Prevalence of and Risk Factors for Autopsy-Determined Atherosclerosis Among US Service Members, 2001-2011

Webber, Bryant J.; Seguin, P; Burnett, Daniel J.; Clark, Leslie L.; Otto, Jean

doi:10.1001/jama.2012.70830

Cited by 114 publications

(92 citation statements)

References 27 publications

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“…Compared with a study of autopsy-based coronary atherosclerosis in US service members who died of combat or unintentional injuries, the present study found a lower prevalence of CHD, but our questionnaire-based case definition required clinical symptoms that typically occur later in the course of atherosclerotic disease. 38 The rates of CHD in the present study were overall similar to that reported among young persons (12.9/1000 men and 2.2/1000 women over 10 years) in the general US population. 39 There were several limitations to the present study.…”

Section: Discussionsupporting

confidence: 87%

Impact of Combat Deployment and Posttraumatic Stress Disorder on Newly Reported Coronary Heart Disease Among US Active Duty and Reserve Forces

et al. 2014

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Background— The recent conflicts in Iraq and Afghanistan have exposed thousands of service members to intense stress, and as a result, many have developed posttraumatic stress disorder (PTSD). The role of military deployment experiences and PTSD in coronary heart disease (CHD) is not well defined, especially in young US service members with recent combat exposure. Methods and Results— We conducted a prospective cohort study to investigate the relationships between wartime experiences, PTSD, and CHD. Current and former US military personnel from all service branches participating in the Millennium Cohort Study during 2001 to 2008 (n=60 025) were evaluated for newly self-reported CHD. Electronic medical record review for International Classification of Diseases, Ninth Revision, Clinical Modification codes for CHD was conducted among a subpopulation of active duty members (n=23 794). Logistic regression models examined the associations between combat experiences and PTSD with CHD with adjustment for established CHD risk factors. A total of 627 participants (1.0%) newly reported CHD over an average of 5.6 years of follow-up. Deployers with combat experiences had an increased odds of newly reporting CHD (odds ratio, 1.63; 95% confidence interval, 1.11–2.40) and having a diagnosis code for new-onset CHD (odds ratio, 1.93; 95% confidence interval, 1.31–2.84) compared with noncombat deployers. Screening positive for PTSD symptoms was associated with self-reported CHD before but not after adjustment for depression and anxiety and was not associated with a new diagnosis code for CHD. Conclusions— Combat deployments are associated with new-onset CHD among young US service members and veterans. Experiences of intense stress may increase the risk for CHD over a relatively short period among young adults.

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Section: Discussionsupporting

confidence: 87%

Impact of Combat Deployment and Posttraumatic Stress Disorder on Newly Reported Coronary Heart Disease Among US Active Duty and Reserve Forces

et al. 2014

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“…20 Similarly, evidence from autopsy reports of United States military service members show a decreasing prevalence of atherosclerosis: the prevalence of coronary atherosclerosis was 77% in the Korean War in 1953, 45% in the Vietnam War in 1975, and 8.5% in the Iraq war. [21][22][23] A considerable strength of our study is the large number of patients we were able to collect and the availability of all clinically relevant information. All of our patients had carotid ultrasound, something that was a major limitation in previous studies.…”

Section: Bogiatzi Et Al Secular Trends In Stroke Subtypes 3211mentioning

confidence: 99%

Secular Trends in Ischemic Stroke Subtypes and Stroke Risk Factors

Bogiatzi

Hackam

McLeod

et al. 2014

Stroke

120

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Ischemic strokes account for ≈87% of all types of strokes; the distribution of ischemic stroke subtypes varies in different parts of the world.1 In Asia and South America, small vessel disease is the most prominent ischemic stroke subtype, whereas in Europe and the United States there is regional and ethnic variation in the distribution of stroke subtypes and their risk factors.2 Correctly identifying the cause of stroke is important for selection of the appropriate therapy to best reduce the risk of recurrence. 3 This may be particularly important in patients with minor or moderate stroke/transient ischemic attack (TIA), because they are less disabled, so will have more to lose from a recurrent stroke. With changing patterns of practice, in particular, increasing use of statins in the past decade, the distribution of risk factors and stroke subtypes in this population is expected to change over time. Changes in stroke subtypes resulting from these changes in practice can be expected to lead to changes in how physicians view the likelihood of different causes of stroke among their patients and plan strategies for investigation of their patients.The motivation for this study was the clinical suspicion, on the part of 2 senior stroke neurologists at our center, that cardioembolic strokes seemed to be increasing as a proportion of new patients referred to our local urgent TIA clinic. Our primary objective was to determine secular trends in ischemic stroke subtypes. We hypothesized that with more intensive management of atherosclerotic risk factors, there will have been a decrease in atherosclerotic risk factors and a decrease in large artery atherosclerosis and small vessel disease, and, in consequence, a proportional increase in cardioembolic stroke/TIA. Methods Study Setting and TimelineThis was a retrospective cohort study of patients diagnosed with minor or moderate stroke/TIA at the urgent TIA Clinic at University Hospital, a designated regional stroke hospital in London, Ontario. Based on Census reports from Statistics Canada, 599 538 residents were living in the referral area in 2006, and 619 881 residents were recorded in 2011. According to the 2011 census, 82% of the population of London are white, 2.7% Latin American, 2.6% Arab, 2.4% black, 2.2% South Asian, 2.0% Chinese, 1.9% Aboriginal, 1% Southeast Asian, 0.8% West Asian, 0.8% Korean, 0.6% Filipino, and 0.7% belong to other groups. In the surrounding farming area a higher Background and Purpose-Early diagnosis and treatment of a stroke improves patient outcomes, and knowledge of the cause of the initial event is crucial to identification of the appropriate therapy to maximally reduce risk of recurrence. Assumptions based on historical frequency of ischemic subtypes may need revision if stroke subtypes are changing as a result of recent changes in therapy, such as increased use of statins. Methods-We analyzed secular trends in stroke risk factors and ischemic stroke subtypes among patients with transient ischemic attack or minor or moderate stroke refer...

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“…In an study which included 2,562 autopsies performed between 1979 and 1994, the prevalence of anatomicallyevident CHD in subjects aged 20-59 years fell from 42% to 32% in men and from 29% to 16% in women when the periods 1979-1983 and 1990-1994 were compared (20 (21). Data from 44 years of follow-up in the original Framingham Study cohort and 20 years of surveillance of their offspring has allowed ascertainment of the incidence of initial coronary events such as MI (whether clinically recognized or not), angina pectoris, unstable angina, and sudden and non-sudden coronary deaths (22)(23)(24), reporting the following observations.…”

Section: Introduction and Definitionsmentioning

confidence: 99%

Epidemiology of coronary heart disease and acute coronary syndrome

Sanchís-Gomar¹,

Pérez-Quilis²,

Leischik³

et al. 2016

Ann. Transl. Med.

928

617

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The aim of this review is to summarize the incidence, prevalence, trend in mortality, and general prognosis of coronary heart disease (CHD) and a related condition, acute coronary syndrome (ACS). Although CHD mortality has gradually declined over the last decades in western countries, this condition still causes about one-third of all deaths in people older than 35 years. This evidence, along with the fact that mortality from CHD is expected to continue increasing in developing countries, illustrates the need for implementing effective primary prevention approaches worldwide and identifying risk groups and areas for possible improvement.

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Prevalence of and Risk Factors for Autopsy-Determined Atherosclerosis Among US Service Members, 2001-2011

Cited by 114 publications

References 27 publications

Impact of Combat Deployment and Posttraumatic Stress Disorder on Newly Reported Coronary Heart Disease Among US Active Duty and Reserve Forces

Impact of Combat Deployment and Posttraumatic Stress Disorder on Newly Reported Coronary Heart Disease Among US Active Duty and Reserve Forces

Secular Trends in Ischemic Stroke Subtypes and Stroke Risk Factors

Epidemiology of coronary heart disease and acute coronary syndrome

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