Coronary Heart Disease The Magnitude of the Problem
Coronary Heart Disease The 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 US v 13, 200, 000 Americans have CHD v v v Myocardial infarction = 7, 800, 000 v 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]
Number of MI patients Acute Myocardial Infarctions Evolve Most Frequently From Plaques With Mild to Moderate Obstruction E Falk, PK Shah, V Fuster. Circulation 1995; 92: 657
Features of Vulnerable Plaques v Large lipid pool (>40% plaque volume) v Thin fibrous cap (<65 μm) v Decreased collagen content of cap v Macrophage infiltration v Activated T cells v Mast cells v Depletion of cap smooth muscle cells v Outward remodeling v Necrotic core v Increased neoangiogenesis v Calcium nodule v Temperature and p. H heterogeneity v Mechanical stress
Atherosclerotic Vulnerable Plaque
Estimated Direct and Indirect Costs (in Billions of Dollars) of Cardiovascular Diseases and Stroke United States: 2004 Source: All estimates prepared by Thomas Thom, NHLBI. p 42
2001 data from the Healthcare Cost and Utilization Project (HCUP) hcup. ahrq. gov
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