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Chapter 36: Definitions of Acute Coronary Syndromes

Coronary artery disease (CAD) accounts for what proportion of all global deaths?

A. 20%

B. 30%

C. 40%

D. 50%

E. 60%

The answer is B. (Hurst’s The Heart, 14th Edition, Chap. 36) Coronary artery disease accounts for 30% of all global deaths, representing the single most common cause of adult mortality and equivalent to the combined number of deaths caused by nutritional deficiencies, infectious diseases, and maternal/perinatal complications.1,2 Recent growth in the global burden of cardiovascular disease (CVD) is primarily attributable to the rising incidence across low- and middle-income countries.3 Among European member states of the World Health Organization (WHO), for example, CVD death rates for men and women were highest in the Russian Federation and Uzbekistan, respectively, whereas risk was lowest in France and Israel.4 Conversely, in the United States, over 15 million Americans, or 6.2% of the adult population, have CHD, with an MI occurring once every 43 seconds.5

In 2011, the costs associated with myocardial infarction (MI) and coronary heart disease (CHD) in the United States were $11 billion and $10 billion, respectively. These costs are projected to do what by 2030?

A. Decrease by 100%

B. Decrease by 50%

C. Stay approximately the same

D. Increase by 50%

E. Increase by 100%

The answer is E. (Hurst’s The Heart, 14th Edition, Chap. 36) Health care resource utilization for CHD is significant; over 1.1 million hospital discharges in 2010 listed MI or UA as a primary or secondary diagnosis.5 Health care expenditures are also substantial; costs for MI and CHD were approximately $11 billion and $10 billion, respectively, in 2011.6 These diagnoses constitute two of the most expensive discharge diagnoses and are expected to increase by 100% by 2030. Despite these sobering statistics, important strides in the diagnosis, prevention, and management of CHD have occurred over the past 50 years. In the United States, for example, several population-based studies have shown a reduction in both the incidence and the case fatality rate associated with MI.7,8 These favorable trends have been attributed to greater utilization of evidence-based therapies and improvements in the control and burden of risk factors.9 Concordant changes in the epidemiology of ACS have occurred over the past 10 years as a result of changing demographics and updated definitions of MI.

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