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(Circulation. 2008;117:598-604.)
© 2008 American Heart Association, Inc.

Epidemiology

How Much of the Recent Decline in the Incidence of Myocardial Infarction in British Men Can Be Explained by Changes in Cardiovascular Risk Factors?

Evidence From a Prospective Population-Based Study

Sarah L. Hardoon, MSc; Peter H. Whincup, PhD, FRCP; Lucy T. Lennon, MSc; S. Goya Wannamethee, PhD, FFPH; Simon Capewell, MD; Richard W. Morris, PhD

From the Department of Primary Care and Population Sciences (S.L.H., L.T.L., S.G.W., R.W.M.), UCL, London, United Kingdom; Division of Community Health Sciences (P.H.W.), St George’s, University of London, London, United Kingdom; and Division of Public Health (S.C.), University of Liverpool, Liverpool, United Kingdom.

Correspondence to Sarah Hardoon, Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Hampstead Campus, Rowland Hill St, London NW3 2PF, United Kingdom. E-mail s.hardoon{at}pcps.ucl.ac.uk

Received March 27, 2007; accepted October 19, 2007.

Background— The incidence of myocardial infarction (MI) in Britain has fallen markedly in recent years. Few studies have investigated the extent to which this decline can be explained by concurrent changes in major cardiovascular risk factors.

Methods and Results— The British Regional Heart Study examined changes in cardiovascular risk factors and MI incidence over 25 years from 1978 in a cohort of 7735 men. During this time, the age-adjusted hazard of MI decreased by 3.8% (95% confidence interval 2.6% to 5.0%) per annum, which corresponds to a 62% decline over the 25 years. At the same time, after adjustment for age, cigarette smoking prevalence, mean systolic blood pressure, and mean non–high-density lipoprotein (HDL) cholesterol decreased, whereas mean HDL cholesterol, mean body mass index, and physical activity levels rose. No significant change occurred in alcohol consumption. The fall in cigarette smoking explained the greatest part of the decline in MI incidence (23%), followed by changes in blood pressure (13%), HDL cholesterol (12%), and non-HDL cholesterol (10%). In combination, 46% (approximate 95% confidence interval 23% to 164%) of the decline in MI could be explained by these risk factor changes. Physical activity and alcohol consumption had little influence, whereas the increase in body mass index would have produced a rise in MI risk.

Conclusions— Modest favorable changes in the major cardiovascular risk factors appear to have contributed to considerable reductions in MI incidence. This highlights the potential value of population-wide measures to reduce exposure to these risk factors in the prevention of coronary heart disease.

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