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      The Marked Decline in Coronary Heart Disease Mortality Rates in the United States, 1968-1981; Summary of Findings and Possible Explanations

      Cardiology

      S. Karger AG

      Coronary heart disease, Mortality, Risk factors, Management, Trends

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          Abstract

          During the years 1940–1967, age-adjusted mortality rates from coronary heart disease (CHD) rose in the USA by 14.1 % for all persons aged 35–74. This upward trend was recorded for white men, black men, and black women, but not for white women. From 1968 to 1981 (year of latest record), the trend in the preceding period was reversed, i.e., CHD death rates decreased steadily, at a rate averaging about 3% per year. This downward trend has involved all age-sex-color groups in the adult population and all regions of the country. It has encompassed both main categories of CHD, i.e., acute myocardial infarction (AMI) and chronic ischemic heart disease (CIHD), the former more prominently than the latter, especially among adults aged 35–64. The US decline in CHD mortality rates is greater – absolutely and relatively – than that of any other country. US death rates from stroke have also fallen markedly over these years, so that death rates from the major cardiovascular diseases (CVD) and all causes also fell substantially, with savings of hundreds of thousands of people from premature death since 1968. Responding to vigorous development in the USA over the last 25 years of public policy and strategy for the prevention and control of the coronary epidemic, tens of millions of Americans have made changes in eating habits resulting in lower population mean intake of total fat, saturated fat, cholesterol; increased intake of polyunsaturated fats; decreased mean levels of serum cholesterol and rates of hypercholesterolemia. Prevalence rates of cigarette smoking among adults have also decreased markedly. Tens of millions have taken up leisure time exercise. All these changes have occurred more among the more educated-affluent than among the less educated-affluent. Over the last decade the proportion of persons with hypertension whose hypertension was detected, treated, and controlled has risen from 10 to 15% to embrace a majority of hypertensives. It is a reasonable inference that these mass changes in life-styles and life-style-related major CHD risk factors have contributed importantly to the large sustained declines in CHD, CVD, and all causes death rates in the USA. Concordant Stamler with this inference are data sets indicating greater declines in CHD mortality among the more educated-affluent strata than among the general population (matched for age-sex-color), in keeping with the greater changes in life-styles among the more educated-affluent, e.g., as exemplified by findings for physicians. Many developments in medical-surgical care (emergency, acute, long-term) for patients with clinical CHD of various types – and the expanding application of these developments, especially over the last decade – have in all likelihood also contributed to both the sustained nature and substantial extent of the decline in CHD mortality in the USA.

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          Author and article information

          Journal
          CRD
          Cardiology
          10.1159/issn.0008-6312
          Cardiology
          S. Karger AG
          978-3-8055-4015-5
          978-3-318-01556-0
          0008-6312
          1421-9751
          1985
          1985
          11 November 2008
          : 72
          : 1-2
          : 11-22
          Affiliations
          Department of Community Health and Preventive Medicine, Northwestern University Medical School, Chicago, Ill., USA
          Article
          173836 Cardiology 1985;72:11–22
          10.1159/000173836
          3978664
          © 1985 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 12
          Categories
          Changing Trends in Coronary Heart Disease Mortality. Possible Explanations

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