This chapter discusses trends in coronary heart disease (CHD) in the United States, including mortality trends, morbidity trends, and factors associated with temporal CHD trends. CHD mortality adjusted for age continues to decline in the United States. However, crude mortality, unadjusted for age, has changed more modestly, with CHD being postponed, and manifesting at progressively older ages. The incidence of acute myocardial infarction (AMI) — defined to include both first hospitalized event and out-of-hospital death as first CHD manifestation — is declining modestly, mainly due to a decline in out-of-hospital mortality. Recurrent or second AMI is declining at a rate greater that incident AMI, particularly in the 1990s, as is case fatality for hospitalized AMI. There is also evidence that the severity of hospitalized AMI is declining.
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