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Biomedical subjects

V Salomaa

Publications and source records attributed to V Salomaa.

At least 37 records · Page 2Linked to original sources
PubMed2001

Socioeconomic differences in the incidence, mortality and prognosis of intracerebral hemorrhage in Finnish Adult Population. The FINMONICA Stroke Register.

We examined the association of socioeconomic status (SES) with the incidence, mortality and case fatality of intracerebral hemorrhage (ICH). During 1982-1992, 909 ICH events were registered among persons aged 25-74 years. Taxable income was used as an indicator of SES. It was stratified into three categories: low, middle and high. The age-standardized incidence and mortality of ICH were significantly higher in the low- than in the high-income group in both genders. Among men aged 25-59 years, the adjusted odds ratio (OR) of ICH death within 1 year after the onset of the event was twice as high in the low-income group as in the high-income group (OR = 2.12, 95% confidence interval 1.02-4.40). In conclusion, marked socioeconomic differences were found in the incidence and mortality of ICH, in particular among working aged men.

Adult↗
PubMed2001

Prospective study of fibrinolytic factors and incident coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) Study.

The fibrinolytic system may play a role in the pathogenesis of coronary heart disease (CHD), but existing prospective studies have not consistently shown an independent association between fibrinolytic factors and CHD. None has reported an association between plasminogen and CHD incidence. In the prospective Atherosclerosis Risk in Communities (ARIC) Study of middle-aged adults, we examined the association of incident CHD with several fibrinolytic factors: tissue plasminogen activator antigen, plasminogen activator inhibitor-1, plasminogen, and fibrin fragment D-dimer as well as a marker of coagulation activation (prothrombin fragment F1.2). We measured these in stored baseline plasma samples of 326 subjects who developed CHD and, for comparison, a stratified random sample of the entire cohort (n=720). Tissue plasminogen activator and plasminogen activator inhibitor-1 antigen levels were associated positively with CHD incidence in analyses adjusted for age, race, and sex but were not associated with CHD after adjustment for other risk factors. Plasminogen and D-dimer levels were associated positively and independently with CHD incidence; the multivariable-adjusted relative risks (95% CIs) for the highest versus lowest quintiles were 2.20 (1.2 to 4.2) for plasminogen and 4.21 (1.9 to 9.6) for D-dimer. F1.2 was not associated with CHD incidence. Our findings lend support for a link between fibrinolytic factors and CHD incidence. A positive association between plasminogen and CHD is seemingly opposite the direction expected but may reflect a compensatory response to impaired plasminogen activation in subjects prone to CHD.

Biomarkers↗
PubMed2001

Socioeconomic status and ischemic stroke: The FINMONICA Stroke Register.

BACKGROUND AND PURPOSE: It has been shown that low socioeconomic status is associated with death from stroke. More-detailed data have, however, remained scanty. The purpose of the present study was to examine the association of socioeconomic status with ischemic stroke. Besides mortality, we analyzed the incidence, case-fatality ratio, and prognosis of ischemic stroke events. METHODS: Our population-based study included 6903 first stroke events registered by the FINMONICA Stroke Register in 3 areas of Finland during 1983 to 1992. Indicators of socioeconomic status, such as taxable income and education, were obtained by record linkage of the stroke register data with files of Statistics Finland. RESULTS: Incidence, case-fatality ratio, and mortality rates for ischemic stroke were all inversely related to income. Furthermore, 28 days after the onset of symptoms, a greater proportion of patients with low income than of those with high income was still in institutionalized care and/or in need of help for their activities of daily living. Population-attributable risk of the incidence of first ischemic stroke due to low socioeconomic status was 36% for both sexes. For the death from first ischemic stroke, it was 56% for both sexes. CONCLUSIONS: Persons with low socioeconomic status have considerable excess rates of morbidity and mortality from ischemic stroke in Finland. A reduction in this excess could markedly decrease the burden of ischemic stroke to the society and thus constitute an important public health improvement.

Adult↗
PubMed2000

Apolipoprotein E variation at the sequence haplotype level: implications for the origin and maintenance of a major human polymorphism.

Three common protein isoforms of apolipoprotein E (apoE), encoded by the epsilon2, epsilon3, and epsilon4 alleles of the APOE gene, differ in their association with cardiovascular and Alzheimer's disease risk. To gain a better understanding of the genetic variation underlying this important polymorphism, we identified sequence haplotype variation in 5.5 kb of genomic DNA encompassing the whole of the APOE locus and adjoining flanking regions in 96 individuals from four populations: blacks from Jackson, MS (n=48 chromosomes), Mayans from Campeche, Mexico (n=48), Finns from North Karelia, Finland (n=48), and non-Hispanic whites from Rochester, MN (n=48). In the region sequenced, 23 sites varied (21 single nucleotide polymorphisms, or SNPs, 1 diallelic indel, and 1 multiallelic indel). The 22 diallelic sites defined 31 distinct haplotypes in the sample. The estimate of nucleotide diversity (site-specific heterozygosity) for the locus was 0.0005+/-0.0003. Sequence analysis of the chimpanzee APOE gene showed that it was most closely related to human epsilon4-type haplotypes, differing from the human consensus sequence at 67 synonymous (54 substitutions and 13 indels) and 9 nonsynonymous fixed positions. The evolutionary history of allelic divergence within humans was inferred from the pattern of haplotype relationships. This analysis suggests that haplotypes defining the epsilon3 and epsilon2 alleles are derived from the ancestral epsilon4s and that the epsilon3 group of haplotypes have increased in frequency, relative to epsilon4s, in the past 200,000 years. Substantial heterogeneity exists within all three classes of sequence haplotypes, and there are important interpopulation differences in the sequence variation underlying the protein isoforms that may be relevant to interpreting conflicting reports of phenotypic associations with variation in the common protein isoforms.

Alleles↗
PubMed2000

Relationship of socioeconomic status to the incidence and prehospital, 28-day, and 1-year mortality rates of acute coronary events in the FINMONICA myocardial infarction register study.

BACKGROUND: Low socioeconomic status (SES) is associated with increased coronary heart disease mortality rates. There are, however, very little data on the relation of SES to the incidence, recurrence, and prognosis of myocardial infarction (MI) events. METHODS AND RESULTS: The FINMONICA MI Register recorded detailed information on all MI events among men and women aged 35 to 64 years in 3 areas of Finland during the period of 1983 to 1992. We carried out a record linkage of the MI register data with files of Statistics Finland to obtain information on indicators of SES, such as taxable income and education, for each individual who is registered. In the analyses, income was grouped into 3 categories (low, middle, and high), and education was grouped into 2 categories (basic and secondary or higher). Among men with their first MI event (n=6485), the adjusted incidence rate ratios were 1.67 (95% CI 1.57 to 1.78) and 1.84 (95% CI 1.73 to 1.95) in the low- and middle-income categories compared with the high-income category. For 28-day mortality rates, the corresponding rate ratios were 3.18 (95% CI 2.82 to 3.58) and 2.33 (95% CI 2.03 to 2.68). Significant differentials were observed for prehospital mortality rates, and they remained similar up to 1 year after the MI. Findings among the women were consistent with those among the men. CONCLUSIONS: The excess coronary heart disease mortality and morbidity rates among persons with low SES are considerable in Finland. To bring the mortality rates of low- and middle-SES groups down to the level of that of the high-SES group constitutes a major public health challenge.

Adult↗
PubMed2000

The feasibility of combining data from routine Hospital Discharge and Causes-of-Death Registers for epidemiological studies on stroke.

We assessed the validity of hospital discharge data on stroke in Finland and the feasibility of linked hospital discharge and causes-of-death data for epidemiological studies using the FINMONICA Stroke Register as the reference. The results showed that such data can, with some caution, be used for incidence studies and for identifying first stroke events. They cannot, however, be used for assessing secular trends in all stroke events.

Adult↗
PubMed2000

The feasibility of routine mortality and morbidity register data linkage to study the occurrence of acute coronary heart disease events in Finland. The Finnish Cardiovascular Diseases Registers (CVDR) Project.

Validated population-based data on the occurrence of coronary heart disease in Finland have previously been obtained from myocardial infarction (MI) registers. Such registers cannot, however, cover large areas. Therefore, the Finnish Cardiovascular Diseases Registers (CVDR) Project was set up to obtain data for the whole of Finland. The CVDR Project is based on routine mortality and morbidity data linkage. We report here the overall approach used in the project, the results of the feasibility study and the first main results. In Finland, data on all hospitalizations are registered in the nationwide Hospital Discharge Register. Also, data on all deaths are collected in the nationwide Causes of Death Register. The unique personal identification number assigned to all persons residing in Finland was used for data linkage. Data have been validated using the FINMONICA MI registers. Sensitivity analyses showed that the data were robust and consistent between different geographical areas. Coronary heart disease (CHD) mortality as well as the incidence and event rates showed the same very clear geographical pattern, dividing Finland to a southwest area with a lower occurrence and a northeast area with nearly twice higher occurrence. Case fatality did not differ much between the areas and did not follow this Southwest-Northeast division. The differences between northeast and southwest Finland may be related to differences in risk factor levels but also to socioeconomic and genetic differences. The CVDR Project data will be instrumental in further research addressing these issues.

Acute Disease↗
PubMed2000

Genetic background of Lewis negative blood group phenotype and its association with atherosclerotic disease in the NHLBI family heart study.

OBJECTIVES: To examine the prevalence of four mutations, T59G, T1067A, T202C and C314T, of the human alpha(1,3/1,4) fucosyltransferase 3 (FUT 3) gene amongst persons with Lewis negative and those with Lewis positive blood group phenotype. An additional objective was to explore the hypothesis that these mutations are associated with coronary heart disease and inflammatory reaction. DESIGN: A population-based cross-sectional study. SETTING: Analysis of samples and data from the National Heart Lung and Blood Institute Family Heart Study. SUBJECTS: All Lewis (a-b-) participants (n = 136) and a sample of Lewis positive participants (n = 136) of the Family Heart Study; all were of Caucasian ethnicity. MAIN OUTCOME MEASURES: The prevalence of examined mutations by Lewis phenotype. RESULTS: The examined mutations were common and strongly associated with the Lewis (a-b-) phenotype. Accordingly, 90-95% of Lewis (a-b-) individuals amongst Caucasians can be identified by screening for these four mutations. Exploratory analyses suggested that with the exception of T59G, all examined mutations were positively associated with prevalent coronary heart disease, although not statistically significantly, perhaps due to the small number of prevalent coronary heart disease cases. C-reactive protein tended to be higher amongst persons with a TC or CC genotype at position 202 (3.07 +/- 0.41 vs. 2.08 +/- 0.32 mg L-1, P = 0.06). CONCLUSIONS: Four specific mutations of fucosyltransferase 3 gene are responsible for the vast majority of Lewis (a-b-) phenotypes in Caucasians. These mutations are common in the population at large and may be associated with increased risk of coronary heart disease. Further studies using larger samples are warranted.

Arteriosclerosis↗
PubMed2000

White coat effect, blood pressure and mortality in men: prospective cohort study.

BACKGROUND: Because long-term follow-up studies, which also included normotensive controls, have been lacking, the clinical significance of 'white coat' effect and of 'white coat' hypertension has remained controversial. METHODS AND RESULTS: Twenty-one-year prospective data was gathered in 536 men with cardiovascular risk factors at baseline. Blood pressure was measured both by a nurse and by a physician and 'white coat effect' was defined as the difference between the two measurements (physician minus nurse). In addition, four blood pressure groups were categorized: normotensive (n=259), white coat hypertensive (n=18), mildly hypertensive (n=150) and persistently hypertensive (n=109). Comparison of these groups at baseline showed that men with white coat hypertension had higher levels of metabolic risk factors. Sixty-eight men died during follow-up. The men with a white coat effect >30 mmHg (n=37) had significantly higher mortality than other men (relative risk 2.2, 95% confidence interval 1.1-4.2). Mortality was significantly higher in the white coat hypertensive group (33.3%) than in the normotensive group (9.5%, P=0.0005 between groups). Relative risk adjusted for baseline risk factors in the white coat hypertensive group was 3.3 (1.2-7.6) compared with the normotensive group. The development of drug-treated hypertension was also more common (27.8% vs 13.4% in the normotensive group, P<0.0001 between groups). CONCLUSION: The results suggest that white coat hypertension or a large white coat effect is not an innocent phenomenon. It tends to co-exist with metabolic risk factors and predicts total and cardiovascular mortality during long-term follow-up.

Blood Pressure↗
PubMed2000

Sequence diversity and large-scale typing of SNPs in the human apolipoprotein E gene.

A common strategy for genotyping large samples begins with the characterization of human single nucleotide polymorphisms (SNPs) by sequencing candidate regions in a small sample for SNP discovery. This is usually followed by typing in a large sample those sites observed to vary in a smaller sample. We present results from a systematic investigation of variation at the human apolipoprotein E locus (APOE), as well as the evaluation of the two-tiered sampling strategy based on these data. We sequenced 5.5 kb spanning the entire APOE genomic region in a core sample of 72 individuals, including 24 each of African-Americans from Jackson, Mississippi; European-Americans from Rochester, Minnesota; and Europeans from North Karelia, Finland. This sequence survey detected 21 SNPs and 1 multiallelic indel, 14 of which had not been previously reported. Alleles varied in relative frequency among the populations, and 10 sites were polymorphic in only a single population sample. Oligonucleotide ligation assays (OLA) were developed for 20 of these sites (omitting the indel and a closely-linked SNP). These were then scored in 2179 individuals sampled from the same three populations (n = 843, 884, and 452, respectively). Relative allele frequencies were generally consistent with estimates from the core sample, although variation was found in some populations in the larger sample at SNPs that were monomorphic in the corresponding smaller core sample. Site variation in the larger samples showed no systematic deviation from Hardy-Weinberg expectation. The large OLA sample clearly showed that variation in many, but not all, of OLA-typed SNPs is significantly correlated with the classical protein-coding variants, implying that there may be important substructure within the classical epsilon 2, epsilon 3, and epsilon 4 alleles. Comparison of the levels and patterns of polymorphism in the core samples with those estimated for the OLA-typed samples shows how nucleotide diversity is underestimated when only a subset of sites are typed and underscores the importance of adequate population sampling at the polymorphism discovery stage. [The sequence data described in this paper have been submitted to the GenBank data library under accession no. AF261279.]

Alleles↗
PubMed2000

Factors related to the development of diabetes during a 20-year follow-up. A prospective study in a homogeneous group of middle-aged men.

BACKGROUND AND AIMS: To investigate factors associated with the development of type 2 diabetes mellitus (DM) during a 20-year follow-up in a homogeneous group of initially healthy middle-aged men with similar socioeconomic status. METHODS AND RESULTS: We studied 1802 executives and businessmen, born 1919-34, without type 2 DM at baseline and with coronary heart disease (CHD) risk factor measurements in 1974-75. Diagnosis of type 2 DM during the follow-up was based on entitlement to re-imbursement for type 2 DM medication during 1975-1995, retrieved from national registers, self-report of type 2 DM or fasting blood glucose (> or = 6.7 mmol/L) in 1985-1986 (72% of the initial cohort re-evaluated). During the follow-up (up to 1995) type 2 DM was diagnosed using the above criteria in 94 men (5.2%). At baseline, men who later developed type 2 DM smoked more (p = 0.01), and had significantly higher body mass index (BMI), systolic and diastolic blood pressure, pulse pressure, serum triglycerides, and fasting and one-hour blood glucose. In a subset of high-risk men, those who developed type 2 DM also showed signs of white-coat effect on blood pressure (p = 0.008). Already at baseline, the CHD risk score was 23% higher in future type 2 DM subjects (p = 0.008). Re-evaluation in 1985-1986 showed essentially similar results for risk factors, but in addition, LDL cholesterol without lipid lowering drugs was significantly lower (p = 0.0018) in type 2 DM subjects. During the follow-up, 23.4% of the men with type 2 DM developed CHD as compared to 13.4% of those without (p = 0.008). CONCLUSIONS: During a 20-year follow-up, several cardiovascular risk factors, including smoking, pulse pressure and the white-coat effect, predicted the development of type 2 DM in initially healthy middle-aged men. However, despite the higher incidence of CHD, development of type 2 DM was associated with lowered LDL cholesterol.

Aged↗
PubMed1999

Soluble thrombomodulin as a predictor of incident coronary heart disease and symptomless carotid artery atherosclerosis in the Atherosclerosis Risk in Communities (ARIC) Study: a case-cohort study.

BACKGROUND: Small amounts of soluble thrombomodulin in plasma are thought to reflect endothelial damage. In a case-cohort study, we examined whether soluble thrombomodulin is a predictor of incident coronary heart disease and carotid artery atherosclerosis. METHODS: The study population consisted of 14,170 black and white participants from the Atherosclerosis Risk in Communities (ARIC) study, who did not have cardiovascular disease at the start of the study and who we followed up for 6 years. After appropriate exclusions, we analysed 258 cases of incident coronary heart disease and 449 cases of carotid atherosclerosis. A stratified random sample of 753 individuals from the ARIC cohort was used as the comparison group. We used EIA to measure soluble thrombomodulin in plasma samples from both groups. For the analysis, we used quintiles of soluble thrombomodulin concentrations (< 24.7, 24.8-30.6, 30.7-40.2, 40.3-55.2, and > or = 55.3 ng/mL). FINDINGS: Soluble thrombomodulin showed a strong, graded, inverse association with incident coronary heart disease (p=0.005). The adjusted rate ratio of the highest quintile of soluble thrombomodulin compared with the lowest quintile was 0.29 (95% CI 0.15-0.57). The association with carotid atherosclerosis, however, tended to be positive, especially among white participants (odds ratio 2.94 [1.15-7.51] for highest vs lowest quintile). The relation of soluble thrombomodulin to incident coronary heart disease and carotid atherosclerosis was dependent on factor VIII coagulant activity (p=0.06 and 0.003, respectively). INTERPRETATION: The prospective association of soluble thrombomodulin with incident coronary heart disease differs from its cross-sectional association with carotid atherosclerosis. In healthy people, plasma concentrations of soluble thrombomodulin may reflect endothelial expression of thrombomodulin. High concentration of soluble thrombomodulin may be associated with decreased risk of coronary heart disease.

Analysis of Variance↗
PubMed1999

Symptoms of chronic bronchitis, haemostatic factors, and coronary heart disease risk.

Positive association has been suggested between a variety of infections and coronary heart disease. Disturbances in blood coagulation system may form a link between infections and coronary heart disease. The aim of this study was to analyze whether chronic bronchitis, defined by the occurrence of symptoms, is associated with selected haemostatic factors in a cross-sectional population study of 2379 Finnish men and women aged between 45 and 64 years. Plasma fibrinogen level was significantly higher, 3.70 versus 3.35 g/l (P < 0.001) in men and 3.64 versus 3.44 g/l (P < 0.001) in women, among subjects with symptoms of chronic bronchitis than among those without symptoms. The association was independent of age, smoking, body mass index, physical exercise, and alcohol consumption. Also plasminogen was higher among men with symptoms than among those without but the difference disappeared after adjustment for age and smoking. Factor VII coagulant activity and factor VII antigen level did not differ between subjects with and without symptoms. Thus, fibrinogen may be associated with a possible mechanism to link chronic bronchitis to coronary heart disease risk, even though the causality of the association cannot be verified in a cross-sectional study.

Blood Coagulation Factors↗
PubMed1999

The validity of the routine mortality statistics on coronary heart disease in Finland: comparison with the FINMONICA MI register data for the years 1983-1992. Finnish multinational MONItoring of trends and determinants in CArdiovascular disease.

We compared the diagnoses obtained from the routine mortality statistics with the standardized World Health Organization (WHO) MONICA (multinational MONItoring of trends and determinants in CArdiovascular disease) classification in suspect coronary heart disease (CHD) deaths registered in the FINMONICA myocardial infarction (MI) register during 1983-1992. All CHD deaths from routine mortality statistics (International Classification of Diseases codes 410-414) were registered in the MI register. Of the CHD deaths in routine mortality statistics 1.7% in men and 4.8% in women did not fulfill the MONICA criteria for CHD death (P<0.001 for the difference between the sexes). In men 4.7% and in women 7.3% (P=0.004) of the deaths registered in the MI Register and classified as CHD deaths by MONICA criteria had another underlying cause of death than CHD in routine mortality statistics; this proportion increased over time in both sexes (P=0.002 in men and P=0.77 in women). The CHD mortality trends obtained separately from the routine mortality statistics and from the FINMONICA MI Register were very similar. In conclusion, the high CHD mortality in Finland reported by the routine mortality statistics is real. It is possible that some CHD deaths have escaped registration, but the decline seen in the CHD mortality is also real.

Adult↗
PubMed1999

Trends in the treatment of patients with myocardial infarction and coronary revascularization procedures in Finland during 1986-92: the FINMONICA Myocardial Infarction Register Study.

OBJECTIVES: To investigate changes in the medical treatment of patients with myocardial infarction and the trends in revascularization procedures in Finland. DESIGN: A population-based myocardial infarction (MI) register study. SETTING: Populations, aged 25-64 years, of the three geographical areas of Finland, provinces of North Karelia and Kuopio in eastern Finland and the Turku-Loimaa area in south-western Finland. MAIN OUTCOME MEASURES: Medical treatment administered prior to the coronary event, during the hospitalization and at discharge from hospital to all patients hospitalized due to suspected myocardial infarction and all CAD deaths occurring during three separate 4-month periods in 1986, 1989 and 1992. Data on coronary bypass surgery and percutaneous coronary angioplasty in the study areas for 1986-92. RESULTS: The most marked change in the medical treatment of hospitalized myocardial infarction patients was the significant increase in the use of thrombolytic treatment (5% of patients in 1986 and 24% in 1992, P < 0.001 for trend). The use of antiplatelet agents increased from 1986 to 1992 prior to the coronary event, during the hospitalization and at discharge. The use of beta-blockers and intravenous nitrates increased and the use of calcium-channel blockers declined significantly in hospitalized patients during the study period. Hospitalized male myocardial infarction patients were treated more often with beta-blockers, nitrates, antiplatelet agents and thrombolytic agents than female patients, suggesting less intensive medical treatment in women. CONCLUSION: The results of the large clinical trials regarding the medical treatment of myocardial infarction patients were adopted in the clinical practice rapidly and the treatment of myocardial infarction patients and the number of revascularization procedures changed markedly from 1986 to 1992 in Finland. These changes may in part explain the favourable changes in mortality from CAD in Finland.

Adult↗
PubMed1999

Alarmingly high occurrence and case fatality of acute coronary heart disease events in Estonia: results from the Tallinn AMI register 1991-94.

OBJECTIVE: The purpose of this study was to produce stable estimates for the incidence, attack and mortality rates and case fatality of acute myocardial infarction (AMI) in Tallinn, the capital of Estonia. RESEARCH DESIGN AND METHODS: The Tallinn AMI register covers the population aged 25-64 years and official residents of Tallinn. The register follows the WHO MONICA project protocols in the data collection and diagnostic evaluation of the suspected AMI events and CHD death. RESULTS: Age-standardized annual incidence, attack rate and mortality in men aged 35-64 years were high, varying from (per 100000 per year) 352, 499 and 208, respectively, in 1991 to 438, 628 and 317, respectively, in 1993. In addition, in women, annual incidence, attack rate and mortality were high, varying from (per 100000 per year) 82, 100 and 31, respectively, in 1991 to 110 and 142 in 1993 for the incidence and attack rate, and to 61 in 1992 for mortality. The percentage of out-of-hospital coronary death (sudden death) increased in men from 33 to 52% and in women from 24 to 42% during 1991-94, and the 28-day case fatality increased in men from 42 to 58%, and in women from 32 to 50%. In Tallinn, women with AMI were treated as actively as men with invasive treatment (thrombolysis, angioplasty, bypass surgery) during the acute phase of MI. CONCLUSIONS: The incidence, attack rate and mortality of AMI were high in both men and women in Tallinn. The high 28-day case fatality observed was primarily due to the high proportion of out-of-hospital deaths.

Age Distribution↗
PubMed1999

Decreasing mortality from acute myocardial infarction: effect of incidence and prognosis.

Coronary heart disease (CHD) mortality rates have declined for the past 25 years in most western countries. During the 1970s and early 1980s, a decline in incidence was the main factor in the decline in mortality, but more recently, improvements in treatment and prognosis have played a larger role. Most of the change is a result of improvements in the treatment of risk factors among patients with chronic CHD, while the treatment of acute myocardial infarction has contributed a smaller part. CHD mortality has consistently decreased more than incidence, which may have led to an increased prevalence of CHD. Simultaneously, the treatment practice patterns and possibly also clinical presentation of CHD has changed so that hospitalizations as a result of CHD diagnoses other than myocardial infarction have increased, while definite myocardial infarctions have decreased. Furthermore, the stabilizing rates of incident myocardial infarction combined with the aging population tend to increase the numbers of CHD patients. Therefore, the total burden of CHD to the community has decreased less than one would expect on the basis of age-standardized mortality rates. There is a need to re-emphasize primary prevention, since heavy reliance on expensive treatments for the post-war baby-boom generation presents a major concern for public health resources.

Global Health↗