Published online before print January 22, 2008, doi: 10.1161/CIRCULATIONAHA.107.705947
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(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
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.
CLINICAL PERSPECTIVE
Related Article:
-
Clinical Summaries
Circulation 2008 117: 589-591.[Extract] [Full Text]
This article has been cited by other articles:
 |
|
 |
|
  A W Murphy, M E Cupples, S M Smith, M Byrne, M C Byrne, J Newell, and for the SPHERE study team Effect of tailored practice and patient care plans on secondary prevention of heart disease in general practice: cluster randomised controlled trial BMJ, October 29, 2009; 339(oct29_4): b4220 - b4220. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Clarke, J. Emberson, A. Fletcher, E. Breeze, M. Marmot, and M. J Shipley Life expectancy in relation to cardiovascular risk factors: 38 year follow-up of 19 000 men in the Whitehall study BMJ, September 16, 2009; 339(sep16_3): b3513 - b3513. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. O. Bonow Should Coronary Calcium Screening Be Used in Cardiovascular Prevention Strategies? N. Engl. J. Med., September 3, 2009; 361(10): 990 - 997. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Blomstrand, C. Bjorkelund, N. Ariai, L. Lissner, and C. Bengtsson Effects of leisure-time physical activity on well-being among women: a 32-year perspective Scand J Public Health, September 1, 2009; 37(7): 706 - 712. [Abstract] [PDF]
|
|
|
|
 |
|
 M.A. H. Talukder, J. L. Zweier, and M. Periasamy Targeting calcium transport in ischaemic heart disease Cardiovasc Res, August 17, 2009; (2009) cvp264v2. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Hlatky and P. A. Heidenreich The Year in Epidemiology, Health Services Research, and Outcomes Research J. Am. Coll. Cardiol., April 21, 2009; 53(16): 1459 - 1466. [Full Text] [PDF]
|
|
|
|
|
|
J. Sanz, P. R. Moreno, and V. Fuster The year in atherothrombosis. J. Am. Coll. Cardiol., April 14, 2009; 53(15): 1326 - 1337. [Full Text] [PDF]
|
|
|
|
|
|
P. K Myint, R. N Luben, N. J Wareham, S. A Bingham, and K.-T. Khaw Combined effect of health behaviours and risk of first ever stroke in 20 040 men and women over 11 years' follow-up in Norfolk cohort of European Prospective Investigation of Cancer (EPIC Norfolk): prospective population study BMJ, February 19, 2009; 338(feb19_2): b349 - b349. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. P. Giugliano and E. Braunwald The Year in Non-ST-Segment Elevation Acute Coronary Syndrome J. Am. Coll. Cardiol., September 23, 2008; 52(13): 1095 - 1103. [Full Text] [PDF]
|
|
|
|
 |
|
 Declining MI and Cardiovascular Risk Factors Journal Watch (General), March 11, 2008; 2008(311): 4 - 4. [Full Text]
|
|
|
|
 |
|
 R. V. Luepker Decline in Incident Coronary Heart Disease: Why Are the Rates Falling? Circulation, February 5, 2008; 117(5): 592 - 593. [Full Text] [PDF]
|
|