Explaining the Decline in Coronary Heart Disease Mortality in Scotland

Paul S. Mueller, MD, MPH, FACP

Benefits of improvements in prevention and treatment were slightly offset by increases in diabetes and body-mass index.

In the U.S. and Europe, rates of coronary heart disease (CHD) have fallen markedly in recent decades. In this population-based, retrospective study, investigators quantified the effects of primary prevention and active treatment on CHD mortality among all adults (age, ≥25) living in Scotland between 2000 and 2010.

During the study period, the age-standardized CHD mortality rate fell by 43% (from 262 to 148 deaths per 100,000 people). Improved uptake of patient-based treatments (especially primary prevention treatment with statins for patients with hyperlipidemia, secondary prevention treatments after myocardial infarction and revascularization, drug treatment for patients with chronic stable CHD, and treating patients with heart failure and hypertension) accounted for 43% of the decrease in CHD-related mortality; 39% of the fall was attributable to population-based changes in CHD risk factors, especially reductions in systolic blood pressure and cholesterol in people who did not take medications, more physical activity, and less smoking. However, more diabetes and higher average body-mass index added 475 and 235 deaths, respectively.

Citation(s):

Hotchkiss JW et al. Explaining trends in Scottish coronary heart disease mortality between 2000 and 2010 using IMPACTSEC model: Retrospective analysis using routine data. BMJ 2014 Feb 6; 348:g1088.