coronary heart disease the magnitude of the problem 2004 james t. willerson, md medical director:...
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Coronary Heart Disease Coronary Heart Disease The Magnitude of the Problem 2004The Magnitude of the Problem 2004
James T. Willerson, MD
Medical Director: Texas Heart Institute
Chief Of Cardiology: St. Luke’s Episcopal Hospital
Editor: Circulation (1993-2004)
President: University of Texas Health Science Center at Houston
Cardiovascular Disease in USCardiovascular Disease in US
13,200,000 Americans have CHD Myocardial infarction = 7,800,000 Angina pectoris = 6,800,000
Stroke = 4,800,000 1 in 5 males and females has some form of CVD Since 1900 CVD has been the No. 1 killer in the
United States every year but 1918 Nearly 2,600 Americans die of CVD each day, an
average of 1 death every 34 seconds CVD accounted for 38.5% of all deaths or 1 of every 2.6
deaths in the United States in 2001
National Health and Nutrition Examination Survey III [NHANES III, 1988-94]
Acute Myocardial Infarctions Evolve Most Frequently Acute Myocardial Infarctions Evolve Most Frequently From Plaques With Mild to Moderate ObstructionFrom Plaques With Mild to Moderate Obstruction
1127 23
72
132
7
136
8
35
27
110
5
12
0
20
40
60
80
100
120
140
160
180
200
Ambrose et al.1988
Little et al. 1988 Nobuyoshi et al.1991
Giroud et al. 1992 ALL
<50% 50-70% >70%
Nu
mb
er o
f M
I p
atie
nts
E Falk, PK Shah, V Fuster. Circulation 1995;92:657
Features of Vulnerable PlaquesFeatures of Vulnerable Plaques Large lipid pool (>40% plaque volume)Large lipid pool (>40% plaque volume) Thin fibrous cap (<65 μm)Thin fibrous cap (<65 μm) Decreased collagen content of cap Decreased collagen content of cap Macrophage infiltrationMacrophage infiltration Activated T cellsActivated T cells Mast cellsMast cells Depletion of cap smooth muscle cellsDepletion of cap smooth muscle cells Outward remodelingOutward remodeling Necrotic coreNecrotic core Increased neoangiogenesisIncreased neoangiogenesis Calcium noduleCalcium nodule Temperature and pH heterogeneityTemperature and pH heterogeneity Mechanical stressMechanical stress
Atherosclerotic Vulnerable PlaqueAtherosclerotic Vulnerable Plaque
Estimated Direct and Indirect Costs (in Billions of Dollars) of Cardiovascular Diseases and Stroke United States: 2004
p42Source: All estimates prepared by Thomas Thom, NHLBI.
2001 data from the Healthcare Cost and Utilization Project (HCUP)
hcup.ahrq.gov
