In the Journals

Mortality decreasing for ischemic heart disease, rising for HF in US

Jamal S. Rana

Mortality attributed to ischemic heart disease declined from 2000 to 2015, but the rate of decline slowed from 2011 to 2014. At the same time, rates of mortality attributed to HF and all other causes of heart disease have increased in recent years, according to a new report published in BMC Cardiovascular Disorders.

“Our study brings into light that [HF] remains the most challenging subset of heart disease,” Jamal S. Rana, MD, PhD, FACC, cardiologist at Oakland Medical Center and adjunct investigator in the division of research at Kaiser Permanente Northern California in Oakland, California, told Cardiology Today. “[HF] is a complex disease with subtypes such as [HF] with preserved ejection fraction, with no definitive treatment so far to be proven effective in reducing morbidity and mortality.”

Mortality trends

The researchers analyzed CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) to determine national trends in age-standardized mortality rates attributable to HF, ischemic heart disease and other heart diseases from 2000 to 2011 and from 2011 to 2015.

“Heart disease by itself is the biggest category of [CVD] in terms of mortality. We wanted to break it down and to see if, within its major categories, the patterns were the same or whether there was something else going on to really help provide insight into whether there might potentially be more targeted effect in prevention and treatment approaches,” Stephen Sidney, MD, MPH, director of research clinics at the division of research at Kaiser Permanente Northern California, told Cardiology Today.

According to their findings, the rate of ischemic heart disease death decreased from 2000 to 2015. However, the rate of decline slowed in recent years, from 4.96% for 2000 to 2011 to 2.66% for 2011 to 2015.

Stephen Sidney

During the same period, mortality rates attributable to HF declined at an annual rate of 1.94%, but increased at an annual rate of 3.73% from 2011 to 2015. Similarly, mortality rates attributable to all other causes of heart disease declined at an annual rate of 0.64% from 2000 to 2011, but continued to rise at an annual rate of 1.89% from 2011 to 2015.

The decline and rise in mortality during the 2000-2011 and 2011-2015 time periods were statistically significant for all endpoints, both sexes and all race/ethnicity groups except American Indian/Alaskan Natives and Asian/Pacific Islanders, in which HF was only significant.

Implications of increasing mortality

The researchers discussed potential factors underlying the heterogeneity in U.S. mortality trends within heart disease subgroups.

“Part of the reason we think we may be seeing an increase is because we’ve been involved in an approximately 30-year obesity epidemic,” Sidney said. “In general, average body weights in the United States have increased substantially, resulting in higher rates of obesity. Obesity contributes to the development of hypertension and diabetes, which makes matters worse. In my mind, those factors are contributing to the heterogeneity.”

“The next step is greater understanding of the subcategories of HF,” Rana told Cardiology Today. “We know right now that [HF] mortality overall is increasing, but it is important to know specifically what type of [HF] is causing more mortality. … Could it be the preserved ejection fraction mortality of [HF] or the low ejection fraction [HF]? Having those data and that type of surveillance would guide us better to have more focused interventions to treat this rising tide of [HF].” – by Darlene Dobkowski

For more information:

Jamal S. Rana, MD, PhD, FACC, can be reached at jamal.s.rana@kp.org.

Stephen Sidney, MD, MPH, can be reached at steve.sidney@kp.org.

Disclosures: Rana reports receiving grant funding from Regeneron and Sanofi. Sidney reports no relevant financial disclosures. Please see the full study for a list of the other authors’ relevant financial disclosures.

 

Editor’s Note: This article was updated on August 7, 2017 to fix an incorrect range of years. The Editors regret the error.

Jamal S. Rana

Mortality attributed to ischemic heart disease declined from 2000 to 2015, but the rate of decline slowed from 2011 to 2014. At the same time, rates of mortality attributed to HF and all other causes of heart disease have increased in recent years, according to a new report published in BMC Cardiovascular Disorders.

“Our study brings into light that [HF] remains the most challenging subset of heart disease,” Jamal S. Rana, MD, PhD, FACC, cardiologist at Oakland Medical Center and adjunct investigator in the division of research at Kaiser Permanente Northern California in Oakland, California, told Cardiology Today. “[HF] is a complex disease with subtypes such as [HF] with preserved ejection fraction, with no definitive treatment so far to be proven effective in reducing morbidity and mortality.”

Mortality trends

The researchers analyzed CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) to determine national trends in age-standardized mortality rates attributable to HF, ischemic heart disease and other heart diseases from 2000 to 2011 and from 2011 to 2015.

“Heart disease by itself is the biggest category of [CVD] in terms of mortality. We wanted to break it down and to see if, within its major categories, the patterns were the same or whether there was something else going on to really help provide insight into whether there might potentially be more targeted effect in prevention and treatment approaches,” Stephen Sidney, MD, MPH, director of research clinics at the division of research at Kaiser Permanente Northern California, told Cardiology Today.

According to their findings, the rate of ischemic heart disease death decreased from 2000 to 2015. However, the rate of decline slowed in recent years, from 4.96% for 2000 to 2011 to 2.66% for 2011 to 2015.

Stephen Sidney

During the same period, mortality rates attributable to HF declined at an annual rate of 1.94%, but increased at an annual rate of 3.73% from 2011 to 2015. Similarly, mortality rates attributable to all other causes of heart disease declined at an annual rate of 0.64% from 2000 to 2011, but continued to rise at an annual rate of 1.89% from 2011 to 2015.

The decline and rise in mortality during the 2000-2011 and 2011-2015 time periods were statistically significant for all endpoints, both sexes and all race/ethnicity groups except American Indian/Alaskan Natives and Asian/Pacific Islanders, in which HF was only significant.

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Implications of increasing mortality

The researchers discussed potential factors underlying the heterogeneity in U.S. mortality trends within heart disease subgroups.

“Part of the reason we think we may be seeing an increase is because we’ve been involved in an approximately 30-year obesity epidemic,” Sidney said. “In general, average body weights in the United States have increased substantially, resulting in higher rates of obesity. Obesity contributes to the development of hypertension and diabetes, which makes matters worse. In my mind, those factors are contributing to the heterogeneity.”

“The next step is greater understanding of the subcategories of HF,” Rana told Cardiology Today. “We know right now that [HF] mortality overall is increasing, but it is important to know specifically what type of [HF] is causing more mortality. … Could it be the preserved ejection fraction mortality of [HF] or the low ejection fraction [HF]? Having those data and that type of surveillance would guide us better to have more focused interventions to treat this rising tide of [HF].” – by Darlene Dobkowski

For more information:

Jamal S. Rana, MD, PhD, FACC, can be reached at jamal.s.rana@kp.org.

Stephen Sidney, MD, MPH, can be reached at steve.sidney@kp.org.

Disclosures: Rana reports receiving grant funding from Regeneron and Sanofi. Sidney reports no relevant financial disclosures. Please see the full study for a list of the other authors’ relevant financial disclosures.

 

Editor’s Note: This article was updated on August 7, 2017 to fix an incorrect range of years. The Editors regret the error.