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INTRODUCTION

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Cardioscular diseases (CVDs) are public health concerns around the world, particularly coronary or ischemic heart disease (CHD), hypertensive heart disease, and rheumatic heart disease. CHD remains the leading cause of adult death in industrial societies, although its incidence differs widely and the mortality ascribed to it is changing dramatically (Figs. 62-1 and 62-2). While deaths from CHD are falling in industrialized nations, they are rising dramatically in others particularly in the developing world.1 The decline of age-adjusted U.S. deaths ascribed to CHD continues for men and women, white and nonwhite (Fig. 62-3). The exact causes of the decline are not established, but much is now known about U.S. trends in out-of-hospital deaths, in-hospital case fatality, and longer-term survival after acute myocardial infarction.2 Parallel to the CHD mortality trends are improvements in medical diagnosis and treatment, in population levels of risk factors, and in lifestyle.3 Nevertheless, the critical explanatory data, including incidence trends from representative populations, are few. This deficiency, along with the difficulty of measuring change in diagnostic custom and in severity of CHD, or of its precursor, atherosclerosis, leaves considerable uncertainty about the causes of the mortality trends. Systematic surveillance is now in place in several areas to improve the future detection, prediction, and explanation of trends in CVD rates.2,3,4,5

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Figure 62-1.

Age-adjusted death rates for coronary heart disease by country and sex, Ages 35–74, 2002. (Source: National Heart, Lung, and Blood Institute. Morbidity and Mortality Chart Book on Cardiovascular, Lung, and Blood Diseases. Bethesda, Maryland, 2004; NIH Publication.)

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Figure 62-2.

Change in age-adjusted death rates for coronary heart disease in males and females by country, Ages 35–74, 1995–2002. (Source: National Heart, Lung, and Blood Institute. Morbidity and Mortality Chart Book on Cardiovascular, Lung, and Blood Diseases. Bethesda, Maryland, 2004; NIH Publication.)

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Figure 62-3.

Death and age-adjusted death rates for coronary heart disease, U.S., 1979–2002. (Source: National Heart, Lung, and Blood Institute. Morbidity and Mortality Chart Book on Cardiovascular, Lung, and Blood Diseases. Bethesda, MD, 2004; NIH Publication.)

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Deaths ascribed to hypertensive heart disease have diminished over recent decades in many industrialized countries.6 In West Africa, Latin America, and the Orient, however, the high prevalence still found in hospitals and clinics indicates the continued worldwide importance of hypertension.

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Rheumatic fever and rheumatic valvular heart disease remain public health concerns in many developing countries and are still seen among disadvantaged peoples in affluent nations. On the other hand, syphilitic heart disease, a worldwide scourge until the 1940s, is now rare. Cardiomyopathies, often of unknown or infectious origin, constitute a common cause of heart disease in many ...

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