Coronary heart disease mortality rates

An extension of the Seven Countries Study, by Ancel Keys and colleagues, indicated the particular importance of the flavonoids. During the study, which was reported in 1980, random samples of the food eaten by the participants were taken and stored for future analysis. When this was done, it was found that the average intakes of the antioxidants vitamin E, P-carotene and vitamin C were not related to the 25-year coronary heart disease mortality rates. In contrast, the intake of flavonoids was inversely related to the mortality. 

The same authors [204] confirmed these results in the Seven Country Study. The contribution of flavonols and flavones in explaining the variance in coronary heart disease mortality rates across 16 cohorts from seven countries was studied. Flavonol and flavone intake was inversely correlated with mortality from coronary heart disease. These finding are in line with the results of a cohort study in Finnland [205], where a significant inverse gradient was observed between dietary intake of flavonoids and total and coronary mortality. 

Figure 26-22 Relationship between cholesterol concentration and coronary heart disease mortality expressed by yearly rate per 1000 and risk ratios (Multiple Risk Factor Intervention Trial [MRFIT] participants). (From Grundy SA1. Cholesterol and coronary heart disease A new era. JAMA i 986,256 2849-55. Copyright 1986, American Medical Association.)...

Timstall-Pedoe, H., Kuulasmaa, K., Mahonen, M., Tolonen, H., Ruokokoski, E., and Tkmouyel, P. (1999). Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality 10-year results from 37 WHO MONICA Project populations. Lancet, 353(9164), 1547-1557. 

The results were that income inequality was strongly associated with lack of social trust, and that states with high levels of social mistrust had higher age-adjusted rates of total mortality (level of social trust explained 18% of variance in total mortality, under their regression). Lower levels of social trust were associated with higher rates of most major causes of death, including coronary heart disease, malignant neoplasms, cerebrovascular disease, unintentional injury, and infant mortality. 

A modest but not significant inverse correlation between the intake of flavonols and flavones and subsequent mortality rates was found in a prospective cohort study of US Health Professionals by Rimm et al [206]. The authors do not exclude that flavonoids have a protective effect in men with established coronary heart disease although strong evidence was missing. Also other studies failed to demonstrate a significant statistical association between the intake of polyphenols and CHD. In Great Britain for instance coronary and total mortality even rose with the intake of the major flavonol source, tea [207], The most likely explanation for the latter observation is that in this study tea consumption merely acted as a marker for a lifestyle that favours the development of cardiovascular disease. Indeed, men with the highest intake of tea and flavonols tended to be manual workers, and they smoked more and ate more fat [208],... 

Furthermore, polyphenolics present in wine, of which flavonoids are important components, have been suggested to be responsible of the so called French paradox, that is, the unexpectedly low rate of mortality from coronary heart disease in French population despite an unfavourable exposure to known cardiovascular risk factors such as high saturated fat consumption [19-21]. Epidemiological studies in USA [22] and Denmark [23] reported that moderate red wine drinkers had a lower risk of coronary artery disease than participants with no alcoholic beverage preference. However, controversial results about the antioxidant capacity of human serum after red wine consumption have been reported [24-27]. It is therefore uncertain whether wine constituents other than alcohol add to the cardioprotective effects of red wine. 

An interesting case is the prevention of cardio-vascular diseases as a result of the consumption of wine. Like most fruits grapes are rich in polyphenols, and the process of wine making results in the concentration of polyphenols. Wine polyphenols are considered to have beneficial effects on coronary heart disease and atherosclerosis. The presence of polyphenols in wine are thought to be the reason for the French paradox France was shown to have a coronary mortality rate close to that of China and Japan in spite of the high amount of saturated fat and cholesterol levels in the French diet. The consumption of red wine in France, however, is considerably higher than in either China or Japan (Staggs, 1996). 

The well-known French paradox was first noted by Irish physician Samuel Black in 1819. Back in the nineteenth century, he was the first to observe the fact that people in France suffer relatively low incidence of coronary heart disease, despite their diet being rich in saturated fats. It was proposed that France s profound red wine consumption is a primary factor contributing to the protective effect. The first scientific evidence, however, for the cardiovascular benefits of red wine was put forward by Renaud and his associates in 1992 [Renaud and Lorgeril, 1992]. In this study, popularly known as the French paradox, the researchers found that there had been a low mortality rate from, and incidence of, coronary heart disease among French men above the age of 40 years compared to men in the United Kingdom and the United States, despite their high consumption of saturated fats and the prevalence of other... 

Recent reports on clinical trials of pravastatin and simvastatin have shown a significant reduction in patient mortality rates for both hypercholesterolemic patients without known coronary heart disease and for those with existing coronary heart disease [7,8], These trials have established cholesterol-lowering agents as an effective treatment for coronary disease and have stimulated the search for new cholesterol-lowering agents with other mechanisms of action. 

It is estimated that about 2000 years ago, the average life expectancy (birth to death) of a Roman citizen was 22 years (W6). From then to 1900 it increased to 47 years in the United States and over the subsequent nine decades (1992) increased to 75.8 years (G16) (Fig. 1). This remarkable increase in life expectancy since 1900 is due primarily to the prominent decline in neonatal, infant, and maternal mortality rates, along with the control of various infectious diseases. More recently, there has been a significant, albeit much less, reduction in early deaths due to coronary heart disease and stroke (i.e., due to atherosclerosis), as well as to improved management and treatment of diabetes mellitus, cancer, and various other chronic disorders. Nevertheless, the maximum theoretical life span has possibly increased slightly over the past many centuries. The oldest-ever documented person in the world, Jeanne Calment of France, died on August 4, 1997, at the age of 122 years, 5 months, and 14 days (W10). It has recently been suggested that the maximum life span could be extended to 130 years or more (M6). 

Dekker JM, Crow RS, Folsom AR, et al. Low heart rate variability in a 2-minute rhythm strip predicts risk of coronary heart disease and mortality from several causes the ARIC study. Atherosclerosis Risk In Communities. Circulation2000 102(11) 113—20. 

Multiple well-controlled clinical trials have documented the efhcacy and safety of simvastatin, pravastatin, lovastatin, and atorvastatin in reducing fatal and nonfatal coronary heart disease (CHD) events, strokes, and total mortality. Rates of adverse events in statin trials were the same in the placebo groups and in the groups receiving the drug. This was trae with regard to noncardiac illness and the two laboratory tests, hepatic transaminases and creatine kinase (CK), that are commonly monitored in patients taking statins. 

In the western countries the most prevalent form of heart disease is coronary heart disease, i.e. the sequelae of atherosclerosis [18] of the coronary arteries. Culmination of coronary arteriosclerosis is manifested by erratic heart activity, arrhythmia or fibrillation, i.e. in drastic cases by coronary occlusion, myocardial infarction and sudden death. Mortality from coronary heart disease varies greatly from one country to the other. The following statistics represent the death rate due to coronary heart disease among the male population between the ages of... 

LEAD is an independent risk factor for CAD and a prognosticator of cardiovascular mortality (87-89,180). Cardiovascular death rates are higher in men than in women. In patients with LEAD, morbidity from coronary heart disease and stroke is increased 2.5 times more likely to present with morbidity from all forms of cardiovascular disease compared to subjects who do not have LEAD (44). There is a graded effect of the ABI on survival (45). The 10-year survival estimates among those patients with an ABI of less than 0.4 was only 33%, whereas the group with ABI ranging between 0.4-0.85 had a survival rate of 51%. Three out of four patients with an ABI greater than 0.85 survive 10 years (45). 

The majority of xanthomas appear in the 4th decade, and the prevalence increases during the folloAving decades. Some authors have discussed a lower rate of occurrence with further increase of age, but the early mortality of patients with xanthomas from coronary heart disease has to be considered here. The youngest patient with xanthomas in the study of Piper and Orrild (1956) was 19 years old in the age group from 20—29, 3 out of 10 (30%) exhibited xanthomas. The... 

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