Coronary heart disease trends in four United States communities. The Atherosclerosis Risk in Communities (ARIC) Study 1987-1996

Objective The objective of this paper is to report trends in mortality due to coronary heart disease (CHD), rates of first and recurrent hospitalized myocardial infarction, and survival after myocardial infarction in the Athe rosclerosis Risk in Communities (ARIC) Study from 1987 through 1996. Method The ARIC study used retrospective community surveillance to monitor admissions to acute care hospitals and deaths due to CHD (both in- and out- of-hospital) among all residents 35-74 years of age. The surveillance areas included over 360 000 men and women in four communities: Forsyth County, N orth Carolina; the city of Jackson, Mississippi; eight northern suburbs of Minneapolis, Minnesota; and Washington County, Maryland. Results The annual age-adjusted mortality rate of CHD fell 3.2% (95% CI:2.0 , 4.3) among men and 3.8% (95% CI : 1.9, 5.6) among women. The greater part of the decline took place between 1987 and 1991. Significant declines were observed for both in-hospital and out-of-hospital CHD death. Significant i mprovements in case-fatality were also observed. Recurrent hospitalized myo cardial infarction event rate fell an average of 1.9% per year among men (9 5% Cl : 0.7, 3.1) and 2.1% (95% Cl: 0.3, 3.9) among women. Average annual p er cent change in incident hospitalized myocardial infarction was not stati stically significant, except in blacks where there was evidence of an incre ase over time. Conclusion Factors associated with the occurrence of recurrent hospitalized myocardial infarction, as well as those creating a better chance of surviv al after an event (including reductions in sudden death), were likely the p rominent components in the recent decline in CHD mortality in ARIC communit ies.