Decline in Incident Coronary Heart Disease

Abstract

In the fall of 1979, the National Heart, Lung, and Blood Institute held a conference on the decline in coronary heart disease (CHD) death rates. It was apparent that in the previous 10 to 15 years, the epidemic crested and began to fall.1 The reasons for this decline were unclear, but many hypotheses were offered. Explanations ranged from death classification artifact, new coronary care units, and coronary surgery to broad social change. Many were more than willing to take credit for this change, but few data were available. A search for explanations began. Article p 598 Three major themes emerged as possible explanations: (1) primary prevention through risk factor reduction, including public health measures such as reduction in cigarettes and clinical approaches such as lipid and blood pressure management; (2) modern care for acute coronary syndromes, including emergency services, coronary care units, and revascularization strategies; and (3) secondary prevention in those with known CHD, including revascularization, medications, and lifestyle approaches. Each of these has substantial clinical trial evidence to support its utility in reducing new cases (incidence), recurrent events, and/or death. Early attempts to understand the causes were hampered by a lack of data. Stern2 suggested that a decline in mortality was related to improved diet, reduced smoking, …