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Coronary Heart Disease The Magnitude of the Problem 2004

This article discusses the prevalence and impact of coronary heart disease (CHD) in the United States, including statistics on myocardial infarction, angina pectoris, stroke, and cardiovascular disease (CVD). It highlights the alarming number of deaths caused by CVD and the features of vulnerable plaques associated with acute myocardial infarctions.

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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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