Current strategies for explaining the decline in ischemic heart disease mortality

Mortality from ischemic heart disease has declined sharply since the mid 1960's in the United States and several other industrialized nations. The causes of this decline have thus far not been established. Six major strategies for investigating determinants of ischemic heart disease mortality trends are discussed in this review: (1) analyses of mortality data; (2) morbidity surveillance; (3) surveillance of change in medical care; (4) surveillance of cardiovascular risk factors; (5) social and ecological surveillance; (6) experimental and quasi-experimental community approaches. The rationale, problems and limitations of each are discussed.