) comprises the following CVRFs: age, blood pressure, total cholesterol, high-density lipoprotein cholesterol (HDL-C), smoking, and DM.…”

“…3,5 The burden of CVRFs was demonstrated in an analysis of over 120 000 patients with acute coronary syndrome (ACS) enrolled in 14 international randomized clinical trials that showed at least 1 of 4 conventional risk factors (smoking, diabetes mellitus [DM], dyslipidemia, and hypertension) was present in >80% of patients. 5,10 The Framingham risk score (FRS) comprises the following CVRFs: age, blood pressure, total cholesterol, high-density lipoprotein cholesterol (HDL-C), smoking, and DM. The FRS is designed to predict the long-term risk of cardiovascular (CV) first event.…”

“…3,5 The burden of CVRFs was demonstrated in an analysis of over 120 000 patients with acute coronary syndrome (ACS) enrolled in 14 international randomized clinical trials that showed at least 1 of 4 conventional risk factors (smoking, diabetes mellitus [DM], dyslipidemia, and hypertension) was present in >80% of patients. 5,10…”