Affiliation:
1. Department of Health Sciences Research Mayo Clinic Rochester MN
2. Department of Epidemiology and Preventive Medicine School of Public Health Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
3. Department of Cardiovascular Medicine Mayo Clinic Rochester MN
4. Department of Cardiovascular Surgery Mayo Clinic Rochester MN
Abstract
Background
Temporal declines in cardiac stress tests results, coronary revascularization, and cardiovascular mortality have suggested a decline in the population burden of coronary disease until the 2000s. However, recent data indicate these favorable trends could be ending. We aimed to assess the evolution of the population burden of coronary disease in the community by examining trends in angiography and revascularization.
Methods and Results
We analyzed age‐ and sex‐adjusted trends from all coronary angiographic diagnostic procedures and revascularizations performed in Olmsted County, MN from 2000 to 2018. A total of 12 981 invasive angiograms were performed among 9049 individuals (64% men; 55% aged ≥65 years). Adjusted angiography rates decreased by 30% (95%
CI
, 25%–34%) between 2000 and 2009 and leveled off thereafter. Including
computed tomography,
angiography uncovered an increase in angiography use in recent years (risk ratio=1.15 [95%
CI
, 1.07–1.23] for 2018 versus 2014) and a decline in the prevalence of anatomic
CAD
from 2000 to 2018.
CAD
severity declined substantially from 2000 to 2009, followed by a plateau. Among 6570 revascularizations (72% men; 57% aged ≥65 years), 77% were percutaneous coronary interventions and 23% coronary artery bypass graft surgeries. The adjusted revascularization rates declined by 34% (95%
CI
, 27%–39%) from 2000 to 2009, followed by a plateau (risk ratio=1.10 [95%
CI
, 1.00–1.22]).
Conclusions
Between 2000 and 2018 in the community, coronary angiography use declined initially, leveled off, and then increased. Trends in
CAD
severity and revascularization use decreased then plateaued. The most recent trends are concerning as they suggest the burden of coronary disease is no longer declining. This warrants reinvigorated primary prevention and population surveillance.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
19 articles.
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