You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


ABOUT JAMA
Advanced Search

Welcome   | My Account | E-mail Alerts | Access Rights | Sign In


  Vol. 277 No. 7, February 19, 1997 TABLE OF CONTENTS
  JAMA
  •  Online Features
  ARTICLE
 This Article
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Contact me when this article is cited
 Related Content
 •Similar articles in JAMA

The recent decline in mortality from coronary heart disease, 1980-1990. The effect of secular trends in risk factors and treatment

M. G. Hunink, L. Goldman, A. N. Tosteson, M. A. Mittleman, P. A. Goldman, L. W. Williams, J. Tsevat and M. C. Weinstein
Department of Health Policy and Management, Harvard School of Public Health, Boston, Mass., USA.

OBJECTIVE: To examine whether secular trends in risk factor levels and improvements in treatment can account for the observed decline in coronary heart disease mortality in the United States from 1980 to 1990 and to analyze the proportional contribution of these changes. DATA SOURCES: Literature review, US statistics, health surveys, and ongoing clinical trials. STUDY SELECTION: Data representative of the US situation nationwide reported in adequate detail. DATA EXTRACTION: A computer-simulation state-transition model of the US population between the ages of 35 and 84 years was developed to forecast coronary mortality. The input variables were estimated such that the combination of values led to an adequate agreement with reported coronary mortality figures. Subsequently, secular trends were modeled. DATA SYNTHESIS: Actual coronary mortality in 1990 was 34% (127,000 deaths) lower than would be predicted if risk factor levels, case-fatality rates, and event rates in those with and without coronary disease remained the same as in 1980. When secular changes in these factors were included in the model, predicted coronary mortality in 1990 was within 3% (10,000 deaths) of the observed mortality and explained 92% of the decline; only 25% of the decline was explained by primary prevention, while 29% was explained by secondary reduction in risk factors in patients with coronary disease and 43% by other improvements in treatment in patients with coronary disease. CONCLUSIONS: These results suggest that primary and secondary risk factor reductions explain about 50% of the striking decline in coronary mortality in the United States between 1980 and 1990 but that more than 70% of the overall decline in mortality has occurred among patients with coronary disease.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The Effect of Comorbid Illness and Functional Status on the Expected Benefits of Intensive Glucose Control in Older Patients with Type 2 Diabetes: A Decision Analysis
Huang et al.
ANN INTERN MED 2008;149:11-19.
ABSTRACT | FULL TEXT  

Secular decline in mortality from coronary heart disease in adults with diabetes mellitus: cohort study
Dale et al.
BMJ 2008;337:a236-a236.
ABSTRACT | FULL TEXT  

Adolescent Overweight and Coronary Heart Disease
Kumar et al.
NEJM 2008;358:1521-1522.
FULL TEXT  

Improvements in Long-Term Mortality After Myocardial Infarction and Increased Use of Cardiovascular Drugs After Discharge: A 10-Year Trend Analysis
Setoguchi et al.
J Am Coll Cardiol 2008;51:1247-1254.
ABSTRACT | FULL TEXT  

Population health and the health system: a comparative analysis of avoidable mortality in three nations and their world cities
Weisz et al.
Eur J Public Health 2008;18:166-172.
ABSTRACT | FULL TEXT  

Cardiovascular Disease and Global Health Equity: Lessons From Tuberculosis Control Then and Now
Bukhman and Kidder
Am. J. Public Health 2008;98:44-54.
ABSTRACT | FULL TEXT  

Adolescent Overweight and Future Adult Coronary Heart Disease
Bibbins-Domingo et al.
NEJM 2007;357:2371-2379.
ABSTRACT | FULL TEXT  

Coronary Heart Disease Mortality Among Young Adults in the U.S. From 1980 Through 2002: Concealed Leveling of Mortality Rates
Ford and Capewell
J Am Coll Cardiol 2007;50:2128-2132.
ABSTRACT | FULL TEXT  

Mortality Trends in Men and Women with Diabetes, 1971-2000
Gregg et al.
ANN INTERN MED 2007;0:0000605-200708070-00167-E-59.
ABSTRACT | FULL TEXT  

Explaining the Decrease in U.S. Deaths from Coronary Disease, 1980-2000
Ford et al.
NEJM 2007;356:2388-2398.
ABSTRACT | FULL TEXT  

Economic analysis of treatments reducing coronary heart disease mortality in England and Wales, 2000-2010
Fidan et al.
QJM 2007;100:277-289.
ABSTRACT | FULL TEXT  

Life-years-gained from population risk factor changes and modern cardiology treatments in Ireland
Kabir et al.
Eur J Public Health 2007;17:193-198.
ABSTRACT | FULL TEXT  

Using Public Health Indicators to Measure the Success of Hypertension Control
Cooper
Hypertension 2007;49:773-774.
FULL TEXT  

Socioeconomic Status and Trends in Disparities in 4 Major Risk Factors for Cardiovascular Disease Among US Adults, 1971-2002
Kanjilal et al.
Arch Intern Med 2006;166:2348-2355.
ABSTRACT | FULL TEXT  

Chapter 1: Modeling the Impact of Adjuvant Therapy and Screening Mammography on U.S. Breast Cancer Mortality Between 1975 and 2000: Introduction to the Problem
Feuer
J Natl Cancer Inst Monogr 2006;2006:2-6.
FULL TEXT  

The value of medical spending in the United States, 1960-2000.
Cutler et al.
NEJM 2006;355:920-927.
ABSTRACT | FULL TEXT  

Measuring hospital quality: what physicians do? How patients fare? Or both?
Jha
JAMA 2006;296:95-97.
FULL TEXT  

Explaining the recent decrease in coronary heart disease mortality rates in Ireland, 1985-2000.
Bennett et al.
J. Epidemiol. Community Health 2006;60:322-327.
ABSTRACT | FULL TEXT  

Preventing coronary heart disease.
Jackson et al.
BMJ 2006;332:617-618.
FULL TEXT  

Improvement in Stroke Mortality in Canada and the United States, 1990 to 2002
Yang et al.
Circulation 2006;113:1335-1343.
ABSTRACT | FULL TEXT  

Apparent and Internal Validity of a Monte Carlo-Markov Model for Cardiovascular Disease in a Cohort Follow-up Study.
Nijhuis et al.
Med Decis Making 2006;26:134-144.
ABSTRACT  

Impact of the Increasing Burden of Diabetes on Acute Myocardial Infarction in New York City: 1990-2000
Fang and Alderman
Diabetes 2006;55:768-773.
ABSTRACT | FULL TEXT  

Role of the Metabolic Syndrome in Risk Assessment for Coronary Heart Disease
Kohli and Greenland
JAMA 2006;295:819-821.
FULL TEXT  

Noise burden and the risk of myocardial infarction
Willich et al.
Eur Heart J 2006;27:276-282.
ABSTRACT | FULL TEXT  

Dynamics of cardiovascular and all-cause mortality in Western and Eastern Europe between 1970 and 2000
Kesteloot et al.
Eur Heart J 2006;27:107-113.
ABSTRACT | FULL TEXT  

Cardiovascular Disease and Associated Risk Factors in Cuba: Prospects for Prevention and Control
Cooper et al.
Am. J. Public Health 2006;96:94-101.
ABSTRACT | FULL TEXT  

Urban-Rural Inequalities in Ischemic Heart Disease in Scotland, 1981-1999
Levin and Leyland
Am. J. Public Health 2006;96:145-151.
ABSTRACT | FULL TEXT  

Explaining the Decline in Coronary Heart Disease Mortality in Finland between 1982 and 1997
Laatikainen et al.
Am J Epidemiol 2005;162:764-773.
ABSTRACT | FULL TEXT  

Cost-Effectiveness in a Flat World -- Can ICDs Help the United States Get Rhythm?
Goldman
NEJM 2005;353:1513-1515.
FULL TEXT  

Initial Appraisal of Acute Coronary Syndromes
Aazami
Journal of Pharmacy Practice 2005;18:377-393.
ABSTRACT  

Modelling the decline in coronary heart disease deaths in England and Wales, 1981-2000: comparing contributions from primary prevention and secondary prevention
Unal et al.
BMJ 2005;331:614.
ABSTRACT | FULL TEXT  

Predictors of Adherence With Antihypertensive and Lipid-Lowering Therapy
Chapman et al.
Arch Intern Med 2005;165:1147-1152.
ABSTRACT | FULL TEXT  

Life-Years Gained From Modern Cardiological Treatments and Population Risk Factor Changes in England and Wales, 1981-2000
Unal et al.
Am. J. Public Health 2005;95:103-108.
ABSTRACT | FULL TEXT  

The Cost-Effectiveness of Screening Programs Using Single and Multiple Birth Cohort Simulations: A Comparison Using a Model of Cervical Cancer
Dewilde and Anderson
Med Decis Making 2004;24:486-492.
ABSTRACT  

Explaining the Increase in Coronary Heart Disease Mortality in Beijing Between 1984 and 1999
Critchley et al.
Circulation 2004;110:1236-1244.
ABSTRACT | FULL TEXT  

What's Wrong with Social Epidemiology, and How Can We Make It Better?
Kaplan
Epidemiol Rev 2004;26:124-135.
FULL TEXT  

Explaining the Decline in Coronary Heart Disease Mortality in England and Wales Between 1981 and 2000
Unal et al.
Circulation 2004;109:1101-1107.
ABSTRACT | FULL TEXT  

Influenza and Cardiovascular Disease: A New Opportunity for Prevention and the Need for Further Studies
Madjid et al.
Circulation 2003;108:2730-2736.
FULL TEXT  

Measuring the health of nations: analysis of mortality amenable to health care
Nolte and McKee
BMJ 2003;327:1129.
ABSTRACT | FULL TEXT  

Starting Earlier to Prevent Heart Disease
McGill and McMahan
JAMA 2003;290:2320-2322.
FULL TEXT  

Communitywide Trends in the Use and Outcomes Associated With {beta}-Blockers in Patients With Acute Myocardial Infarction: The Worcester Heart Attack Study
Silvet et al.
Arch Intern Med 2003;163:2175-2183.
ABSTRACT | FULL TEXT  

Clinical Research to Clinical Practice -- Lost in Translation?
Lenfant
NEJM 2003;349:868-874.
FULL TEXT  

Health Care in America: Lost Opportunities Amid Plenty
Whalen
Qual Health Res 2003;13:857-870.
ABSTRACT  

Challenges and opportunities in quantifying the quality of care for acute myocardial infarction: Summary from the acute myocardial infarction working group of the American heart association/American college of cardiology first scientific forum on quality of care and outcomes research in cardiovascular disease and stroke
Spertus et al.
J Am Coll Cardiol 2003;41:1653-1663.
FULL TEXT  

The challenges of treating peripheral arterial disease
Kugler and Rudofsky
Vasc Med 2003;8:109-114.
ABSTRACT  

Substantial potential for reductions in coronary heart disease mortality in the UK through changes in risk factor levels
Critchley and Capewell
J. Epidemiol. Community Health 2003;57:243-247.
ABSTRACT | FULL TEXT  

Challenges and Opportunities in Quantifying the Quality of Care for Acute Myocardial Infarction: Summary From the Acute Myocardial Infarction Working Group of the American Heart Association/American College of Cardiology First Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke
Spertus et al.
Circulation 2003;107:1681-1691.
FULL TEXT  

Trends in coronary events in Finland during 1983-1997; The FINAMI study
Salomaa et al.
Eur Heart J 2003;24:311-319.
ABSTRACT | FULL TEXT  

Ethnic differences in acute myocardial infarction in Singapore
Mak et al.
Eur Heart J 2003;24:151-160.
ABSTRACT | FULL TEXT  

Empirically Calibrated Model of Hepatitis C Virus Infection in the United States
Salomon et al.
Am J Epidemiol 2002;156:761-773.
ABSTRACT | FULL TEXT  

Secular changes in prevalence of cardiovascular diseases in elderly Finns
Kattainen et al.
Scand J Public Health 2002;30:274-280.
ABSTRACT  

Trends in mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world
Levi et al.
Heart 2002;88:119-124.
ABSTRACT | FULL TEXT  

Cost Effectiveness of Aspirin, Clopidogrel, or Both for Secondary Prevention of Coronary Heart Disease
Gaspoz et al.
NEJM 2002;346:1800-1806.
ABSTRACT | FULL TEXT  

Cost-effectiveness of Intensive Glycemic Control, Intensified Hypertension Control, and Serum Cholesterol Level Reduction for Type 2 Diabetes
The CDC Diabetes Cost-effectiveness Group
JAMA 2002;287:2542-2551.
ABSTRACT | FULL TEXT  

Aspirin for Primary Prevention of Coronary Events
Lauer
NEJM 2002;346:1468-1474.
FULL TEXT  

What is the real hospital mortality from acute myocardial infarction?. Epidemiological vs clinical view
Kuch et al.
Eur Heart J 2002;23:714-720.
ABSTRACT | FULL TEXT  

Coronary heart disease risk factors ranked by importance for the individual and community. A 21 year follow-up of 12000 men and women from The Copenhagen City Heart Study
Schnohr et al.
Eur Heart J 2002;23:620-626.
ABSTRACT | FULL TEXT  

Cost-effectiveness of Homocysteine-Lowering Therapy to Prevent Coronary Heart Disease
Bostom et al.
JAMA 2002;287:190-192.
FULL TEXT  

Why model coronary heart disease?
Critchley and Capewell
Eur Heart J 2002;23:110-116.
FULL TEXT  

The Real Contribution of the Major Risk Factors to the Coronary Epidemics: Time to End the "Only-50%" Myth
Magnus and Beaglehole
Arch Intern Med 2001;161:2657-2660.
FULL TEXT  

The role of medical care in contributing to health improvements within societies
Bunker
Int J Epidemiol 2001;30:1260-1263.
FULL TEXT  

Is the prevalence of coronary heart disease falling in British men?
Lampe et al.
Heart 2001;86:499-505.
ABSTRACT | FULL TEXT  

The effect of risk factor reductions between 1981 and 1990 on coronary heart disease incidence, prevalence, mortality and cost
Goldman et al.
J Am Coll Cardiol 2001;38:1012-1017.
ABSTRACT | FULL TEXT  

Patients, families and populations at high risk for coronary heart disease
Higgins
Eur Heart J 2001;22:1682-1690.
 

Local Increases in Coronary Heart Disease Mortality Among Blacks and Whites in the United States, 1985-1995
Barnett and Halverson
Am. J. Public Health 2001;91:1499-1506.
ABSTRACT | FULL TEXT  

Cost-effectiveness of Vitamin Therapy to Lower Plasma Homocysteine Levels for the Prevention of Coronary Heart Disease: Effect of Grain Fortification and Beyond
Tice et al.
JAMA 2001;286:936-943.
ABSTRACT | FULL TEXT  

Coronary Heart Disease in the First 30 Years of the 21st Century: Challenges and Opportunities : The 33rd Annual James B. Herrick Lecture of the Council on Clinical Cardiology of the American Heart Association
Beller
Circulation 2001;103:2428-2435.
FULL TEXT  

Gender differences in recurrent coronary events. The FINMONICA MI register
Schreiner et al.
Eur Heart J 2001;22:762-768.
ABSTRACT  

Quality Of Care For Coronary Heart Disease In Two Countries
Ayanian and Quinn
Health Aff (Millwood) 2001;20:55-67.
ABSTRACT | FULL TEXT  

Non-communicable disease mortality rates using the verbal autopsy in a cohort of middle aged and older populations in Beirut during wartime, 1983-93
Sibai et al.
J. Epidemiol. Community Health 2001;55:271-276.
ABSTRACT | FULL TEXT  

Quest for an optimal population cardiovascular risk factor burden
Kannel
Eur Heart J 2001;22:105-107.
 

Health and Economic Benefits of Increased {beta}-Blocker Use Following Myocardial Infarction
Phillips et al.
JAMA 2000;284:2748-2754.
ABSTRACT | FULL TEXT  

Explanation for the Decline in Coronary Heart Disease Mortality Rates in Auckland, New Zealand, Between 1982 and 1993
Capewell et al.
Circulation 2000;102:1511-1516.
ABSTRACT | FULL TEXT  

Trends in the Incidence of Coronary Heart Disease and Changes in Diet and Lifestyle in Women
Hu et al.
NEJM 2000;343:530-537.
ABSTRACT | FULL TEXT  

Coronary heart disease trends in France and elsewhere
CAPEWELL and MCMURRAY
Heart 2000;84:121-122.
FULL TEXT  

Association of Coronary Heart Disease Risk Factors With Microscopic Qualities of Coronary Atherosclerosis in Youth
McGill et al.
Circulation 2000;102:374-379.
ABSTRACT | FULL TEXT  

Review: high dose and moderate dose oral anticoagulants reduce events in coronary artery disease but increase major bleeding and are no more effective than aspirin
Beyth
Evid. Based Med. 2000;5:111-111.
FULL TEXT  

Respiratory Disturbance Index . An Independent Predictor of Mortality in Coronary Artery Disease
PEKER et al.
Am. J. Respir. Crit. Care Med. 2000;162:81-86.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of Cholesterol-Lowering Therapies according to Selected Patient Characteristics
Prosser et al.
ANN INTERN MED 2000;132:769-779.
ABSTRACT | FULL TEXT  

Effects of Angiotensin-Converting Enzyme Inhibitors and Digoxin on Health Outcomes of Very Old Patients With Heart Failure
Gambassi et al.
Arch Intern Med 2000;160:53-60.
ABSTRACT | FULL TEXT  

The Need for Perspective in Evidence-Based Medicine
Woolf
JAMA 1999;282:2358-2365.
ABSTRACT | FULL TEXT  

Conquering Cardiovascular Disease: Progress and Promise
Lenfant
JAMA 1999;282:2068-2070.
FULL TEXT  

Increasing the impact of cardiological treatments. How best to reduce deaths
Capewell et al.
Eur Heart J 1999;20:1386-1392.
ABSTRACT  

Diabetes and Decline in Heart Disease Mortality
Poothullil and Harris
JAMA 1999;282:1132-1132.
FULL TEXT  

The relative influence of secondary versus primary prevention using the National Cholesterol Education Program Adult Treatment Panel II guidelines
Goldman et al.
J Am Coll Cardiol 1999;34:768-776.
ABSTRACT | FULL TEXT  

The role of dietary fats in plant-based diets
Coulston
Am. J. Clin. Nutr. 1999;70:512S-515.
ABSTRACT | FULL TEXT  

Estimating the population impact of an intervention: a decision-analytic approach
Hersh et al.
Stat Methods Med Res 1999;8:311-330.
ABSTRACT  

Cardiovascular disease in the Netherlands, 1975 to 1995: decline in mortality, but increasing numbers of patients with chronic conditions
Reitsma et al.
Heart 1999;82:52-56.
ABSTRACT | FULL TEXT  

Vitamin E and Coronary Artery Disease
Spencer et al.
Arch Intern Med 1999;159:1313-1320.
ABSTRACT | FULL TEXT  

Trends in the Prevalence of Hypertension, Antihypertensive Therapy, and Left Ventricular Hypertrophy from 1950 to 1989
Mosterd et al.
NEJM 1999;340:1221-1227.
ABSTRACT | FULL TEXT  

Diabetes and Decline in Heart Disease Mortality in US Adults
Gu et al.
JAMA 1999;281:1291-1297.
ABSTRACT | FULL TEXT  

Relationship of Therapeutic Improvements and 28-Day Case Fatality in Patients Hospitalized With Acute Myocardial Infarction Between 1978 and 1993 in the REGICOR Study, Gerona, Spain
Gil et al.
Circulation 1999;99:1767-1773.
ABSTRACT | FULL TEXT  

Contribution of modern cardiovascular treatment and risk factor changes to the decline in coronary heart disease mortality in Scotland between 1975 and 1994
Capewell et al.
Heart 1999;81:380-386.
ABSTRACT | FULL TEXT  

Use of Cardiovascular Procedures among Black Persons and White Persons: A 7-Year Nationwide Study in Patients with Renal Disease
Daumit et al.
ANN INTERN MED 1999;130:173-182.
ABSTRACT | FULL TEXT  

Direct-to-Consumer Prescription Drug Advertising Builds Bridges Between Patients and Physicians
Holmer
JAMA 1999;281:380-382.
FULL TEXT  

Social Movements as Catalysts for Policy Change: The Case of Smoking and Guns
Nathanson
Journal of Health Politics, Policy and Law 1999;24:421-488.
ABSTRACT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 1997 American Medical Association. All Rights Reserved.