Scientific Concept of the National Cohort (status ... - Nationale Kohorte

A.2
A.2. Scientific background and rationale for study elements
A.2.2.1 Cardiovascular diseases
CVD are among the most common chronic diseases in developed countries, and they are
the leading cause of death worldwide, accounting for approximately one third of all deaths
in men and women 33 . In Germany, they account largely for the 20 most frequent hospital
diagnoses 34 and are responsible for the largest proportion of direct health care costs (35
billion Euros yearly) 35 .
Among CVD, coronary heart disease (CHD) is the single leading cause of death in Germany
and worldwide 34, 36, 37 . In the year 2009, 73,899 persons died from chronic ischemic
heart disease (8.6% of all deaths in Germany), and an additional 56,226 died from acute
MI (6.6% of all deaths) 34 . The age-standardized incidence of MI in Germany in the years
2001–2003 was estimated at 356 events for men and 109 events for women per 100,000
persons per year 38 . CHD is a multifactorial disease resulting from atherosclerotic narrowing
of the coronary arteries and the formation of an occlusive thrombus after plaque rupture.
Although a number of genetic and nongenetic risk factors for CHD have been identified, the
quantitative interplay of these factors remains poorly understood, and the prediction of CHD
is still relatively imprecise.
Assessment of CHD:
Examinations and questionnaires (at baseline and during reassessment)
Level 1: Questionnaire
10-s, 12-lead ECG
Active follow-up (and medical verification of self-reports):
Self-report of physician-diagnosed MI, angina pectoris, coronary artery bypass graft
(CABG), percutaneous transluminal angioplasty (PTCA)
Passive follow-up: MI registries, where available
Heart failure is one of the most prevalent forms of CVD, with prevalence and incidence
increasing in the aging populations of industrialized nations. The prevalence of heart failure
was estimated to increase from 1% in 55- to 64-year-olds, to 7% in 75- to 84-year–olds, and
to >10% in >85-year-old subjects (Rotterdam study) 39 . Incidence in industrialized nations
increase from about 0.2-2.5/1000 person years in the 45- to 55-year-old group to 12.4-
44/1000 person years in >85-year-old persons (Hillingdon study and Rotterdam study) 39 ,
and the lifetime risk of heart failure in >40-year-old persons is >20% 39 . Data from the Framingham
study show 5-year survival rates of 25-40% 40, 41 .
While MI, hypertension, valvular heart disease, and cardiomyopathy are among the main
underlying causes of heart failure, little is known about the role of inflammatory factors
and autonomic dysfunction and about the exact role of risk factors such as physical activity,
obesity, or dietary factors. Moreover, heart failure can be divided into heart failure with
preserved ejection fraction (HFPEF), i.e., impaired left ventricular diastolic function with
normal systolic left ventricular function (previously denominated diastolic heart failure), and
heart failure with reduced ejection fraction (HFREF, systolic heart failure only 42 ), i. e., with
impaired systolic function. HFPEF currently accounts for about 50% of all cases of heart
failure 43 ; it is associated with the same morbidity and mortality and is even responsible for a
larger percentage of hospitalizations than is HFREF 44 . However, only few population-based
studies have described the burden of diastolic dysfunction and HFPEF 45, 46 . The distinction
between HFPEF and HFREF seems especially important since they seem to be partially different
entities potentially requiring different approaches to early detection and prevention 47 .
However, little is known about the determinants of diastolic dysfunction and its progression
to HFPEF. Further, the relationship between other measures of subclinical CVD (such as
arterial stiffness) and left ventricular diastolic function has not been described in detail. Like-
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