title: Contributions of increasing obesity and diabetes to slowing decline in subclinical coronary artery disease.
abstract: BACKGROUND
  Our previous study of nonelderly adult decedents with nonnatural (accident, suicide, or homicide) cause of death (96% autopsy rate) between 1981 and 2004 revealed that the decline in subclinical coronary artery disease (CAD) ended in the mid-1990s. The present study investigated the contributions of trends in obesity and diabetes mellitus to patterns of subclinical CAD and explored whether the end of the decline in CAD persisted.
  
  
  RESULTS
  We reviewed provider-linked medical records for all residents of Olmsted County, Minnesota, who died from nonnatural causes within the age range of 16 to 64 years between 1981 and 2009 and who had CAD graded at autopsy. We estimated trends in CAD risk factors including age, sex, systolic blood pressure, diabetes (qualifying fasting glucose or medication), body mass index, smoking, and diagnosed hyperlipidemia. Using multiple regression, we tested for significant associations between trends in CAD risk factors and CAD grade and assessed the contribution of trends in diabetes and obesity to CAD trends. The 545 autopsied decedents with recorded CAD grade exhibited significant declines between 1981 and 2009 in systolic blood pressure and smoking and significant increases in blood pressure medication, diabetes, and body mass index ≥30 kg/m(2). An overall decline in CAD grade between 1981 and 2009 was nonlinear and ended in 1994. Trends in obesity and diabetes contributed to the end of CAD decline.
  
  
  CONCLUSIONS
  Despite continued reductions in smoking and blood pressure values, the previously observed end to the decline in subclinical CAD among nonelderly adult decedents was apparent through 2009, corresponding with increasing obesity and diabetes in that population.
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN (C.Y.S., K.R.B., J.A.E., P.N.N., R., C.L.L.).
authors.forename: Carin Y
authors.initials: CY
authors.lastname: Smith
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN (C.Y.S., K.R.B., J.A.E., P.N.N., R., C.L.L.).
authors.forename: Kent R
authors.initials: KR
authors.lastname: Bailey
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN (C.Y.S., K.R.B., J.A.E., P.N.N., R., C.L.L.).
authors.forename: Jane A
authors.initials: JA
authors.lastname: Emerson
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN (C.Y.S., K.R.B., J.A.E., P.N.N., R., C.L.L.) Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada (P.N.N.).
authors.forename: Peter N
authors.initials: PN
authors.lastname: Nemetz
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, MN (R.) Department of Health Sciences Research, Mayo Clinic, Rochester, MN (C.Y.S., K.R.B., J.A.E., P.N.N., R., C.L.L.).
authors.forename: Véronique L
authors.initials: VL
authors.lastname: Roger
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ (P.J.P.).
authors.forename: Pasquale J
authors.initials: PJ
authors.lastname: Palumbo
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN (W.D.E.).
authors.forename: William D
authors.initials: WD
authors.lastname: Edwards
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN (C.Y.S., K.R.B., J.A.E., P.N.N., R., C.L.L.).
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Leibson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001794:Blood Pressure; D015992:Body Mass Index; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000401:mortality*; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology* / Q000401:mortality; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D055815:Young Adult
keywords: atherosclerosis; coronary artery disease; diabetes mellitus; obesity; subclinical atherosclerosis risk factor