A new analysis of death rates from heart disease among Americans confirms the salutary trend of the past thirty years: mortality from coronary heart disease continue to plummet. The New England Journal of Medicine study goes into depth to attempt to show the how's and the why's of this decline.
The authors -- from the Centers for Disease Control in Atlanta and the Public Health Division at the University of Liverpool, UK -- found that the decline in CAD death from 1980 to 2000 was an amazing 50%, almost equally divided between men and women. Their statistical model determined that over 341,000 lives had been saved or extended in 2000, as compared to the expected death rate of 1980. This decline was partially due to the improvement or reduction in risk factors (44%), such as cholesterol levels, blood pressure, and smoking rates, and even more importantly, due to medical and surgical treatments (47%).
The evidence-based treatments documented as contributing to this astounding public health accomplishment included secondary preventive therapies after heart attack or revascularization, acute treatments for heart attack or unstable angina, heart failure therapies, and surgical revascularization (coronary artery bypass), among others.
The benefits from improved risk factors were distributed among them as follows: diminished cholesterol, 24%; lower systolic blood pressure, 20%; and lowered smoking rate, 12%.
To put it simply: over 160,000 lives were saved over the twenty-year study period by medical and surgical heart-related treatments, and an additional 150,000+ were saved by dietary, lifestyle, and/or pharmaceutical therapies.
Coincidentally, in tomorrow's edition of another respected medical journal, The Lancet, Dr. Jane Armitage, an epidemiologist at the University of Oxford, discusses the benefit-risk analysis of statin drugs. Her conclusion is that "their proven impact on cardiovascular disease risk has been driving their widespread use...[S]tatins seem to be a remarkably safe group of drugs when used at their usual doses. The recognised adverse effects...are rare."
Taking these two articles together leads to the conclusion that the decline in cholesterol levels over the period 1980-2000 (which occurred despite the increase in overweight in that same period) resulted in saving about 83,000 lives and was accomplished with remarkably safe statin drugs. The repeated attacks on this class of drugs by so-called "consumer groups" should not only be ignored but condemned. Some activists hate all pharmaceuticals so much that they would rather stick to their agendas than accept the fact that statin drugs can save tens of thousands of American lives each year.
Another lesson from the NEJM study is that those of us in public health and consumer education should maintain our full-court press to keep cigarettes out of the hands of teens, which is when cigarette addiction typically starts. We should also expand our arsenal of smoking cessation methods, including making smokeless tobacco more accessible and easing the dissemination of evidence-based information documenting the efficacy of smokeless to help addicted smokers quit. The currently available quitting aids simply are not doing the job. While smoking rates declined significantly over the past decade, that decline has been slowing of late -- we can't let that continue to happen. The whole truth about the dangers of cigarettes must be repeated, in every generation.
Gilbert Ross, M.D., is Executive and Medical Director of the American Council on Science and Health (ACSH.org, HealthFactsAndFears.com).
See: ACSH's full report on Helping Smokers Quit: A Role for Smokeless Tobacco?
