Time trends in the prevalence of atherosclerosis: A population-based autopsy study

PURPOSE: Mortality from coronary heart disease is declining but little is k nown about trends in the prevalence of atherosclerosis. Autopsy rates in Ol msted County, Minnesota, are higher than the national average, offering an opportunity to address this matter. In this study, we determined the preval ence of anatomic coronary disease among autopsied Olmsted County residents and examined the generalizability of these findings. SUBJECTS AND METHODS: Reports of the 2,562 autopsies performed between 1979 and 1994 on Olmsted County residents greater than or equal to 20 years of age were reviewed for the presence of coronary disease. RESULTS: Among autopsied decedents less than 60 years old at death and amon g coroner's cases, the prevalence of anatomic coronary disease declined wit h time (P for trend = 0.05); no trend was detected among older persons or n oncoroner's cases. By logistic regression analysis, the crude odds ratio ([ OR] per 5 years) for the association between time and anatomic coronary dis ease was 0.94 (95% confidence interval [CI]:0.86 to 1.03; P = 0.18].Age, se x, and antemortem diagnosis of heart disease were also strongly related to the presence of disease. After adjustment for sex and antemortem diagnosis of heart disease, the prevalence of anatomic coronary disease decreased mor e in younger people than in older people (age 40 years: OR 0.43 [95% CI: 0. 24 to 0.80]; age 60 years: OR 0.62 [95% CI: 0.45 to 0.87]; age 80 years: OR 0.89 [95% CI: 0.64 to 1.231). CONCLUSION: The prevalence of anatomic coronary disease at autopsy decrease d between 1979 and 1994, particularly among younger people, supporting the notion that the burden of coronary disease has shifted toward the elderly. These results suggest that the decreased incidence of coronary artery disea se has contributed to the recent decrease in coronary mortality, particular ly among younger people.