FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 335:316-322 August 1, 1996 Number 5 Next

	Full Text PDF Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Between 1980 and 1989, mortality due to coronary artery disease decreased considerably in the United States, suggesting a possible decrease in the prevalence of coronary atherosclerosis. We examined this possibility in patients with valvular regurgitation who, often in the absence of angina, underwent coronary angiography before valve-replacement surgery.

Methods We studied 601 patients with isolated, nonischemic valvular regurgitation who were operated on between 1980 and 1989 and who had undergone preoperative coronary angiography. From the angiograms we determined the prevalence of clinically significant coronary artery disease and of multivessel disease, assessed the mean degree of stenosis, and analyzed the trends in the data over the years of the study.

Results The prevalence of coronary artery disease (35 percent in 1980–1981, 37 percent in 1982–1983, 34 percent in 1984–1985, 37 percent in 1986–1987, and 35 percent in 1988–1989; P = 0.97) did not change significantly during the study period. We found no significant change in the prevalence of multivessel disease (24 percent in 1980–1981 and 23 percent in 1988–1989, P = 0.99) or in the mean (±SD) degree of stenosis (11±13 percent in 1980–1981 and 13±14 percent in 1988–1989, P = 0.07). When these measures of coronary atherosclerosis were adjusted for age and sex, there were still no significant changes over time (P = 0.39 for the prevalence of coronary artery disease, P = 0.81 for that of multivessel disease, and P = 0.57 for the mean degree of stenosis). The patients' mean total cholesterol level decreased from 219±48 mg per deciliter (5.66±1.24 mmol per liter) to 206±44 mg per deciliter (5.33±1.14 mmol per liter) between 1980 and 1989 (P = 0.04).

Conclusions From 1980 to 1989, no significant change was observed in angiographic measures of coronary atherosclerosis in patients with nonischemic valvular regurgitation, in contrast to the marked decrease in mortality due to coronary disease in the general population. These findings suggest that the well-documented reduction in mortality due to coronary disease may not be due to a reduction in the prevalence of coronary atherosclerosis.

Source Information

From the Division of Cardiovascular Diseases and Internal Medicine (M.E.-S., E.K., K.N.G., A.J.T., D.R.H.) and the Section of Biostatistics (K.R.B.), Mayo Clinic and Mayo Foundation, Rochester, Minn.

Address reprint requests to Dr. Enriquez-Sarano at the Mayo Clinic, 200 First St., SW, Rochester, MN 55905.

Full Text of this Article

Related Letters:

Secular Trends in Coronary Atherosclerosis
Ruygrok P., Umans V., Smith G. D., Burnand B., Feinstein A. R., Enriquez-Sarano M.
Extract | Full Text  
N Engl J Med 1997; 336:224-226, Jan 16, 1997. Correspondence

This article has been cited by other articles:

• 2006 WRITING COMMITTEE MEMBERS, , Bonow, R. O., Carabello, B. A., Chatterjee, K., de Leon, A. C. Jr, Faxon, D. P., Freed, M. D., Gaasch, W. H., Lytle, B. W., Nishimura, R. A., O'Gara, P. T., O'Rourke, R. A., Otto, C. M., Shah, P. M., Shanewise, J. S. (2008). 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 118: e523-e661 [Full Text]  
• Bonow, R. O., Carabello, B. A., Chatterjee, K., de Leon, A. C. Jr, Faxon, D. P., Freed, M. D., Gaasch, W. H., Lytle, B. W., Nishimura, R. A., O'Gara, P. T., O'Rourke, R. A., Otto, C. M., Shah, P. M., Shanewise, J. S., Nishimura, R. A., Carabello, B. A., Faxon, D. P., Freed, M. D., Lytle, B. W., O'Gara, P. T., O'Rourke, R. A., Shah, P. M. (2008). 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 52: e1-e142 [Full Text]  
• Bonow, R. O., Carabello, B. A., Chatterjee, K., de Leon, A. C. Jr, Faxon, D. P., Freed, M. D., Gaasch, W. H., Lytle, B. W., Nishimura, R. A., O'Gara, P. T., O'Rourke, R. A., Otto, C. M., Shah, P. M., Shanewise, J. S., Smith, S. C. Jr, Jacobs, A. K., Adams, C. D., Anderson, J. L., Antman, E. M., Faxon, D. P., Fuster, V., Halperin, J. L., Hiratzka, L. F., Hunt, S. A., Lytle, B. W., Nishimura, R., Page, R. L., Riegel, B. (2006). ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol 48: e1-e148 [Full Text]  
• Bonow, R. O., Carabello, B. A., Chatterjee, K., de Leon, A. C. Jr, Faxon, D. P., Freed, M. D., Gaasch, W. H., Lytle, B. W., Nishimura, R. A., O'Gara, P. T., O'Rourke, R. A., Otto, C. M., Shah, P. M., Shanewise, J. S., Smith, S. C. Jr, Jacobs, A. K., Adams, C. D., Anderson, J. L., Antman, E. M., Faxon, D. P., Fuster, V., Halperin, J. L., Hiratzka, L. F., Hunt, S. A., Lytle, B. W., Nishimura, R., Page, R. L., Riegel, B. (2006). ACC/AHA 2006 Practice Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol 48: 598-675 [Full Text]  
• Detaint, D., Sundt, T. M., Nkomo, V. T., Scott, C. G., Tajik, A. J., Schaff, H. V., Enriquez-Sarano, M. (2006). Surgical Correction of Mitral Regurgitation in the Elderly: Outcomes and Recent Improvements. Circulation 114: 265-272 [Abstract] [Full Text]  
• Bittner, V. (2005). Perspectives on Dyslipidemia and Coronary Heart Disease in Women. J Am Coll Cardiol 46: 1628-1635 [Abstract] [Full Text]  
• Peltier, M., Iannetta Peltier, M. C., Sarano, M. E., Lesbre, J.-P. M., Colas, J.-L., Tribouilloy, C. M. (2002). Elevated Serum Lipoprotein(a) Level Is an Independent Marker of Severity of Thoracic Aortic Atherosclerosis*. Chest 121: 1589-1594 [Abstract] [Full Text]  
• Smith, G. D. (2001). The uses of 'Uses of Epidemiology'. Int J Epidemiol 30: 1146-1155 [Full Text]  
• Walker, A.R.P. (2001). With increasing ageing in Western populations, what are the prospects for lowering the incidence of coronary heart disease?. QJM 94: 107-112 [Abstract] [Full Text]  
• Tribouilloy, C. M., Peltier, M., Iannetta Peltier, M. C., Trojette, F., Andrejak, M., Lesbre, J.-P. M. (2000). Plasma Homocysteine and Severity of Thoracic Aortic Atherosclerosis. Chest 118: 1685-1689 [Abstract] [Full Text]  
• Landau, W. M. (1999). Is Cholesterol a Risk Factor for Stroke?: No. Arch Neurol 56: 1521-1524 [Full Text]  
• Izhar, U., Daly, R. C., Dearani, J. A., Orszulak, T. A., Schaff, H. V., Mullany, C. J. (1999). Mitral Valve Replacement or Repair After Previous Coronary Artery Bypass Grafting. Circulation 100 : II-84-II-89 [Abstract] [Full Text]  
• Ruygrok, P., Umans, V., Smith, G. D., Burnand, B., Feinstein, A. R., Enriquez-Sarano, M. (1997). Secular Trends in Coronary Atherosclerosis. NEJM 336: 224-226 [Full Text]