Cardiovascular Diseases Clinical Trial
Official title:
Study of Trends of Cardiovascular Disease in a Metropolitan Area.
To continue surveillance of coronary heart disease (CHD) mortality and morbidity in the seven county metropolitan Minneapolis/St. Paul (Twin Cities) areas.
BACKGROUND:
The Minnesota Heart Survey (MHS) is among the few population-based longitudinal studies to
monitor and explain trends in coronary heart disease (CHD) mortality and morbidity, the
leading cause of death and disability in the United States. It encompasses a large and
well-defined community, the Minneapolis/St. Paul (Twin Cities) metropolitan area of
Minnesota, comprising a population of 2.3 million (1990 census) For almost two decade the
Minnesota Heart Survey has made contributions to understanding 1) the components of the
decline of coronary heart disease mortality including incidence rate, hospitalized attach
rate, case fatality, and population levels of CHD risk factors; and 2) the methodology of
disease surveillance in a time when classification and diagnostic technologies are
constantly changing.
DESIGN NARRATIVE:
The Minnesota Heart Survey continues surveillance of coronary heart disease (CHD) mortality
and morbidity in the seven county metropolitan Minneapolis/St. Paul (Twin Cities) areas
through the year 2002. The study will also monitor trends in acute myocardial infarction
(AMI), evaluate the effect on AMI diagnosis of the widespread use of new biomarkers
(troponins), perform a validation study to the previous standard, and evaluate
out-of-hospital sudden cardiac death (SCD) through an autopsy study
A combination of different techniques will be used for surveillance. CHD deaths will be
obtained from death certificate data from the Minneapolis Department of Public Health.
Census data will be used to construct the appropriate denominators. A major focus is based
on in-hospital CHD morbidity and mortality. Data from the Minnesota Hospital and Health Care
Partnership, which originally receives data from 22 of the 23 area hospitals, will be used
to identify and validate acute myocardial infarction (AMI) cases. Census data will again be
used to obtain the appropriate denominators. An important issue in assessing time trends in
hospitalized AMI attack rate is the changing definitions used to identify cases over time. A
specific issue in this regard is the increasing use of troponin levels that are more
sensitive than previously used CKMB levels to identify cases. Thus, a validation study will
be conducted comparing these two methodologies on the same subjects. The goal of the study
is to obtain correction factors so that time trends in AMI attack rates are not influenced
by differences in diagnostic criteria.
A new important area of investigation is that of out of-hospital sudden cardiac deaths
(SCD). Autopsy studies of 100 cases per year (about 300 total) will be conducted to describe
risk factors for SCD. In addition, comparisons will be made between a control group of 600
persons in the risk factor study.
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