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. 1993 May 15;306(6888):1313–1318. doi: 10.1136/bmj.306.6888.1313

How can we best prolong life? Benefits of coronary risk factor reduction in non-diabetic and diabetic subjects.

J S Yudkin 1
PMCID: PMC1677709  PMID: 8518573

Abstract

OBJECTIVE--To compare the theoretical benefits of different approaches to reduce risk factors for coronary heart disease in subjects at risk. DESIGN--The results of findings from meta-analyses of intervention studies on cause specific mortality and of observational studies on smokers and ex-smokers were applied to observational data on 10 year cause specific mortality derived from the multiple risk factor intervention trial. Lifetable analyses were used to estimate gains in life expectancy. SUBJECTS--Diabetic and non-diabetic men initially 35-57 years of age. MAIN OUTCOME MEASURES--10 year mortality from coronary heart disease, 10 year total mortality, man years of intervention to prevent one death and one death from coronary heart disease, gain in life expectancy, and drug costs per year of additional life in diabetic and non-diabetic men of 45. RESULTS--In non-diabetic men a 10 year mortality from coronary heart disease of 14.4 per 1000 would be reduced by a mean of 0.58, 0.82, 2.64, and 2.74 per 1000 by antihypertensive treatment, lowering cholesterol concentration, taking aspirin, and stopping smoking respectively; a 10 year total mortality of 44.1 per 1000 would fall by a mean of 1.06, 5.16, and 8.65 per 1000 with antihypertensive and aspirin treatment and stopping smoking respectively and increased by a mean of 0.07 per 1000 with the lowering of cholesterol concentration. In diabetic men the reductions in mortality from coronary heart disease would be between three and five times greater, and total mortality would show mean reductions of 5.81, 0.56, 16.17, and 20.84 per 1000 respectively, with all interventions of significant benefit except the lowering of cholesterol concentration. Between 2400 and 3800 man years of pharmacological intervention were calculated as being necessary to prevent one death from coronary heart disease in a non-diabetic man, and between 800 and 1200 man years in a diabetic man. The loss of life expectancy associated with smoking and hypertension is greater than that accruing from hypercholesterolaemia, but stopping smoking would prolong life by a mean of around four years in a 45 year old non-diabetic man and three years in a diabetic man, whereas aspirin and antihypertensive treatment would provide approximately one year of additional life expectancy in both categories. CONCLUSIONS--Studies to date have shown little impact of drugs that lower cholesterol concentration and blood pressure on either coronary heart disease or total mortality. Although new treatments for hypercholesterolaemia and hypertension might help prevent coronary heart disease, other approaches to reduce the burden of premature death are required.

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Selected References

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  1. Barker D. J., Bull A. R., Osmond C., Simmonds S. J. Fetal and placental size and risk of hypertension in adult life. BMJ. 1990 Aug 4;301(6746):259–262. doi: 10.1136/bmj.301.6746.259. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Brett A. S. Treating hypercholesterolemia. How should practicing physicians interpret the published data for patients? N Engl J Med. 1989 Sep 7;321(10):676–680. doi: 10.1056/NEJM198909073211009. [DOI] [PubMed] [Google Scholar]
  3. Brown G., Albers J. J., Fisher L. D., Schaefer S. M., Lin J. T., Kaplan C., Zhao X. Q., Bisson B. D., Fitzpatrick V. F., Dodge H. T. Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. N Engl J Med. 1990 Nov 8;323(19):1289–1298. doi: 10.1056/NEJM199011083231901. [DOI] [PubMed] [Google Scholar]
  4. Collins R., Peto R., MacMahon S., Hebert P., Fiebach N. H., Eberlein K. A., Godwin J., Qizilbash N., Taylor J. O., Hennekens C. H. Blood pressure, stroke, and coronary heart disease. Part 2, Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet. 1990 Apr 7;335(8693):827–838. doi: 10.1016/0140-6736(90)90944-z. [DOI] [PubMed] [Google Scholar]
  5. D'Agostino R. B., Belanger A. J., Kannel W. B., Cruickshank J. M. Relation of low diastolic blood pressure to coronary heart disease death in presence of myocardial infarction: the Framingham Study. BMJ. 1991 Aug 17;303(6799):385–389. doi: 10.1136/bmj.303.6799.385. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Davey Smith G., Pekkanen J. Should there be a moratorium on the use of cholesterol lowering drugs? BMJ. 1992 Feb 15;304(6824):431–434. doi: 10.1136/bmj.304.6824.431. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Farnett L., Mulrow C. D., Linn W. D., Lucey C. R., Tuley M. R. The J-curve phenomenon and the treatment of hypertension. Is there a point beyond which pressure reduction is dangerous? JAMA. 1991 Jan 23;265(4):489–495. [PubMed] [Google Scholar]
  8. Glantz S. A., Parmley W. W. Passive smoking and heart disease. Epidemiology, physiology, and biochemistry. Circulation. 1991 Jan;83(1):1–12. doi: 10.1161/01.cir.83.1.1. [DOI] [PubMed] [Google Scholar]
  9. Heller R. F., Chinn S., Pedoe H. D., Rose G. How well can we predict coronary heart disease? Findings in the United Kingdom Heart Disease Prevention Project. Br Med J (Clin Res Ed) 1984 May 12;288(6428):1409–1411. doi: 10.1136/bmj.288.6428.1409. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Holme I. An analysis of randomized trials evaluating the effect of cholesterol reduction on total mortality and coronary heart disease incidence. Circulation. 1990 Dec;82(6):1916–1924. doi: 10.1161/01.cir.82.6.1916. [DOI] [PubMed] [Google Scholar]
  11. Jarrett R. J., Shipley M. J. Mortality and associated risk factors in diabetics. Acta Endocrinol Suppl (Copenh) 1985;272:21–26. doi: 10.1530/acta.0.110s021. [DOI] [PubMed] [Google Scholar]
  12. Muldoon M. F., Manuck S. B., Matthews K. A. Lowering cholesterol concentrations and mortality: a quantitative review of primary prevention trials. BMJ. 1990 Aug 11;301(6747):309–314. doi: 10.1136/bmj.301.6747.309. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Oliver M. F. Might treatment of hypercholesterolaemia increase non-cardiac mortality? Lancet. 1991 Jun 22;337(8756):1529–1531. doi: 10.1016/0140-6736(91)93208-q. [DOI] [PubMed] [Google Scholar]
  14. Parving H. H. Impact of blood pressure and antihypertensive treatment on incipient and overt nephropathy, retinopathy, and endothelial permeability in diabetes mellitus. Diabetes Care. 1991 Mar;14(3):260–269. doi: 10.2337/diacare.14.3.260. [DOI] [PubMed] [Google Scholar]
  15. Rogot E., Murray J. L. Smoking and causes of death among U.S. veterans: 16 years of observation. Public Health Rep. 1980 May-Jun;95(3):213–222. [PMC free article] [PubMed] [Google Scholar]
  16. Rose G., Hamilton P. J., Colwell L., Shipley M. J. A randomised controlled trial of anti-smoking advice: 10-year results. J Epidemiol Community Health. 1982 Jun;36(2):102–108. doi: 10.1136/jech.36.2.102. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Rosengren A., Welin L., Tsipogianni A., Wilhelmsen L. Impact of cardiovascular risk factors on coronary heart disease and mortality among middle aged diabetic men: a general population study. BMJ. 1989 Nov 4;299(6708):1127–1131. doi: 10.1136/bmj.299.6708.1127. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Rothenberg R., Ford E. S., Vartiainen E. Ischemic heart disease prevention: estimating the impact of interventions. J Clin Epidemiol. 1992 Jan;45(1):21–29. doi: 10.1016/0895-4356(92)90184-o. [DOI] [PubMed] [Google Scholar]
  19. Taylor W. C., Pass T. M., Shepard D. S., Komaroff A. L. Cholesterol reduction and life expectancy. A model incorporating multiple risk factors. Ann Intern Med. 1987 Apr;106(4):605–614. doi: 10.7326/0003-4819-106-4-605. [DOI] [PubMed] [Google Scholar]
  20. Warram J. H., Laffel L. M., Valsania P., Christlieb A. R., Krolewski A. S. Excess mortality associated with diuretic therapy in diabetes mellitus. Arch Intern Med. 1991 Jul;151(7):1350–1356. [PubMed] [Google Scholar]
  21. Yudkin J. S. Hypertension and non-insulin dependent diabetes. BMJ. 1991 Sep 28;303(6805):730–732. doi: 10.1136/bmj.303.6805.730. [DOI] [PMC free article] [PubMed] [Google Scholar]

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