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Explaining the decrease in U.S. deaths from coronary disease, 1980-2000.

Earl S Ford1, Umed A Ajani, Janet B Croft

  • 1Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, USA.

The New England Journal of Medicine
|June 8, 2007
PubMed
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Reductions in cardiovascular risk factors and medical therapies each contributed about half to the significant decline in U.S. coronary heart disease deaths between 1980 and 2000.

Area of Science:

  • Cardiovascular medicine
  • Public health research
  • Epidemiology

Background:

  • Coronary heart disease (CHD) mortality in the U.S. has significantly decreased in recent decades.
  • The relative contributions of medical treatments versus risk factor changes to this decline were previously unclear.

Purpose of the Study:

  • To quantify the impact of medical and surgical treatments on CHD mortality decline.
  • To determine the extent to which changes in cardiovascular risk factors contributed to reduced CHD deaths.

Main Methods:

  • Utilized the validated IMPACT statistical model.
  • Analyzed data on cardiac treatment use, effectiveness, and risk factor changes from 1980-2000 in U.S. adults (25-84 years).
  • Distributed the difference between observed and expected CHD deaths in 2000 among various treatments and risk factors.

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Main Results:

  • CHD death rates declined substantially: from 542.9 to 266.8 per 100,000 in men and 263.3 to 134.4 in women.
  • Medical treatments accounted for approximately 47% of the decrease in CHD deaths.
  • Risk factor changes contributed approximately 44% to the decline, with notable reductions in cholesterol, blood pressure, and smoking, partially offset by increased BMI and diabetes.

Conclusions:

  • Both evidence-based medical therapies and reductions in major cardiovascular risk factors played nearly equal roles in halving U.S. CHD deaths from 1980-2000.
  • This highlights the dual importance of clinical interventions and public health initiatives in cardiovascular disease prevention.