The rate of congenital heart disease in adults and children has risen in
recent decades, mostly due to better cardiac care for all age groups, a
new study has found.
Between 1985 and 2000 severe congenital heart disease increased by 85 percent.
The most dramatic rise occurred in 13- to 25-year-olds. CHD, which is present
at birth, causes structural problems in either the heart or its major blood
vessels.
Once an affliction of childhood, the study clearly shows a shift toward
adult prevalence.
Even so, the boom should not be perceived negatively, said lead author
Dr. Ariane J. Marelli, director of the McGill Adult Unit for Congenital
Heart Disease Excellence at McGill University in Montreal.
"This is really a success story of cardiac care in the last 40 years,"
Marelli said. "It's the result of a remarkable convergence of progress
both in diagnosis and in surgical techniques for congenital heart disease."
The study was published in Circulation, a journal of the American
Heart Association.
Marelli and colleagues took data on CHD diagnoses from administrative databases
in Quebec. They measured prevalence, age and the proportion of adults relative
to children in 1985, 1990, 1995 and 2000.
Mysteriously, more women seemed to have heart defects than men -- a concerning
phenomena, as women can pass the disease on to their children. Researchers
believe certain genetic predispositions cause CHD, although the exact mechanisms
are still unknown.
The study didn't investigate all the reasons for the increase, but Marelli
suspects more efficient diagnoses may explain milder forms of CHD. Likewise,
those with severe forms of the disease are living longer than they were
30 years ago, thanks to advances in new technologies. In the past, most
children with severe CHD didn't make it to adulthood.
The cardiac ultrasound, which became available in the 1980s, has dramatically
improved the ability to diagnose cases. Most patients are treated with
catheters or surgery.
Physicians are also more aware of the condition, said Dr. Berard
Martin, chairman of the American College of Cardiology's Section on Congenital
Heart Disease. Even so, there aren't enough physicians trained in the field,
he said.
Martin also pointed out the study confirmed previous findings of an explosion
in adult patients.
"By all accounts now in the United States we have thought that adults with
CHD had outnumbered children, and this study very much supports that,"
Martin said.
Although the study was conducted in Canada, Marelli believes the findings
would be the same in the United States, where an estimated 1.8 million
Americans had CHD in 2000. Also in 2000 one in every 85 children and one
in every 250 adults had CHD, according to the study.
The study was limited because of its reliance on administrative databases;
the data would be stronger if the researchers interviewed patients one-on-one.
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