The New England Journal of Medicine
e-mail icon  FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |    Advanced Search
Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe
 
Special Article
PreviousPrevious
Volume 356:2388-2398 June 7, 2007 Number 23
NextNext

Explaining the Decrease in U.S. Deaths from Coronary Disease, 1980–2000
Earl S. Ford, M.D., M.P.H., Umed A. Ajani, M.B., B.S., M.P.H., Janet B. Croft, Ph.D., Julia A. Critchley, D.Phil., M.Sc., Darwin R. Labarthe, M.D., M.P.H., Ph.D., Thomas E. Kottke, M.D., Wayne H. Giles, M.D., M.S., and Simon Capewell, M.D.

 Sign up for free e-toc
 

This Article
-Full Text
- PDF
-PDA Full Text
-PowerPoint Slide Set
-CME Exam
-Supplementary Material

Commentary
-Letters

Tools and Services
-Add to Personal Archive
-Add to Citation Manager
-Notify a Friend
-E-mail When Cited
-E-mail When Letters Appear

More Information
-PubMed Citation
ABSTRACT

Background Mortality from coronary heart disease in the United States has decreased substantially in recent decades. We conducted a study to determine how much of this decrease could be explained by the use of medical and surgical treatments as opposed to changes in cardiovascular risk factors.

Methods We applied a previously validated statistical model, IMPACT, to data on the use and effectiveness of specific cardiac treatments and on changes in risk factors between 1980 and 2000 among U.S. adults 25 to 84 years old. The difference between the observed and expected number of deaths from coronary heart disease in 2000 was distributed among the treatments and risk factors included in the analyses.

Results From 1980 through 2000, the age-adjusted death rate for coronary heart disease fell from 542.9 to 266.8 deaths per 100,000 population among men and from 263.3 to 134.4 deaths per 100,000 population among women, resulting in 341,745 fewer deaths from coronary heart disease in 2000. Approximately 47% of this decrease was attributed to treatments, including secondary preventive therapies after myocardial infarction or revascularization (11%), initial treatments for acute myocardial infarction or unstable angina (10%), treatments for heart failure (9%), revascularization for chronic angina (5%), and other therapies (12%). Approximately 44% was attributed to changes in risk factors, including reductions in total cholesterol (24%), systolic blood pressure (20%), smoking prevalence (12%), and physical inactivity (5%), although these reductions were partially offset by increases in the body-mass index and the prevalence of diabetes, which accounted for an increased number of deaths (8% and 10%, respectively).

Conclusions Approximately half the decline in U.S. deaths from coronary heart disease from 1980 through 2000 may be attributable to reductions in major risk factors and approximately half to evidence-based medical therapies.


Source Information

From the Division of Adult and Community Health (E.S.F., U.A.A., W.H.G.) and the Division for Heart Disease and Stroke Prevention (J.B.C., D.R.L.), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta; the Institute of Health and Society, Newcastle University, Newcastle upon Tyne (J.A.C.), and the Division of Public Health, University of Liverpool, Liverpool (S.C.) — both in the United Kingdom; and HealthPartners Research Foundation, Minneapolis (T.E.K.).

Address reprint requests to Dr. Capewell at the Division of Public Health, University of Liverpool, Whelan Building, Quadrangle, Liverpool L69 3GB, United Kingdom, or at capewell{at}liverpool.ac.uk.

Full Text of this Article


Related Letters:

Decrease in U.S. Deaths from Coronary Disease
Kabir Z., Taylor-Robinson D. C., Capewell S.
Extract | Full Text | PDF  
N Engl J Med 2007; 357:941, Aug 30, 2007. Correspondence

This article has been cited by other articles:



HOME  |  SUBSCRIBE  |  SEARCH  |  CURRENT ISSUE  |  PAST ISSUES  |  COLLECTIONS  |  PRIVACY  |  HELP  |  beta.nejm.org

Comments and questions? Please contact us.

The New England Journal of Medicine is owned, published, and copyrighted © 2008 Massachusetts Medical Society. All rights reserved.