We examined trends in heart disease (HD) mortality and the delivery of cardiac in Olmsted County, MN. Between 1979 and 1994, women experienced 51% of the total number of HD (ICD9 codes 390 — 398,402,404 — 429) deaths (3095). Age-adjusted HD mortality rate declined from 123 per 100,000 (95%CI 102, 144) in 1979 to 81 (67,95) in 1994. The risk ratio (RR) of HD death in 1994 compared to 1979 was 0.69 for women vs 0.53 for men (P = 0.06). This equates to a decline in HD mortality of 2.5%=y in women and 4.2%=y in men. The decline in HD mortality was less pronounced in older age groups (P < 0.001), reflecting a shift of the burden of HD towards women and the elderly. Compared to men, there was less use of stress tests among women, of cardiology visits after stress testing, and of cardiac procedures among women presenting to the emergency room with unstable angina. Further studies are needed to examine causal links between these trends.
Anderson RN , Kochanek KD , Murphy SL . Report of finalmortality statistics, 1995. Monthly Vital Statistics Report. Vol. 45. National Center for Health Statistics, Hyattsville, Maryland , 1997.
2.
Gardner P , Hudson BL . Advance report of final mortality statistics, 1993. Monthly Vital Statistic Report. Vol. 44. 1996, National Center for Health Statistics; Hyattsville, Maryland .
3.
Bishop E.Heart disease may actually be rising. Wall Street J, November 13, 1996.
4.
American Heart Association Heart and Stroke Facts. Heart and Stroke Statistical Update, 1999.
5.
Melton LR . History of the Rochester Epidemiology Project . Mayo Clin Proc1996; 71: 266–274 .
6.
Roger VL , Ballard DJ , Halet J Jr. et al. Influence ofcoronary artery disease on morbidity and mortality after abdominal aortic aneurysmectomy: a population-based study, 1971 — 1987 . J Am Coll Cardiol1989; 14: 1245–1252 .
7.
Silverstein MD , Reed CE , O'Connell EJ et al. Long-term survival ofa cohort of community residents with asthma . New Engl J Med1994; 331: 1537–1541 .
8.
Gabriel SE , O'Fallon WM , Kurland LT et al. Risk ofconnective-tissue diseases and other disorders after breast implantation . New Engl J Med1994; 330: 1697–1702 .
9.
Gabriel, SE , Woods JE , O'Fallon WM et al. Complications leading tosurgery after breast implantation . New Engl J Med1997; 336: 677–682 .
Kurland LT , Molgaard CA . The patient record in epidemiology . SciAm1981; 245: 54–63 .
12.
Melton LJ III . Selection bias in the referral of patients and thenatural history of surgical conditions . Mayo Clin Proc1985; 60: 880–885 .
13.
Elveback LR , Connolly DC , Melton LJ . Coronary heart disease inresidents of Rochester, Minnesota. VII. Incidence, 1950 through 1982 . Mayo Clin Proc1986; 61: 896–900 .
14.
Kaplan GA , Cohn BA , Cohen RD , Guralnik J . The decline in ischemicheart disease mortality: prospective evidence from the Alameda County Study . Am J Epidemiol1988; 127: 1131–1142 .
15.
Sempos C , Cooper R , Kovar MG , McMillen M . Divergence of the recenttrends in coronary mortality for the four major race-sex groups in the United States [published erratum appears in Am J Public Health 1989;79:1677] . Am J Public Health1988; 78: 1422–1427 .
16.
Gillum RF . Trends in acute myocardial infarction and coronaryheart disease death in the United States . J Am Coll Cardiol1994; 23: 1273–1277 .
17.
Demirovic J , Blackburn H , McGovern P et al. Sex differences incoronary heart disease mortality trends: the Minnesota Heart Survey, 19701988 . Epidemiology1993; 4: 79–82 .
18.
Roger VL , Jacobsen SJ , Weston SA et al. Trends in heart diseasedeaths in Olmsted County, Minnesota: 1979–1994. Mayo Clin Proc, 1999, in press.
19.
Roger VL , Jacobsen SJ , Weston SA et al. Sex and age differences inthe decline in heart disease mortality: A population based study in Olmsted County, Minnesota . Circulation1998; 98: I-273 .
20.
Orencia A , Bailey K , Yawn BP , Kottke TE . Effect of gender on longterm outcome of angina pectoris and myocardial infarction/sudden unexpected death . JAMA1993; 269: 2392–2397 .
21.
Murabito JM , Evans JC , Larson MG , Levy D . Prognosis after theonset of coronary heart disease. An investigation of differences in outcome between the sexes according to initial coronary disease presentation . Circulation1993; 88: 2548–2555 .
22.
Gillum RF . Toward explaining the decline in coronary heart diseasemortality . Amer Heart J1983; 106: 783–785 .
23.
McGovern PG , Pankow JS , Shahar E et al. Recent trends in acutecoronary heart disease — mortality, morbidity, medical care, and risk factors. The Minnesota Heart Survey Investigators . New Engl J Med1996; 334: 884–890 .
24.
Goldberg RJ , Gorak EJ , Yarzebski J et al. A communitywideperspective of sex differences and temporal trends in the incidence and survival rates after acute myocardial infarction and out-of-hospital deaths caused by coronary heart disease . Circulation1993; 87; 1947–1953 .
25.
Rosamond WD , Chambless LE , Folsom AR et al. Trends in theincidence of myocardial infarction and in mortality due to coronary heart disease . New Engl J Med1998; 339: 861–867 .
26.
Elveback LR , Connolly DC , Kurland LT . Coronary heart disease in residents of Rochester, Minnesota. II. Mortality, incidence, and survivorship, 1950 — 1975 . Mayo Clin Proc1981; 56: 665–672 .
27.
Elveback L , Lie JT . Continued high incidence of coronary arterydisease at autopsy in Olmsted County, Minnesota, 1950 to 1979 . Circulation1984; 70: 345–349 .
28.
Nemetz PN , Ballard DJ , Beard CM et al. An anatomy of the autopsy,Olmsted County, 1935 through 1985 . Mayo Clin Proc, 1989; 64: 1055–1064 .
29.
Berkson, J.Limitations of the application of four-fold tableanalysis to hospital data . Biometrics Bull1946; 2: 47–53 .
30.
Eysmann SB , Douglas PS . Reperfusion and revascularizationstrategies for coronary artery disease in women . JAMA1992; 268: 1903–1907 .
31.
Demirovic J , Blackburn H , McGovern PG , Luepker R , Sprafka JM , Gilbertson D . Sex differences in early mortality after acute myocardial infarction (the Minnesota Heart Survey) . Am J Cardiol1995; 75: 1096–1101 .
32.
Kannel WB , Sorlie P , McNamara PM . Prognosis after initialmyocardial infarction: The Framingham study . Am J Cardiol1979; 44: 53–59 .
33.
Naylor CD . What is appropriate care?New Engl J Med, 1998; 338: 1918–1920 .
34.
Marrugat J , Sala J , Masia R et al. Mortality differences betweenmen and women following first myocardial infarction . JAMA1998; 280: 1405–1409 .
35.
Vaccarino V , Krumholz HM , Berkman LF , Horwitz RI . Sex differencesin mortality after myocardial infarction. Is there evidence for an increased risk for women?Circulation1995; 91: 1861–1871 .
36.
Weaver WD , White HD , Wilcox RG et al. Comparisons ofcharacteristics and outcomes among women and men with acute myocardial infarction treated with thrombolytic therapy. GUSTO-I Investigators . JAMA, 1996; 275: 777–782 .
37.
Roger VL , Gersh BJ . Myocardial infarction. In: Julian DG , WengerNK , (Eds) 1997, Women and Heart Disease. St. Louis, Mosby , pp. 135–150.
38.
Bickell NA , Pieper KS , Lee KL et al. Referral patterns forcoronary artery disease treatment: gender bias or good clinical judgment?Ann Intern Med1992; 116: 791–797 .
39.
Krumholz HM , Douglas PS , Lauer MS , Pasternak RC . Selection ofpatients for coronary angiography and coronary revascularization early after myocardial infarction: is there evidence for a gender bias?Ann Intern Med1992; 116: 785–790 .
40.
Roger VL , Jacobsen SJ , Pellikka PA et al. Gender differences inthe use of stress testing and coronary heart disease mortality: A population-based study in Olmsted County, Minnesota . J Am Coll Cardiol1998; 32: 345–352 .
41.
Roger VL , Gabriel SE , Reeder GS et al. Evaluation of chest pain inthe emergency room: is there gender bias? A population based study in Olmsted County, Minnesota . J Am Coll Cardiol1997 (Special issue), 49A-49A .
42.
Daly SC , Roger VL , Miller TD , Pellikka PA , Jacobsen SJ . Use ofcardiology services after stress testing: Is there sex bias in the community? A population-based study in Olmsted County, Minnesota . Circulation1997; 96: I-157 .
43.
Barrett-Connor E , Goodman-Gruen, D . Dehydroepiandrosterone sulfate does not predict cardiovascular death in postmenopausal women. The Rancho Bernardo Study . Circulation, 1995; 91: 1757–1760 .
