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What Caused the Decline in Cardiac Death Rate from 1980 to 2000?

A new analysis credits improved treatment and reduction in risk factors about equally.

U.S. death rates from cardiovascular disease have declined markedly in recent decades. To clarify the cause of the decline, CDC investigators sought to determine the contributions of various factors to the changes in death rates.

From 1980 to 2000, in individuals aged 25 to 84, the age-adjusted rate of coronary heart disease fell from 542.9 to 266.8 cases per 100,000 in men, and from 263.3 to 134.4 cases per 100,000 in women. The authors estimate that this decline resulted in the prevention of 341,745 deaths during this period.

The investigators estimated that 159,330 of the prevented deaths were attributable to medical or surgical therapies, of which secondary-prevention medications or rehabilitation contributed the greatest proportion. Treatments for acute MI accounted for about 6% of the total decrease in deaths, and revascularization for any indication accounted for about 7%. About 150,000 of the prevented deaths resulted from changes in risk factors. On a cautionary note, however, obesity and diabetes accounted for an increasing number of deaths from coronary disease over the course of the study.

Comment: This analysis of the considerable decline in cardiovascular deaths in recent years reveals the important roles of secondary prevention and risk factor modification in this public health achievement.

— Harlan M. Krumholz, MD, SM

Published in Journal Watch Cardiology July 11, 2007

Citation(s):

Ford ES et al. Explaining the decrease in U.S. deaths from coronary disease, 1980–2000. N Engl J Med 2007 Jun 7; 356:2388-98.

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