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Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 2003 Apr;57(4):243–247. doi: 10.1136/jech.57.4.243

Substantial potential for reductions in coronary heart disease mortality in the UK through changes in risk factor levels

J Critchley 1, S Capewell 1
PMCID: PMC1732418  PMID: 12646537

Abstract

Design: Secondary analysis of published data using a previously validated mortality model. The model combines uptake and effectiveness of treatments with risk factor trends by sex and age group. It was used to estimate the expected reductions in coronary heart disease mortality: (a) if recent risk factor trends simply continued; (b) if additional risk factor reductions were achieved in line with Scandinavia and the United States. An "analysis of extremes" sensitivity analysis was then carried out.

Setting: Scotland and UK.

Participants: Projected Scottish population aged 45+ in 2010 (2.4 million) and UK population of 26.8 million.

Main results: Continuation of current trends would result in 2169 fewer coronary deaths in 2010 (minimum estimate 1191 from sensitivity analyses to maximum 3870). About 4749 fewer deaths (minimum 3085, maximum 7155) could be achieved by: (a) a reduction in smoking prevalence from 30% to 18% (about 1668 fewer deaths); (b) a mean population cholesterol reduction from 6.2 to 5.2 mmol/l (about 2167 fewer deaths); (c) a 3.7 mm Hg fall in diastolic blood pressure (about 914 fewer deaths). Extrapolation from the Scottish population to the UK suggests 24 000 fewer deaths in 2010 if current trends continue, or 53 000 fewer deaths with the additional reductions.

Conclusions: With additional interventions it would be possible to almost halve current UK coronary heart disease mortality. Even without gains from medical treatments, the UK government target of 28 000 fewer deaths in 2010 does not seem challenging.

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Selected References

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  1. Beaglehole R. Medical management and the decline in mortality from coronary heart disease. Br Med J (Clin Res Ed) 1986 Jan 4;292(6512):33–35. doi: 10.1136/bmj.292.6512.33. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bonneux L., Looman C. W., Barendregt J. J., Van der Maas P. J. Regression analysis of recent changes in cardiovascular morbidity and mortality in The Netherlands. BMJ. 1997 Mar 15;314(7083):789–792. doi: 10.1136/bmj.314.7083.789. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Briggs A. Economics notes: handling uncertainty in economic evaluation. BMJ. 1999 Jul 10;319(7202):120–120. doi: 10.1136/bmj.319.7202.120. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Briggs A., Sculpher M., Buxton M. Uncertainty in the economic evaluation of health care technologies: the role of sensitivity analysis. Health Econ. 1994 Mar-Apr;3(2):95–104. doi: 10.1002/hec.4730030206. [DOI] [PubMed] [Google Scholar]
  5. Capewell S., Morrison C. E., McMurray J. J. Contribution of modern cardiovascular treatment and risk factor changes to the decline in coronary heart disease mortality in Scotland between 1975 and 1994. Heart. 1999 Apr;81(4):380–386. doi: 10.1136/hrt.81.4.380. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Capewell S., Pell J. P., Morrison C., McMurray J. Increasing the impact of cardiological treatments. How best to reduce deaths. Eur Heart J. 1999 Oct;20(19):1386–1392. doi: 10.1053/euhj.1999.1631. [DOI] [PubMed] [Google Scholar]
  7. Cooper R., Cutler J., Desvigne-Nickens P., Fortmann S. P., Friedman L., Havlik R., Hogelin G., Marler J., McGovern P., Morosco G. Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States: findings of the national conference on cardiovascular disease prevention. Circulation. 2000 Dec 19;102(25):3137–3147. doi: 10.1161/01.cir.102.25.3137. [DOI] [PubMed] [Google Scholar]
  8. DAWBER T. R., MEADORS G. F., MOORE F. E., Jr Epidemiological approaches to heart disease: the Framingham Study. Am J Public Health Nations Health. 1951 Mar;41(3):279–281. doi: 10.2105/ajph.41.3.279. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Dobson A. J. Relationship between risk factor trends and disease trends. Ann Med. 1994 Feb;26(1):67–71. doi: 10.3109/07853899409147330. [DOI] [PubMed] [Google Scholar]
  10. Dobson A., Filipiak B., Kuulasmaa K., Beaglehole R., Stewart A., Hobbs M., Parsons R., Keil U., Greiser E., Korhonen H. Relations of changes in coronary disease rates and changes in risk factor levels: methodological issues and a practical example. Am J Epidemiol. 1996 May 15;143(10):1025–1034. doi: 10.1093/oxfordjournals.aje.a008666. [DOI] [PubMed] [Google Scholar]
  11. Fichtenberg C. M., Glantz S. A. Association of the California Tobacco Control Program with declines in cigarette consumption and mortality from heart disease. N Engl J Med. 2000 Dec 14;343(24):1772–1777. doi: 10.1056/NEJM200012143432406. [DOI] [PubMed] [Google Scholar]
  12. Goldman L., Cook E. F. The decline in ischemic heart disease mortality rates. An analysis of the comparative effects of medical interventions and changes in lifestyle. Ann Intern Med. 1984 Dec;101(6):825–836. doi: 10.7326/0003-4819-101-6-825. [DOI] [PubMed] [Google Scholar]
  13. Grover S. A., Gray-Donald K., Joseph L., Abrahamowicz M., Coupal L. Life expectancy following dietary modification or smoking cessation. Estimating the benefits of a prudent lifestyle. Arch Intern Med. 1994 Aug 8;154(15):1697–1704. [PubMed] [Google Scholar]
  14. Gunning-Schepers L. The health benefits of prevention: a simulation approach. Health Policy. 1989 Jul;12(1-2):1–255. [PubMed] [Google Scholar]
  15. Hunink M. G., Goldman L., Tosteson A. N., Mittleman M. A., Goldman P. A., Williams L. W., Tsevat J., Weinstein M. C. The recent decline in mortality from coronary heart disease, 1980-1990. The effect of secular trends in risk factors and treatment. JAMA. 1997 Feb 19;277(7):535–542. [PubMed] [Google Scholar]
  16. Kuulasmaa K., Tunstall-Pedoe H., Dobson A., Fortmann S., Sans S., Tolonen H., Evans A., Ferrario M., Tuomilehto J. Estimation of contribution of changes in classic risk factors to trends in coronary-event rates across the WHO MONICA Project populations. Lancet. 2000 Feb 26;355(9205):675–687. doi: 10.1016/s0140-6736(99)11180-2. [DOI] [PubMed] [Google Scholar]
  17. Law M. R., Wald N. J., Thompson S. G. By how much and how quickly does reduction in serum cholesterol concentration lower risk of ischaemic heart disease? BMJ. 1994 Feb 5;308(6925):367–372. doi: 10.1136/bmj.308.6925.367. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. McElduff P., Dobson A. J., Jamrozik K., Hobbs M. S. Opportunities for control of coronary heart disease in Australia. Aust N Z J Public Health. 2001;25(1):24–30. doi: 10.1111/j.1467-842x.2001.tb00545.x. [DOI] [PubMed] [Google Scholar]
  19. Robinson B. R., Houng A. K., Reed G. L. Catalytic life of activated factor XIII in thrombi. Implications for fibrinolytic resistance and thrombus aging. Circulation. 2000 Sep 5;102(10):1151–1157. doi: 10.1161/01.cir.102.10.1151. [DOI] [PubMed] [Google Scholar]
  20. Shaper A. G., Pocock S. J., Walker M., Cohen N. M., Wale C. J., Thomson A. G. British Regional Heart Study: cardiovascular risk factors in middle-aged men in 24 towns. Br Med J (Clin Res Ed) 1981 Jul 18;283(6285):179–186. doi: 10.1136/bmj.283.6285.179. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Sigfusson N., Sigvaldason H., Steingrimsdottir L., Gudmundsdottir I. I., Stefansdottir I., Thorsteinsson T., Sigurdsson G. Decline in ischaemic heart disease in Iceland and change in risk factor levels. BMJ. 1991 Jun 8;302(6789):1371–1375. doi: 10.1136/bmj.302.6789.1371. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Tsevat J., Weinstein M. C., Williams L. W., Tosteson A. N., Goldman L. Expected gains in life expectancy from various coronary heart disease risk factor modifications. Circulation. 1991 Apr;83(4):1194–1201. doi: 10.1161/01.cir.83.4.1194. [DOI] [PubMed] [Google Scholar]
  23. Vartiainen E., Puska P., Pekkanen J., Tuomilehto J., Jousilahti P. Changes in risk factors explain changes in mortality from ischaemic heart disease in Finland. BMJ. 1994 Jul 2;309(6946):23–27. doi: 10.1136/bmj.309.6946.23. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Yusuf S., Lessem J., Jha P., Lonn E. Primary and secondary prevention of myocardial infarction and strokes: an update of randomly allocated, controlled trials. J Hypertens Suppl. 1993 Jun;11(4):S61–S73. [PubMed] [Google Scholar]
  25. van den Hoogen P. C., Feskens E. J., Nagelkerke N. J., Menotti A., Nissinen A., Kromhout D. The relation between blood pressure and mortality due to coronary heart disease among men in different parts of the world. Seven Countries Study Research Group. N Engl J Med. 2000 Jan 6;342(1):1–8. doi: 10.1056/NEJM200001063420101. [DOI] [PubMed] [Google Scholar]

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[Appendices]
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