Modelling the decline in coronary heart disease deaths in England and Wales, 1981-2000: comparing contributions from primary prevention and secondary prevention.

Published on Sep 15, 2005in BMJ30.223
· DOI :10.1136/BMJ.38561.633345.8F
Belgin Ünal24
Estimated H-index: 24
(Dokuz Eylül University),
Julia A Critchley58
Estimated H-index: 58
(LSTM: Liverpool School of Tropical Medicine),
Simon Capewell89
Estimated H-index: 89
(University of Liverpool)
Sources
Abstract
Abstract Objective To investigate whether population based primary prevention (risk factor reduction in apparently healthy people) might be more powerful than current government initiatives favouring risk factor reduction in patients with coronary heart disease (CHD) (secondary prevention). Design, setting, and participants The IMPACT model was used to synthesise data for England and Wales describing CHD patient numbers, uptake of specific treatments, trends in major cardiovascular risk factors, and the mortality benefits of these specific risk factor changes in healthy people and in CHD patients. Results Between 1981 and 2000, CHD mortality rates fell by 54%, resulting in 68 230 fewer deaths in 2000. Overall smoking prevalence declined by 35% between 1981 and 2000, resulting in approximately 29 715 (minimum estimate 20 035, maximum estimate 44 675) fewer deaths attributable to smoking cessation: approximately 5035 in known CHD patients and approximately 24 680 in healthy people. Population total cholesterol concentrations fell by 4.2%, resulting in approximately 5770 fewer deaths attributable to dietary changes (1205 in CHD patients and 4565 in healthy people) plus 2135 fewer deaths attributable to statin treatment (1990 in CHD patients, 145 in people without CHD). Mean population blood pressure fell by 7.7%, resulting in approximately 5870 fewer deaths attributable to secular falls in blood pressure (520 in CHD patients and 5345 in healthy people) plus approximately 1890 fewer deaths attributable to antihypertensive treatments in people without CHD. Approximately 45 370 fewer deaths were thus attributable to reductions in the three major risk factors in the population: some 36 625 (81%) in people without recognised CHD and 8745 (19%) in CHD patients. Conclusions Compared with secondary prevention, primary prevention achieved a fourfold larger reduction in deaths. Future CHD policies should prioritise population-wide tobacco control and healthier diets.
📖 Papers frequently viewed together
275 Citations
199745.54JAMA
603 Citations
2,184 Citations
References20
Newest
#1Shah Ebrahim (Lond: University of London)H-Index: 150
#2Fiona Taylor (Lond: University of London)H-Index: 1
Last. George Davey Smith (UoB: University of Bristol)H-Index: 250
view all 6 authors...
Multiple risk factor interventions using counselling and educational methods assumed to be efficacious and cost-effective in reducing coronary heart disease (CHD) mortality and morbidity and that they should be expanded. Trials examining risk factor changes have cast doubt on the effectiveness of these interventions. The objective of this review is to assess the effects of multiple risk factor interventions for reducing total mortality, fatal and non-fatal events from CHD and cardiovascular risk...
457 CitationsSource
#1Belgin ÜnalH-Index: 24
#2Julia A CritchleyH-Index: 58
Last. Simon CapewellH-Index: 89
view all 4 authors...
Objectives. We estimated life-years gained from cardiological treatments and cardiovascular risk factor changes in England and Wales between 1981 and 2000.Methods. We used the IMPACT model to integrate data on the number of coronary heart disease patients, treatment uptake and effectiveness, risk factor trends, and median survival in coronary heart disease patients.Results. Compared with 1981, there were 68230 fewer coronary deaths in 2000. Approximately 925415 life-years were gained among peopl...
80 CitationsSource
#1Cyril W.C. Kendall (U of T: University of Toronto)H-Index: 76
#2David J. A. Jenkins (U of T: University of Toronto)H-Index: 10
Over the past two decades, cholesterol-lowering drugs have proven to be effective and have been found to significantly reduce the risk of coronary heart disease (CHD). However, diet and lifestyle factors are still recognized as the first line of intervention for CHD risk reduction by the National Cholesterol Education Program and the American Heart Association, which now advocate use of viscous fibers and plant sterols, and soy protein and nuts, respectively. In a series of metabolically control...
65 CitationsSource
#1Julia A Critchley (LSTM: Liverpool School of Tropical Medicine)H-Index: 58
#2Jing LiuH-Index: 50
Last. Simon CapewellH-Index: 89
view all 5 authors...
Background— Coronary heart disease (CHD) mortality is rising in many developing countries. We examined how much of the increase in CHD mortality in Beijing, China, between 1984 and 1999 could be attributed to changes in major cardiovascular risk factors and assessed the impact of medical and surgical treatments. Methods and Results— A validated, cell-based mortality model synthesized data on (1) patient numbers, (2) uptake of specific medical and surgical treatments, (3) treatment effectiveness,...
257 CitationsSource
#1Richard Doll (Clinical Trial Service Unit)H-Index: 107
#2Richard Peto (Clinical Trial Service Unit)H-Index: 200
Last. Isabelle Sutherland (Clinical Trial Service Unit)H-Index: 5
view all 4 authors...
Objective To compare the hazards of cigarette smoking in men who formed their habits at different periods, and the extent of the reduction in risk when cigarette smoking is stopped at different ages. Design Prospective study that has continued from 1951 to 2001. Setting United Kingdom. Participants 34 439 male British doctors. Information about their smoking habits was obtained in 1951, and periodically thereafter; cause specific mortality was monitored for 50 years. Main outcome measures Overal...
4,379 CitationsSource
The National Service Framework (NSF) established coronary heart disease as a priority area for the government and for the National Health Service (NHS). In the three and a half years since its launch, good progress has been made and the NSF is already delivering real improvements for patients, demonstrated by a near 25% reduction in the death rate from circulatory diseases. Prescribing of cardiovascular drugs for secondary prevention has increased, acute myocardial infarction is being treated mo...
7 CitationsSource
#1Belgin Ünal (University of Liverpool)H-Index: 24
#2Julia A Critchley (University of Liverpool)H-Index: 58
Last. Simon Capewell (University of Liverpool)H-Index: 89
view all 3 authors...
Background— Coronary heart disease mortality rates have been decreasing in the United Kingdom since the 1970s. Our study aimed to examine how much of the decrease in England and Wales between 1981 and 2000 could be attributed to medical and surgical treatments and how much to changes in cardiovascular risk factors. Methods and Results— The IMPACT mortality model was used to combine and analyze data on uptake and effectiveness of cardiological treatments and risk factor trends in England and Wale...
606 CitationsSource
#1Jonathan EmbersonH-Index: 69
#2Peter H. WhincupH-Index: 128
Last. Shah EbrahimH-Index: 150
view all 5 authors...
Aims To estimate the potential effectiveness of different “high-risk” and “population” approaches to the primary prevention of cardiovascular disease (CVD) in middle-aged British men, after correction for regression dilution bias. Methods and results We used a combination of cohort and randomised controlled trial evidence to estimate the effectiveness of high-risk strategies, based on the identification of high-risk factors or high absolute risk, and strategies based on population-wide reduction...
188 CitationsSource
#1Julia A Critchley (University of Liverpool)H-Index: 58
#2Simon CapewellH-Index: 89
ContextAs more interventions become available for the treatment of coronary heart disease (CHD), policy makers and health practitioners need to understand the benefits of each intervention, to better determine where to focus resources. This is particularly true when a patient with CHD quits smoking.ObjectiveTo conduct a systematic review to determine the magnitude of risk reduction achieved by smoking cessation in patients with CHD.Data SourcesNine electronic databases were searched from start o...
842 CitationsSource
#1Robert O. Bonow (NU: Northwestern University)H-Index: 166
Cardiovascular disease (CVD) in the United States represents a continuing crisis of epidemic proportions, with nearly 960 000 individuals dying from heart disease and stroke each year.1 CVD has been the leading cause of death in this country every year since 1900, with the exception of 1918, the year of the great influenza epidemic. According to the most recent statistics, if all forms of major CVD were eliminated, life expectancy would rise almost 7 years. Furthermore, although often perceived ...
68 CitationsSource
Cited By267
Newest
#1Anne‐Karien M. de Waard (UU: Utrecht University)H-Index: 2
#2Joke C. KorevaarH-Index: 20
Last. Niek J. de Wit (UU: Utrecht University)H-Index: 32
view all 10 authors...
Background and aims Since cardiometabolic diseases (CMD) are a frequent cause of death worldwide, preventive strategies are needed. Recruiting adults for a health check could facilitate the identification of individuals at risk for CMD. For successful results, participation is crucial. We aimed to identify factors related to unwillingness to participate in CMD health checks. Methods We performed a cross-sectional study in the Czech Republic, Denmark, Greece, the Netherlands, and Sweden. A questi...
Source
By the late 1980s, ‘healthy eating’ had largely failed as a public health discourse in Britain. Rather than providing consumers with a clear set of behavioural guidelines, it had fragmented into a ...
Source
#1Maureen Seguin (Lond: University of London)H-Index: 8
#2Gideon Lasco (UP: University of the Philippines Diliman)H-Index: 7
Last. Benjamin Palafox (Lond: University of London)H-Index: 8
view all 20 authors...
Background: Cardiovascular diseases (CVDs) are the leading cause of premature mortality in the world and are a growing public health concern in low- and middle-income countries (LMICs), including those in South East Asia. Their management requires coordinated responses by a range of healthcare providers, which should preferably be based on knowledge of the national context. We systematically review evidence on the pathways followed by patients with CVD in Malaysia and the Philippines to understa...
Source
view all 4 authors...
Source
#1Susanne StolpeH-Index: 2
#2Bernd KowallH-Index: 26
Last. Andreas Stang (BU: Boston University)H-Index: 64
view all 3 authors...
Mortality rates for coronary heart disease (CHD) experience a longstanding decline, attributed to progress in prevention, diagnostics and therapy. However, CHD mortality rates vary between countries. To estimate whether national patterns of causes of death impact CHD mortality, data from the WHO "European detailed mortality database" for 2000 and 2013 for populations aged ≥ 80 years was analyzed. We extracted mortality rates for total mortality, cardiovascular diseases, neoplasms, dementia and i...
2 CitationsSource
#1Christos LionisH-Index: 51
Last. François G. Schellevis (PHRI: Public Health Research Institute)H-Index: 29
view all 16 authors...
(1) Background: Cardiometabolic diseases are the most common cause of death worldwide. As part of a collaborative European study, this paper aims to explore the implementation of primary care selective-prevention services in five European countries. We assessed the implementation process of the selective-prevention services, participants' cardiometabolic profile and risk and participants' evaluation of the services, in terms of feasibility and impact in promoting a healthy lifestyle. (2) Methods...
Source
#2Martin O'Flaherty (University of Liverpool)H-Index: 54
view all 7 authors...
Background Mexico is still in the growing phase of the epidemic of coronary heart disease (CHD), with mortality increasing by 48% since 1980. However, no studies have analyzed the drivers of these trends. We aimed to model CHD deaths between 2000 and 2012 in Mexico and to quantify the proportion of the mortality change attributable to advances in medical treatments and to changes in population-wide cardiovascular risk factors. Methods We performed a retrospective analysis using the previously va...
1 CitationsSource
#1Feiyu Hu (University of Auckland)H-Index: 2
#2Jim Warren (University of Auckland)H-Index: 21
Last. Daniel J. Exeter (University of Auckland)H-Index: 23
view all 3 authors...
OBJECTIVES This study analyzed patient factors in medication persistence after discharge from the first hospitalization for cardiovascular disease (CVD) with the aim of predicting persistence to lipid-lowering therapy for 1 to 2 years. METHODS A subcohort having a first CVD hospitalization was selected from 313,207 patients for proportional hazard model analysis. Logistic regression, support vector machine, artificial neural networks, and boosted regression tree (BRT) models were used to predict...
1 CitationsSource
#1Jane ParkinsonH-Index: 5
#2Jon MintonH-Index: 11
Last. Gerry McCartneyH-Index: 23
view all 6 authors...
Objective We aimed to explore whether age, period or cohort effects explain the trends and inequalities in ischaemic heart disease (IHD) and cerebrovascular disease (CeVD) mortality in Scotland. Methods We analysed IHD and CeVD deaths for 1974–2015 by sex, age and area deprivation, visually explored the data using heatmaps and dotplots and built regression models. Results CeVD mortality improved steadily over time while IHD mortality improved more rapidly from the late 1980s. Age effects were ev...
Source
#1Sophie Seward (CU: University of Colorado Boulder)
#2Joyce S. Ramos (Flinders University)H-Index: 9
Last. Lance C. Dalleck (Western State Colorado University)H-Index: 21
view all 7 authors...
This study sought to examine the effectiveness of a personalized, community-based exercise program at reducing MetS severity and consequently Type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) risk. One-hundred and fifty physically inactive participants (aged 18–83 years) were randomized to a non-exercise control group (n = 75; instructed to continue their usual lifestyle habits) or treatment group (n = 75). Participants randomized to the treatment group completed a 12 week persona...
3 CitationsSource