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For CHD patients, cause of death often is noncardiac in nature

Tuesday February 11, 2014
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Compared with 20 years ago, more people with known coronary heart disease die from other causes — such as cancer and lung and neurological diseases — and fewer die from heart disease, according to a study.

Researchers with the Mayo Clinic in Rochester, Minn., evaluated the trends in cause-specific, long-term mortality from 1991 to 2008 in clinic patients who underwent percutaneous coronary intervention. They broke the study population into three eras: 1991-96, 1997-2002 and 2003-08.

As published Feb. 10 on the website of the journal Circulation, cardiac deaths predominated in the first era and were about equal with noncardiac deaths in the middle era. In the latest era, noncardiac deaths were most common.

Approximately 20,000 PCI patients were studied. Of those, nearly 7,000 patients died within the study time frame. Among that group, only 37% of deaths in the modern era (2003-08) were cardiac-related.

“We found that patients with established heart disease undergoing angioplasty and stenting in the modern era have about a 1 in 3 chance of dying from their heart disease, and a 2 in 3 chance of dying from noncardiac diseases in the long term,” Rajiv Gulati, MD, PhD, senior author and Mayo Clinic interventional cardiologist, said in a news release.

The decline in cardiac mortality was independent of changes in baseline clinical characteristics, the authors noted.

The results surprised the authors, Gulati said. Patients undergoing angioplasty in the modern era have gotten older, with more complex coronary disease and more risk factors compared with years ago. The authors thus were expecting cardiac death rates to have increased. “In addition, in randomized clinical trials of PCI, deaths from cardiac disease still predominate,” he said.

The authors believe the sharp decline in long-term cardiac deaths in these patients may result from improved cardiac therapies. For example, more patients today with established heart disease take medications to lower cholesterol, prevent heart failure and decrease blood pressure, and technologies used in catheterization laboratories have improved, Gulati said.

Of the cardiac-specific deaths, deaths from myocardial infarction and sudden heart rhythm disturbances declined steeply, while there was no decline in deaths from heart failure.

“These results show that we have an opportunity to focus on the noncardiac diseases in these patients — to treat the patient holistically,” Gulati said. “But it also gives us the opportunity to identify and target those patients who are at risk of dying from heart disease.”

Study abstract: http://circ.ahajournals.org/content/early/2014/02/04/CIRCULATIONAHA.113.006518.abstract


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