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(Circulation. 2008;117:592-593.)
© 2008 American Heart Association, Inc.

Editorial

Decline in Incident Coronary Heart Disease

Why Are the Rates Falling?

Russell V. Luepker, MD, MS

From the University of Minnesota, School of Public Health, Division of Epidemiology and Community Health, Minneapolis.

Correspondence to Russell V. Luepker, Mayo Professor, Division of Epidemiology and Community Health, University of Minnesota, School of Public Health, 1300 S Second St, Ste 300, Minneapolis, MN 55454-1015. E-mail luepker@epi.umn.edu

Key Words: Editorials • coronary disease • risk factors • population • epidemiology • prevention

An extract of the first 250 words of the full text is provided, because this article has no 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, reduced blood pressure, and increased leisure-time physical activity. He noted in 1979 that coronary care units might play a role, but he doubted that surgical revascularization was common enough to affect national rates. Later in 1984, Goldman et al³ performed a modeling . . . [Full Text of this Article]

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