Research question: Atherosclerotic heart disease

[BigNick]

Calling medical people... I promise this is not about me, or a friend!

I am trying to find out more about atherosclerotic heart disease (AHD), which was the subject of this article that recently got a lot of press coverage.

There are many things wrong with that article; one of the things that concerns me is that per-county death rates from AHD, which is the single most common ICD-10 code for cause of death in the US (7.1% of all deaths), vary from 13 to 185 per 100,000, with the two most extreme counties both being quite large (so no statistical fluke effects are likely) and with relatively similar demographics. (Death rates from cancer vary from 105 to 320 per 100,000, which is still quite a range; I'm guessing maybe some hospitals put "cancer" and others put "liver [etc] failure [caused by cancer]".)

So I'm thinking that maybe it's not a very reliable diagnosis. How does a diagnosis of AHD typically work? Do people typically have the condition for many years, and when they finally die the doctor sighs and notes "yep, the AHD got him", or is it something that only manifests itself when someone keels over suddenly and the autopsy reveals the presence of hardening of the arteries?

Also, does anyone know whether, when a death takes place in hospital, the county recorded for CDC statistics is the county of residence, or the county where the death took place?

[Rich_by_the_Bay]

Often termed ASCVD (atherosclerotic cardiovascular disease) this implies various degrees of narrowing of blood vessels by plaques of cholesterol, platelets, and other inflammatory substances. Typical symptoms include pain increased with exertion and relieved at rest. However, ASCVD can be asymptomatic, discovered during various other tests. Common examples of ASCVD include:

Coronary Artery Disease. This may be symptomatic (chest pain, shortness of breath) or silent (detected on a routine exercise tolerance test, abnormal "screening" EKG). Rarely, coronary disease can have a cause that is NOT from atherosclerosis, such as valve disease, inflammatory conditions of the muscles, congenital heart disease.

Peripheral artery disease. Affecting the leg arteries (causing exercise-induced calf pain or buttock pain). Usually detected by abnormal physical exam, noninasive tests and angiogram - dye in the legs during x-ray tests). Also can affect the aorta.

Carotid blockage with increased risk of stroke, ministrokes (TIA). Otherwise similar to the above.

Risk factors are common knowledge - smoking, diabetes, obesity, sedentary lifestyle, family history, hypertension.

Hope that clarifies the definitions.