Coronary Disease Deaths: From Birth Cohorts to Prevention.

Abstract

Cardiovascular diseases remain the number one cause of death in most of the western world. However, mortality from coronary disease nonetheless started to decline in several countries including the United States and part of western Europe 4 decades ago, and this decline has continued until the present time. Conceptually, the decline in coronary disease mortality could reflect a decrease in the incidence of coronary disease with fewer new cases occurring, or a decline in its case fatality, or a combination thereof. Progress in the primary prevention of coronary disease would decrease incidence while improvement in medical care and secondary prevention would increase survival. Hence, describing temporal trends in different populations and examining their causes is important and can help to design interventions, deploy prevention strategies, and advocate for policy changes. Despite the importance of this endeavor, quantifying the role of each of the aforementioned components in coronary mortality decline remains a difficult task and the determinants of the decline are still incompletely understood. This matter is further complicated by the fact that the respective contribution of potential determinants likely evolved over time and across countries. Within this context, studies of trends according to person, place, and time have the potential to shed some light on this subject. The article by Ocaña-Riola et al reports an in-depth analysis of temporal trends in mortality from ischemic heart disease in southern Spain, aiming at separating age, birth cohort, and period effects. In epidemiology, age effect can be defined as a change in the outcome rate according to age, irrespective of birth cohort and calendar time; cohort effect can be defined as a change in the outcome rate according to year of birth, irrespective of age and calendar time; and period effect can be defined as a change in the outcome rate affecting an entire population at some point in time, irrespective of age and birth cohort. The study pertains to 145 539 deaths from ischemic heart disease that occurred in Andalusia between 1981 and 2008 among individuals aged between 30 and 84 years. For age effect, as expected, mortality from ischemic heart disease increased substantially with age for both men and women. Concerning birth cohort effect, the risk of

DOI: 10.1016/j.rec.2014.12.013

Cite this paper

@article{Roger2015CoronaryDD, title={Coronary Disease Deaths: From Birth Cohorts to Prevention.}, author={V{\'e}ronique L . Roger and Yariv Gerber}, journal={Revista española de cardiología}, year={2015}, volume={68 5}, pages={361-2} }