TRENDS IN CARDIOVASCULAR-DISEASE INCIDENCE AND SURVIVAL IN THE ELDERLY

This study compared the age-specific incidence, postdiagnostic surviva l, and mortality for cardiovascular disease (CVD) in two cohorts of pe ople aged 65 years and older. All subjects were members of a large pre paid health maintenance organisation. The influence of changes in CVD risk factors on these rates also was evaluated. Trends in prevalence, incidence, postdiagnostic survival, and mortality for CVD were examine d in both cohorts in 1971 and 1980. Myocardial infarction (MI), angina pectoris, stroke, and congestive heart failure (CHF) were included as CVD outcomes in this analysis. Nine-year prospective data on these di agnoses were abstracted from medical records and computerized hospital ization records for both cohorts. Age-sex-adjusted cardiovascular mort ality was lower for both sexes by similar to 20% in the 1980 cohort. O verall survival did not change, whereas cancer mortality increased by 76% in women and 36% in men. With the exception of stroke, there was n o increase in age-adjusted or age-specific prevalence. In men, the age -adjusted prevalence of stroke in men was 24% higher in the 1980 cohor t. Age-adjusted 9-year incidence of MI, angina pectoris, stroke, and C HF did not change between cohorts in either sex. Postdiagnostic, age-a djusted mortality for men with incident stroke was 24% lower in the 19 80 cohort, and Postdiagnostic, age-adjusted mortality for men with inc ident angina was 35% lower in the 1980 cohort. Adjustment for risk fac tors measured at or before baseline had little influence on cohort dif ferences in CVD incidence or duration of surgical after CVD diagnosis. This study confirms other research showing a decline in CVD mortality over the past 20 years. These findings suggest that prevalent angina pectoris is increasing in men, and that survival with stroke and with angina is improving in men. Later diagnosis of incident CHF in men sug gests that prevention and early detection may be postponing the develo pment of more serious disease. Ann Epidemiol 1996; 6:348-356.