Explaining the decrease in U.S. deaths from coronary disease, 1980-2000

N Engl J Med. 2007 Jun 7;356(23):2388-98.

Ford ES, Ajani UA, Croft JB, Critchley JA, Labarthe DR, Kottke TE,
Giles WH, Capewell S.

Division of Adult and Community Health, National Center for Chronic
Disease Prevention and Health Promotion, Centers for Disease Control
and Prevention, Atlanta, USA.

Mortality from coronary heart disease in the United States has
decreased substantially in recent decades. We conducted a study to
determine how much of this decrease could be explained by the use of
medical and surgical treatments as opposed to changes in
cardiovascular risk factors.


We applied a previously validated statistical model, IMPACT, to data
on the use and effectiveness of specific cardiac treatments and on
changes in risk factors between 1980 and 2000 among U.S. adults 25 to
84 years old. The difference between the observed and expected number
of deaths from coronary heart disease in 2000 was distributed among
the treatments and risk factors included in the analyses.

From 1980 through 2000, the age-adjusted death rate for coronary heart
disease fell from 542.9 to 266.8 deaths per 100,000 population among
men and from 263.3 to 134.4 deaths per 100,000 population among women,
resulting in 341,745 fewer deaths from coronary heart disease in 2000.
Approximately 47% of this decrease was attributed to treatments,
including secondary preventive therapies after myocardial infarction
or revascularization (11%), initial treatments for acute myocardial
infarction or unstable angina (10%), treatments for heart failure
(9%), revascularization for chronic angina (5%), and other therapies
(12%). Approximately 44% was attributed to changes in risk factors,
including reductions in total cholesterol (24%), systolic blood
pressure (20%), smoking prevalence (12%), and physical inactivity
(5%), although these reductions were partially offset by increases in
the body-mass index and the prevalence of diabetes, which accounted
for an increased number of deaths (8% and 10%, respectively).

Approximately half the decline in U.S. deaths from coronary heart
disease from 1980 through 2000 may be attributable to reductions in
major risk factors and approximately half to evidence-based medical

Copyright 2007 Massachusetts Medical Society.