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      Decline in Cardiovascular Mortality: Possible Causes and Implications

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          Abstract

          If the control of infectious diseases was the public health success story of the first half of the 20 th century, then the decline in mortality from coronary heart disease (CHD) and stroke has been the success story of the century’s last 4 decades. The early phase of this decline in CHD and stroke was unexpected and controversial when first reported in the mid-1970s, having followed 60 years of gradual increase as the U.S. population aged. However, in 1978 the participants in a conference convened by the National Heart, Lung, and Blood Institute (NHLBI) concluded that a significant recent downtick in CHD and stroke mortality rates had definitely occurred, at least in the U.S. Since 1978, a sharp decline in mortality rates from CHD and stroke has become unmistakable throughout the industrialized world, with age-adjusted mortality rates having declined to about one-third of their 1960s baseline by 2000. Models have shown that this remarkable decline has been fueled by rapid progress in both prevention and treatment, including precipitous declines in cigarette smoking, improvements in hypertension treatment and control, widespread use of statins to lower circulating cholesterol levels, and the development and timely use of thrombolysis and stents in acute coronary syndrome to limit or prevent infarction. However, despite the huge growth in knowledge and advances in prevention and treatment, there remain many questions about this decline. In fact, there is evidence that the rate of decline may have abated and may even be showing early signs of reversal in some population groups. The NHLBI, through a request for information, is soliciting input that could inform a follow-up conference on or near the 40th anniversary of the original landmark conference in order to further explore these trends in cardiovascular mortality in the context of what has come before and what may lie ahead.

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          Author and article information

          Journal
          0047103
          2974
          Circ Res
          Circ. Res.
          Circulation research
          0009-7330
          1524-4571
          25 December 2016
          20 January 2017
          20 January 2018
          : 120
          : 2
          : 366-380
          Affiliations
          [1 ]Center for Translation Research and Implementation Science (CTRIS); National Heart, Lung, and Blood Institute (NHLBI); National Institutes of Health (NIH), Bethesda, Maryland, USA.
          [2 ]Division of Cardiovascular Sciences, NHLBI, NIH, Bethesda, Maryland, USA.
          Author notes
          Address for Correspondence: George A. Mensah, Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute; National Institutes of Health, One Rockledge Center, 6705 Rockledge Drive, Suite 6070, Bethesda, MD 20892, Telephone: 301-496-1051, Fax: 301-402-1051; George.Mensah@ 123456nih.gov
          Article
          PMC5268076 PMC5268076 5268076 nihpa839089
          10.1161/CIRCRESAHA.116.309115
          5268076
          28104770
          ac2c455c-313e-4b53-8f4b-4e134df613fe
          History
          Categories
          Article

          Coronary heart disease,Cardiovascular mortality rate,Risk factors,Disparities,Hypertension

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