70% of Decline in Death from Heart Disease Due to Treatment Advances in the 1980s
For immediate release: February 14, 1997
Boston, MA--Harvard School of Public Health investigators report that 70% of the decline in deaths from coronary heart disease (CHD) in the U.S. between 1980 and 1990 can be attributed to treatment success with techniques such as thrombolysis and primary coronary angioplasty and the use of medications such as lipid lowering drugs in patients with CHD. Only one-fourth of the decline in coronary heart disease mortality was due to primary prevention, e.g., population-wide diet changes. The study is published in the February 19 Journal of the American Medical Association.
The investigators used a computer simulation model which incorporates mortality data and health outcome data from a variety of sources, including the Framingham Heart Study. Among lifestyle changes and risk factor interventions, improvement in LDL and HDL cholesterol levels explained one-third of the decline in CHD mortality. The reasons for a change in cholesterol levels include changes in diet and use of lipid lowering medications.
The study could not identify how much of each type of improvement could be attributed to every specific type of technology, e.g., thrombolysis. Factors such as exercise, estrogen therapy and aspirin therapy were not included in this study and may be responsible for the small portion of the decline left unexplained.
Dr. Maria Hunink, lead author of the study and adjunct associate professor health policy and management at the Harvard School of Public Health and associate professor at the University of Groningen, the Netherlands, comments, "The decline in CHD mortality has been a well-known fact for more than 20 years now. What startled us was that treating patients with CHD was having so much more effect than trying to prevent the disease. Primary prevention still has an important role to play but most of its effect was realized before 1980."
Milton Weinstein, co-author on the study and professor of health policy and management at the Harvard School of Public Health, comments, "A main point from this study for consumers is that secondary prevention really can save lives. People who have had a heart attack, or other manifestations of CHD, should confer with a doctor to help them consider treatment options that could extend and increase the quality of their lives."
He also notes, "Research to identify and modify cardiac risk factors in addition to cholesterol, high blood pressure and cholesterol, is needed. Promising areas for further progress in CHD prevention are physical activity, hormone replacement and the discovery of new biochemical markers that can lead to nutritional or pharmacological interventions."
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