UK deaths from coronary heart disease (CHD) have declined by 60% since the 1970s. Research published in BMJ Open (online, 22 January 2015)
offers insights into the factors that have driven this decline, finding that population-wide approaches to risk-factor control have had a far greater impact than use of primary prevention medication.
Using data from clinical trials, meta-analyses, national surveys and official statistics, the researchers estimate that approximately 38,000 deaths from CHD were prevented or postponed (DPPs) in England between 2000 and 2007. Approximately 13,000 DPPs were attributable to reductions in blood pressure. Of these, just 1,800 DPPs were ascribed to medication use; the remainder was accounted for by changes in risk factors at the population level.
“Targeting high-risk individuals with medication appears less effective and may also widen socioeconomic inequalities in CHD mortality,” the authors remark.