Stall in Heart Disease Death Rates, Evidence From Maine, 1999-2017
PREVENTING CHRONIC DISEASE
Authors: Sinatra, Jennifer A.; Huston, Sara L.
Abstract
Introduction Since the 1950s, heart disease deaths have declined in the United States, but recent reports indicate a plateau in this decline. Heart disease death rates increased in Maine from 2011-2015. We ex-amined reasons for the trend change in Maine's heart disease death rates, including the contributing types of heart disease. Methods We obtained Maine's annual heart disease death data for 1999-2017 from CDC's Wide-ranging Online Data for Epidemi-ologic Research (CDC WONDER). We used joinpoint regression to determine changes in trend and annual percentage change (APC) in death rates for heart disease overall and by demographic groups, types of heart disease, and geographic area. Results Joinpoint modeling showed that Maine's age-adjusted heart dis-ease death rates decreased during 1999-2010 (-4.2% APC), then plateaued during 2010-2017 (-0.1% APC). Death rates flattened for both sexes and age groups >= 45 years. Although death rates for acute myocardial infarction (AMI) decreased through 2017, hyper-tensive heart disease (HHD) and heart failure death rates in-creased. Death rates attributable to diabetes-related heart disease and non-AMI ischemic heart disease (IHD) plateaued. Conclusion Declines in Maine's heart disease death rates have plateaued, sim-ilar to national trends. Flattening rates appear to be driven by ad-verse trends in HHD, heart failure, diabetes-related heart disease, and non-AMI IHD. Increased efforts to address cardiovascular dis-ease risk factors, chronic heart disease, and access to care are ne-cessary to continue the decrease in heart disease deaths in Maine.
Delay-driven oscillations via Axin2 feedback in the Wnt/beta-catenin signalling pathway
JOURNAL OF THEORETICAL BIOLOGY
Authors: Cavallo, James C.; Scholpp, Steffen; Flegg, Mark B.
Abstract
The Wnt signalling pathway plays an important role in development, disease, and normal tissue function. Mathematical models for Wnt signalling have predominantly focused on quantitatively predicting changes in steady-state beta-catenin concentrations (the main downstream protein regulated by canonical Wnt signalling). One of the genes targeted for expression by Wnt/beta-catenin signalling is the negative Wnt regulator Axin2. Recently, a number of authors have indicated a potential theoretical role of Axin2 feedback to induce oscillatory behaviour in the pathway and this has been observed in a number of detailed mathematical models. Due to the complexity of these models, the investigations to date have been limited to numerical experiments and parameter sensitivity analyses. In this manuscript, we study the fundamental structure of the dynamical system underlying the Wnt signalling mechanism with Axin2 feedback to gain some insight into why and when oscillations occur in models with this structure. We semi-rigorously analyse three simple models and, for these models, gain deep understanding of the characteristic set of conditions that are necessary and sufficient for oscillations to be induced. We discuss the possible biological consequences of these findings for Wnt signalling pathway oscillations. They include; to promote oscillations (1) Keeping all other parameters constant, the Wnt signal strength should neither be too high or too low but within a single finite window of values, (2) Wnt receptor complexes should fully deactivate Axin rather than temporarily deconstruct it from other scaffold proteins, (3) In the absence of stochastic effects or more complicated mechanisms, a critical delay in Axin2 feedback in the system is necessary, (4) Deactivation of Axin by the Wnt receptor complex needs to be critically efficient relative to beta-catenin removal by Axin, and (5) conditions necessary are less strict if Axin2 feedback occurs after a fixed time rather than a Poisson-distributed time with the same average. (C) 2020 Elsevier Ltd. All rights reserved.