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Coronary Heart Disease The Magnitude of the Problem 2004

Coronary Heart Disease The Magnitude of the Problem 2004. James T. Willerson, MD. Medical Director: Texas Heart Institute Chief Of Cardiology: St. Luke’s Episcopal Hospital Editor: Circulation (1993-2004) President: University of Texas Health Science Center at Houston.

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Coronary Heart Disease The Magnitude of the Problem 2004

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  1. Coronary Heart Disease The Magnitude of the Problem 2004 James T. Willerson, MD Medical Director: Texas Heart Institute Chief Of Cardiology: St. Luke’s Episcopal Hospital Editor: Circulation (1993-2004) President: University of Texas Health Science Center at Houston

  2. Cardiovascular Disease in US • 13,200,000 Americans have CHD • Myocardial infarction = 7,800,000 • Angina pectoris = 6,800,000 • Stroke = 4,800,000 • 1 in 5 males and females has some form of CVD • Since 1900 CVD has been the No. 1 killer in the United States every year but 1918 • Nearly 2,600 Americans die of CVD each day, an average of 1 death every 34 seconds • CVD accounted for 38.5% of all deaths or 1 of every 2.6 deaths in the United States in 2001 National Health and Nutrition Examination Survey III [NHANES III, 1988-94]

  3. Acute Myocardial Infarctions Evolve Most Frequently From Plaques With Mild to Moderate Obstruction Number of MI patients E Falk, PK Shah, V Fuster. Circulation 1995;92:657

  4. Features of Vulnerable Plaques • Large lipid pool (>40% plaque volume) • Thin fibrous cap (<65 μm) • Decreased collagen content of cap • Macrophage infiltration • Activated T cells • Mast cells • Depletion of cap smooth muscle cells • Outward remodeling • Necrotic core • Increased neoangiogenesis • Calcium nodule • Temperature and pH heterogeneity • Mechanical stress

  5. Atherosclerotic Vulnerable Plaque

  6. Estimated Direct and Indirect Costs (in Billions of Dollars) of Cardiovascular Diseases and Stroke United States: 2004 p42 Source: All estimates prepared by Thomas Thom, NHLBI.

  7. 2001 data from the Healthcare Cost and Utilization Project (HCUP) hcup.ahrq.gov

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