Coronary disease mortality and changes in risk factors - Tips from Other Journals

Date: Nov, 1990

Coronary Disease Mortality and Changes in Risk Factors A dramatic reduction in cardiovascular disease mortality during the past 30 years has been well documented. To better understand the reasons behind this decline, Sytkowski and colleagues compared the ten-year incidence of cardiovascular disease and mortality rate, as well as risk factor profiles, in three groups of men who took part in the Frammingham Heart Study.

The subjects included 549 men who were 50 to 59 years of age on January 1, 1950 (1950 cohort), 541 men who were 50 to 59 years of age on January 1, 1960 (1960 cohort) and 613 men who were 50 to 59 years of age on January 1, 1970 (1970 cohort). Within each cohort, the men who were free of cardiovascular disease at baseline were identified.

The ten-year cumulative mortality rate from cardiovascular disease in the 1970 cohort was 43 percent less than that in the 1950 cohort and was 37 percent less than that in the 1960 cohort. Compared with the rates in the 1950 cohort, the cumulative incidence of cardiovascular disease in the 1970 cohort declined 19 percent and the cardiovascular mortality rate declined 60 percent among men free of cardiovascular disease at baseline.

Significant improvements in cardiovascular risk factors were found in the 1970 cohort. Compared with the 1950 cohort, the 1970 group had a lower mean serum cholesterol level (221 versus 228 mg per dL [5.70 versus 5.90 mmol per L]), a lower mean systolic blood pressure (135 versus 139 mm Hg), better management of hypertension (22 percent versus none receiving antihypertensive medication) and a lower prevalence of cigarette smoking (34 versus 56 percent).

The authors believe that the improvement in cardiovascular risk factors in the 1970 cohort may have been an important contributor to the reduction in cardiovascular disease mortality, although improved medical interventions and a decline in the incidence of cardiovascular disease may also have contributed to the decline in mortality. (New England Journal of Medicine, June 7, 1990, vol. 322, p. 1635.)

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