Atherosclerotic Vascular Disease Conference: Writing Group I: epidemiology.

Our knowledge of the epidemiology of coronary heart disease (CHD) is extensive. Although CHD mortality peaked in the 1960s and then declined dramatically,1,2 CHD remains the leading cause of death in both men and women in the United States. The aging of the United States population contributes to the high prevalence of CHD. By the year 2020, it is estimated that ischemic heart disease will be the number one cause of disability and death worldwide.3 Data on noncoronary atherosclerotic vascular disease (AVD) are far less available than data on CHD. Studies of the atherosclerotic process underlying ischemic stroke are hampered by the differing vascular mechanisms that lead to stroke, including large-artery atherosclerosis with occlusion and distal embolization and small penetrating arterial disease with lacunar infarction. Also, there are a considerable number of ischemic stroke events for which the mechanism is unclear and the infarct is of undetermined cause. What is known about the epidemiology of atherosclerotic disease in different territories tends to come from snapshots based on several prevalence studies, which often reflect a medical milieu very different from the one today in which many preventive interventions, including lipid-lowering therapy, hypertension control, and antiplatelet therapies, are more widely used. Epidemiologic, pathophysiological, and therapeutic studies of noncoronary atherosclerotic disease have tended to focus on individual territories rather than on the vascular tree in its totality. Although it is still important to understand critical differences among the different territories, it is also important that basic, epidemiologic, and clinical investigators recognize the links among vascular territories (namely, that atherosclerosis is a systemic disease) and that collection of current prevalence and incidence data for both clinical and subclinical vascular disease allows for robust comparisons and improved understanding of both the similarities and differences in atherosclerosis in different vascular territories. The barriers that …