Although the prevalence of coronary heart disease (CHD) in the United States has increased
during the past 25 years, cardiovascular mortality has decreased due to advances in
CHD therapy and prevention. We sought to determine the proportion of patients with
CHD who die from cardiovascular versus noncardiovascular causes and the causes and
predictors of death, in a cohort of patients with CHD. The Heart and Soul Study enrolled
1,024 participants with stable CHD from 2000 to 2002 and followed them for 10 years.
Causes of mortality were assigned based on detailed review of medical records, death
certificates, and coroner reports by blinded adjudicators. During 7,680 person-years
of follow-up, 401 participants died. Of these deaths, 42.4% were cardiovascular and
54.4% were noncardiovascular. Myocardial infarction, stroke, and sudden death accounted
for 72% of cardiovascular deaths. Cancer, pneumonia, and sepsis accounted for 67%
of noncardiovascular deaths. Independent predictors of cardiac mortality were older
age, inducible ischemia on stress echocardiography, higher heart rate at rest, smoking,
lower hemoglobin, and higher N-terminal pro-brain natriuretic peptide (all p values
<0.05); independent predictors of noncardiac mortality included older age, inducible
ischemia, higher heart rate, lower exercise capacity, and nonuse of statins (all p
values <0.05). In conclusion, mortality in this cohort was more frequently due to
noncardiovascular causes, and predictors of noncardiovascular mortality included factors
traditionally associated with cardiovascular mortality.
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References
- Heart disease and stroke statistics–2012 update: a report from the American Heart Association.Circulation. 2012; 125: e2-e220
- Proportion of the decline in cardiovascular mortality disease due to prevention versus treatment: public health versus clinical care.Annu Rev Public Health. 2011; 32: 5-22
- Explaining the decrease in U.S. deaths from coronary disease, 1980-2000.N Engl J Med. 2007; 356: 2388-2398
- Morbidity and mortality weekly report.in: Promotion NCfCDPaH. Centers for Disease Control, Atlanta, GA1999: 649-656
- Temporal trends in mortality in the United States, 1969-2013.JAMA. 2015; 314: 1731-1739
- Global and regional patterns in cardiovascular mortality from 1990 to 2013.Circulation. 2015; 132: 1667-1678
- Predictors of cardiac and noncardiac mortality among 14,697 patients with coronary heart disease.Am J Cardiol. 2003; 91: 121-127
- Depressive symptoms and health-related quality of life: the Heart and Soul Study.JAMA. 2003; 290: 215-221
- Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease.JAMA. 2008; 300: 2379-2388
- The audit alcohol consumption questions (audit-c): an effective brief screening test for problem drinking.Arch Intern Med. 1998; 158: 1789-1795
- Estimating glomerular filtration rate from serum creatinine and cystatin C.N Engl J Med. 2012; 367: 20-29
- 2014 ACC/AHA key data elements and definitions for cardiovascular endpoint events in clinical trials: a report of the American College of Cardiology/American Heart Association Task Force on clinical data standards (writing committee to develop cardiovascular endpoints data standards).J Am Coll Cardiol. 2015; 66: 403-469
- Prognosis of stable angina pectoris: why we need larger population studies with higher endpoint resolution.Heart. 2007; 93: 786-791
- Seven-year outcome in the RITA-2 trial: coronary angioplasty versus medical therapy.J Am Coll Cardiol. 2003; 42: 1161-1170
- Low total cholesterol is associated with high total mortality in patients with coronary heart disease. The Bezafibrate Infarction Prevention (BIP) Study Group.Eur Heart J. 1997; 18: 52-59
- Optimal medical therapy with or without PCI for stable coronary disease.N Engl J Med. 2007; 356: 1503-1516
- Prognosis of patients with stable coronary artery disease (from the CORONOR study).Am J Cardiol. 2014; 113: 1142-1145
- Traditional risk factors versus biomarkers for prediction of secondary events in patients with stable coronary heart disease: from the Heart and Soul Study.J Am Heart Assoc. 2015; 4
- Inducible ischemia and the risk of recurrent cardiovascular events in outpatients with stable coronary heart disease: the Heart and Soul Study.Arch Intern Med. 2008; 168: 1423-1428
- Elevated resting heart rate, physical fitness and all-cause mortality: a 16-year follow-up in the Copenhagen Male Study.Heart. 2013; 99: 882-887
- Retarding effect of lowered heart rate on coronary atherosclerosis.Science. 1984; 226: 180-182
- Resting heart rate is a risk factor for cardiovascular and noncardiovascular mortality: the Chicago Heart Association Detection Project in Industry.Am J Epidemiol. 1999; 149: 853-862
- What is causing extremely elevated amino terminal brain natriuretic peptide in cancer patients?.Congest Heart Fail. 2013; 19: 143-148
- Heterogeneity in healthy aging.J Gerontol A Biol Sci Med Sci. 2014; 69: 640-649
- Statin use and reduced cancer-related mortality.N Engl J Med. 2012; 367: 1792-1802
- Statins and cancer risk: a meta-analysis.JAMA. 2006; 295: 74-80
- Lack of effect of lowering LDL cholesterol on Cancer: meta-analysis of individual data from 175,000 people in 27 randomised trials of statin therapy.PLoS One. 2012; 7: e29849
- Statins and sepsis: multiple modifications at multiple levels.Lancet Infect Dis. 2007; 7: 358-368
- The effect of statins on mortality in septic patients: a meta-analysis of randomized controlled trials.PLoS One. 2013; 8: e82775
- Effect of statin therapy on mortality in patients with ventilator-associated pneumonia: a randomized clinical trial.JAMA. 2013; 310: 1692-1700
Article info
Publication history
Published online: September 29, 2016
Accepted:
September 13,
2016
Received in revised form:
September 13,
2016
Received:
June 6,
2016
Footnotes
Elizabeth Wang was supported by a fellowship from the University of California, San Francisco (Resource Allocation Program for Trainees). The Heart and Soul Study was supported by grants from the Department of Veterans Affairs (Epidemiology Merit Review Program), Washington, DC, the National Heart, Lung, and Blood Institute (R01 HL079235), Bethesda, Maryland, the Robert Wood Johnson Foundation (Generalist Physician Faculty Scholars Program), Princeton, New Jersey, the American Federation for Aging Research (Paul Bees on Faculty Scholars in Aging Research Program), New York, New York, the Ischemia Research and Education Foundation, South San Francisco, California, and Nancy Kirwan Heart Research Fund, San Francisco, California. None of these funding sources had any role in the collection of data, interpretation of results, or preparation of this manuscript.
See page 33 for disclosure information.
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