Treatment and Prevention Reducing Coronary Deaths in U.S.

EMBARGOED FOR RELEASE: 3 p.m. (CT) Tuesday, February 18, 1997

Media Advisory:
To contact Maria G.M. Hunink, M.D., Ph.D., call 011-31-50-363-6859.
To contact Milton C. Weinstein, Ph.D., call Beverly Freeman at 617/432-3863.

Treatment and Prevention Reducing Coronary Deaths in U.S. Coronary heart disease prevalence on the rise

Despite constant messages that diet and exercise can help to prevent coronary heart disease (CHD), advancements in the management of those who have already developed CHD are credited with most of the striking decline in coronary mortality from 1980 to 1990, according to an article in this week's issue of The Journal of the American Medical Association (JAMA).

Maria G.M. Hunink, M.D., Ph.D., from the University of Groningen, the Netherlands; Milton C. Weinstein, Ph.D., from the Harvard School of Public Health, Boston, Mass., and colleagues used a computer technique to determine why the number of deaths from CHD dropped from 1980 to 1990. Data were obtain from a literature review, U.S. statistics, health surveys, and ongoing clinical trials.

The researchers found that actual coronary mortality in 1990 was 34 percent lower (127,000 deaths) than would be predicted if certain variables remained the same as in 1980.

They write: "Our analysis suggests that only about one-fourth of the decline in CHD mortality between 1980 and 1990 was owing to primary prevention [such as lower blood pressure, lower cholesterol levels, losing weight or quitting smoking] ... Most of the decline [72 percent] was explained by improvement in the management of patients with diagnosed CHD through risk factor reduction [secondary prevention] and improvements in treatment."

Improvements in treatment include thrombolysis and primary coronary angioplasty for patients suffering from acute myocardial infarction (MI, or heart attack), and lipid-lowering drugs for patients with high cholesterol, according to the researchers.

The researchers found that improvements in low-density lipoprotein (the bad cholesterol) and high-density lipoprotein (the good cholesterol), whether through diet or medication, explained one-third of the decline in CHD mortality.

They write: "The potential impact of medications appears to be substantial especially in patients with diagnosed CHD. The results from the current study indirectly support the notion demonstrated in other studies that treating hyperlipidemia (high cholesterol) in patients with diagnosed CHD is probably more cost-effective than primary prevention of hyperlipidemia."

CHD Prevalence on the Rise

While the number of deaths from CHD decreased from 1980 to 1990, the researchers found the prevalence of CHD actually increased for men and women of all ages.

They write: "[This] implies a future increase in the financial burden associated with CHD and the possibility that age-adjusted CHD death rates may start to rise again as the enlarging pool of prevalent CHD cases remains at risk for CHD death."

CHD is the leading cause of morbidity and mortality in the United States. Information cited in the study says that about 700,000 patients are hospitalized each year with a diagnosis of acute MI. About 400,000 people die from CHD each year in the U.S., accounting for about one-third of all deaths.

CHD costs the U.S. about $80 billion dollars each year, or about 15 percent of the annual U.S. health care budget. # For more information: contact the AMA's Natalie Olinger at 312/464-4465. email: [email protected] AMA's web site: http://www.ama-assn.org