Over the past century, the rate of death due to heart disease in the United States increased until the mid 1960s and then declined steadily, a trend that continues today. However, the recent obesity and type 2 diabetes epidemic has prompted some authors to suggest that the declines in heart disease mortality seen previously will soon end. Sadly, it has been proposed that today’s children may be the first generation to have a shorter life expectancy than their parents. In this regard, this paper described temporal trends in the prevalence of high-grade coronary artery disease (CAD) (more than a 75% reduction in cross-sectional luminal area in any of left anterior descending, left circumflex, or right coronary arteries) and lesser forms of CAD at autopsy among 3,237 Olmsted County residents 16-64 years of age with non-natural deaths. Over the full study period from 1981 through 2004, the authors found that the proportion of decedents with high-grade CAD declined, more so for males compared with females and younger decedents compared with older. Moreover, there were significant declines both in the proportion of decedents with evidence of any CAD and in the grade of CAD. However, results of this study indicated that declines in the grade of CAD ended after 1995 and have instead increased since 2000. Overall, declines in coronary disease prevalence during 1981-2004 strengthen arguments that any increased prevalence resulting from improved survival among persons with disease was offset by reductions in disease incidence. However, the results indicating that declines have recently reversed provide some of the first evidence to support increasing concerns that declines in heart disease mortality may not continue. Nevertheless, additional studies will be needed to determine if these recent trends are due to the increased prevalence of obesity and type 2 diabetes.
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