Trends in the Incidence of Coronary Heart Disease and Changes in Diet and Lifestyle in Women
Frank B. Hu, M.D., Ph.D., Meir J. Stampfer, M.D., Dr.P.H., JoAnn E. Manson, M.D., Dr.P.H., Francine Grodstein, D.Sc., Graham A. Colditz, M.D., Dr.P.H., Frank E. Speizer, M.D., and Walter C. Willett, M.D., Dr.P.H.
Background Previous studies have found concurrent declines inblood pressure, serum cholesterol levels, and the incidenceof and mortality from coronary disease. However, the effectsof changes in diet and lifestyle on trends in coronary diseaseare largely unknown.
Methods We followed 85,941 women who were 34 to 59 years oldand had no previously diagnosed cardiovascular disease or cancerfrom 1980 to 1994 in the Nurses' Health Study. Diet and lifestylevariables were assessed at base line and updated during follow-up.
Results After adjustment for the effect of age, the incidenceof coronary disease declined by 31 percent from the two-yearperiod 1980–1982 to the two-year period 1992–1994.From 1980 to 1992, the proportion of participants currentlysmoking declined by 41 percent, the proportion of postmenopausalwomen using hormone therapy increased by 175 percent, and theprevalence of overweight, defined as a body-mass index (theweight in kilograms divided by the square of the height in meters)of 25 or more, increased by 38 percent. During the study period,diet improved substantially. Statistically, changes in thesevariables — when considered simultaneously — explaineda 21 percent decline in the incidence of coronary disease, representing68 percent of the overall decline from 1980–1982 to 1992–1994.Taken individually, the reduction in smoking explained a 13percent decline in the incidence of coronary disease; improvementin diet explained a 16 percent decline; and increase in postmenopausalhormone use explained a 9 percent decline. On the other hand,the increase in body-mass index explained an 8 percent increasein the incidence of coronary disease.
Conclusions Reduction in smoking, improvement in diet, and anincrease in postmenopausal hormone use accounted for much ofthe decline in the incidence of coronary disease in this groupof women. An increasing prevalence of obesity, however, appearsto have slowed the decline in the incidence of coronary disease.
Source Information
From the Departments of Nutrition (F.B.H., M.J.S., W.C.W.) and Epidemiology (M.J.S., J.E.M., G.A.C., W.C.W.), Harvard School of Public Health; and the Channing Laboratory (M.J.S., J.E.M., F.G., G.A.C., F.E.S., W.C.W.) and the Division of Preventive Medicine (J.E.M.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School — all in Boston.
Address reprint requests to Dr. Hu at the Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave., Boston, MA 02115, or at frank.hu{at}channing.harvard.edu.
Coronary Heart Disease in Women
Stevenson J. C., Flather M., Collins P., Assefi N. P., Rhoads C. S., Bassan M., Anderson P. W., Moscarelli E., Herrington D. M., Waters D., Hu F. B., Stampfer M. J., Willett W. C., Nabel E. G.
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N Engl J Med 2000;
343:1891-1894, Dec 21, 2000.
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