Contributions of treatment and lifestyle to declining CVD mortality: why have CVD mortality rates declined so much since the 1960s?
Abstract
Developed countries have enjoyed substantial falls in cardiovascular disease (CVD) mortality. However, low and middle income countries are drowning in a rising tide of CVD and other non-communicable diseases. Current and future trends in CVD mortality will therefore require increasing attention in the 21st century. The success of clinical cardiology in providing evidence-based cost-effective treatments should be celebrated. However, the growing understanding of CVD mortality trends highlights the crucial role of tobacco, diet, alcohol and inactivity as key drivers. Pro-active public health approaches focused on ‘upstream’ population-wide policies are increasingly recognised as being potentially powerful, rapid, equitable and cost-saving. However, the future political challenges could be substantial.
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A deterministic health policy model indicated that 40 to 55% of the decline in coronary heart disease in high-income countries can be attributed to the effects of medical and surgical treatments.
“A deterministic health policy model indicated that 40 to 55% of the decline in coronary heart disease in high-income countries can be attributed to the effects of medical and surgical treatments.12”
From Demographic and epidemiologic drivers of global cardiovascular mortality (2015) · cites this paper as [12]
Cites
Explaining the decrease in U.S. deaths from coronary disease, 1980–2000
Ford, E. S., Ajani, U. A., Croft, J. B., Critchley, J. A., Labarthe, D. R., Kottke, T. E., Giles, W. H., & Capewell, S. (2007) · New England Journal of Medicine · doi:10.1056/nejmsa053935 · Cited by 2,757 · see citing works
Self-citationGlobal atlas on cardiovascular disease prevention and control.
Mendis, S., Puska, P., & Norrving, B. G. (2011) · Virtual Defense Library (Ministerio de Defensa) · Cited by 2,691 · see citing works
A Potential Decline in Life Expectancy in the United States in the 21st Century
Olshansky, S. J., Passaro, D. J., Hershow, R. C., Layden, J., Carnes, B. A., Brody, J., Hayflick, L., Butler, R. N., Allison, D. B., & Ludwig, D. S. (2005) · New England Journal of Medicine · doi:10.1056/nejmsr043743 · Cited by 2,612 · see citing works
A Potential Decline in Life Expectancy in the United States in the 21st Century
Olshansky, S. J., Passaro, D. J., Hershow, R. C., Layden, J. E., Carnes, B. A., Brody, J. A., Hayflick, L., Butler, R. N., Allison, D. B., & Ludwig, D. S. (2005) · Obstetrical & Gynecological Survey · doi:10.1097/01.ogx.0000167407.83915.e7 · Cited by 1,944 · see citing works
Priority actions for the non-communicable disease crisis
Beaglehole, R., Bonita, R., Horton, R., Adams, C., Alleyne, G., Asaria, P., Baugh, V., Bekedam, H., Billo, N., Casswell, S., et al. (2011) · The Lancet · doi:10.1016/s0140-6736(11)60393-0 · Cited by 1,615 · see citing works
Tunstall-Pedoe, H., Kuulasmaa, K., Mähönen, M., Tolonen, H., & Ruokokoski, E. (1999) · The Lancet · doi:10.1016/s0140-6736(99)04021-0 · Cited by 1,444 · see citing works
A Tale of Coronary Artery Disease and Myocardial Infarction
Nabel, E. G., & Braunwald, E. (2012) · New England Journal of Medicine · doi:10.1056/nejmra1112570 · Cited by 994 · see citing works
Kuulasmaa, K., Tunstall‐Pedoe, H., Dobson, A. J., Fortmann, S. P., Sans, S., Tolonen, H. K., Evans, A., & Ferrario, M. (2000) · The Lancet · doi:10.1016/s0140-6736(99)11180-2 · Cited by 950 · see citing works
Ünal, B., Critchley, J., & Capewell, S. (2004) · Circulation · doi:10.1161/01.cir.0000118498.35499.b2 · Cited by 740 · see citing works
Self-citationHunink, M. G. M. (1997) · JAMA · doi:10.1001/jama.277.7.535 · Cited by 681 · see citing works
Coronary Heart Disease Mortality Among Young Adults in the U.S. From 1980 Through 2002
Ford, E. S., & Capewell, S. (2007) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.05.056 · Cited by 589 · see citing works
Self-citationBig food, food systems, and global health
Stuckler, D., & Nestle, M. (2012) · PLoS Medicine · doi:10.1371/journal.pmed.1001242 · Cited by 516 · see citing works
Schmidt, M., Jacobsen, J. B., Lash, T. L., Bøtker, H. E., & Sørensen, H. T. (2012) · BMJ · doi:10.1136/bmj.e356 · Cited by 461 · see citing works
Smolina, K., Wright, F., Rayner, M., & Goldacre, M. J. (2012) · BMJ · doi:10.1136/bmj.d8059 · Cited by 384 · see citing works
Lim, S. S., Gaziano, T. A., Gakidou, E. E., Reddy, K. S., Farzadfar, F., Lozano, R., & Rodgers, A. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61699-7 · Cited by 369 · see citing works
The Burden of Disease and the Changing Task of Medicine
Jones, D. S., Podolsky, S. H., & Greene, J. A. (2012) · New England Journal of Medicine · doi:10.1056/nejmp1113569 · Cited by 332 · see citing works
Explaining the Decline in Coronary Heart Disease Mortality in Finland between 1982 and 1997
Laatikainen, T. K., Critchley, J., Vartiainen, E. A., Salomaa, V. V., Ketonen, M., & Capewell, S. (2005) · American Journal of Epidemiology · doi:10.1093/aje/kwi274 · Cited by 331 · see citing works
Self-citationWill Cardiovascular Disease Prevention Widen Health Inequalities?
Capewell, S., & Graham, H. M. (2010) · PLoS Medicine · doi:10.1371/journal.pmed.1000320 · Cited by 329 · see citing works
Self-citationExplaining the Increase in Coronary Heart Disease Mortality in Beijing Between 1984 and 1999
Critchley, J., Liu, J., Zhao, D. H., Wei, W., & Capewell, S. (2004) · Circulation · doi:10.1161/01.cir.0000140668.91896.ae · Cited by 305 · see citing works
Self-citationBarton, P. M., Andronis, L., Briggs, A. H., McPherson, K., & Capewell, S. (2011) · BMJ · doi:10.1136/bmj.d4044 · Cited by 195 · see citing works
Self-citationO’Flaherty, M., Ford, E., Allender, S. E., Scarborough, P., & Capewell, S. (2007) · Heart · doi:10.1136/hrt.2007.118323 · Cited by 171 · see citing works
Self-citationBandosz, P., O’Flaherty, M., Drygas, W., Rutkowski, M., Koziarek, J., Wyrzykowski, B., Bennett, K., Zdrojewski, T. R., & Capewell, S. (2012) · BMJ · doi:10.1136/bmj.d8136 · Cited by 170 · see citing works
Self-citationBajekal, M., Scholes, S., Love, H., Hawkins, N., O'Flaherty, M., Raine, R., & Capewell, S. (2012) · PLoS Medicine · doi:10.1371/journal.pmed.1001237 · Cited by 159 · see citing works
Self-citationChanges in dietary fat and declining coronary heart disease in Poland: population based study
Zatoński, W. A., & Willett, W. C. (2005) · BMJ · doi:10.1136/bmj.331.7510.187 · Cited by 157 · see citing works
Rapid mortality falls after risk-factor changes in populations
Capewell, S., & O'Flaherty, M. (2011) · The Lancet · doi:10.1016/s0140-6736(10)62302-1 · Cited by 149 · see citing works
Self-citationCoronary Heart Disease Epidemiology
(2005) · doi:10.1093/acprof:oso/9780198525738.001.0001 · Cited by 147 · see citing works
Secular trends in mortality by stroke subtype in the 20th century: a retrospective analysis
Lawlor, D. A., Smith, G. D., Leon, D. A., Sterne, J. A. C., & Ebrahim, S. B. J. (2002) · The Lancet · doi:10.1016/s0140-6736(02)11769-7 · Cited by 137 · see citing works
Zatonski, W., Campos, H., & Willett, W. (2008) · European Journal of Epidemiology · doi:10.1007/s10654-007-9195-1 · Cited by 119 · see citing works
Explaining the Decrease in Coronary Heart Disease Mortality in Italy Between 1980 and 2000
Palmieri, L., Bennett, K., Giampaoli, S., & Capewell, S. (2009) · American Journal of Public Health · doi:10.2105/ajph.2008.147173 · Cited by 116 · see citing works
Self-citationFlores‐Mateo, G., Grau, M., O’Flaherty, M., Ramos, R., Elosúa, R., Violán, C., Quesada, M., Martí‐Lluch, R., Sala, J., Marrugat, J., et al. (2011) · Revista Española de Cardiología (English Edition) · doi:10.1016/j.rec.2011.05.035 · Cited by 111 · see citing works
Self-citationMoran, A. E., Zhao, D. H., Gu, D., Coxson, P. G., Chen, C.-S., Cheng, J., Liu, J., He, J., & Goldman, L. (2008) · BMC Public Health · doi:10.1186/1471-2458-8-394 · Cited by 108 · see citing works
Aspelund, T., Gudnason, V., Magnusdottir, B. T., Andersen, K., Sigurdsson, G., Thorsson, B., Steingrimsdottir, L., Critchley, J., Bennett, K., O'Flaherty, M., et al. (2010) · PLoS ONE · doi:10.1371/journal.pone.0013957 · Cited by 106 · see citing works
Self-citationEffective tobacco control is key to rapid progress in reduction of non-communicable diseases
Glantz, S., & Gonzalez, M. (2012) · The Lancet · doi:10.1016/s0140-6736(11)60615-6 · Cited by 99 · see citing works
O’Flaherty, M., Bishop, J., Redpath, A., McLaughlin, T., Murphy, D., Chalmers, J., & Capewell, S. (2009) · BMJ · doi:10.1136/bmj.b2613 · Cited by 97 · see citing works
Self-citationVesper, H. W. (2012) · JAMA · doi:10.1001/jama.2012.112 · Cited by 86 · see citing works
Bots, M. L., & Grobbee, D. E. (1996) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1177/174182679600300302 · Cited by 76 · see citing works
Thinking Forward: The Quicksand of Appeasing the Food Industry
Brownell, K. D. (2012) · PLoS Medicine · doi:10.1371/journal.pmed.1001254 · Cited by 68 · see citing works
Coronary heart disease mortality trends in the Netherlands 1972–2007
Vaartjes, I. C. H., O’Flaherty, M., Grobbee, D. E., Bots, M. L., & Capewell, S. (2011) · Heart · doi:10.1136/hrt.2010.206565 · Cited by 65 · see citing works
Self-citationBots, M. L., & Grobbee, D. E. (1996) · Journal of Cardiovascular Risk · doi:10.1097/00043798-199606000-00002 · Cited by 54 · see citing works
Why have total cholesterol levels declined in most developed countries?
Capewell, S., & Ford, E. S. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-641 · Cited by 49 · see citing works
Self-citationCheng, J., Zhao, D. H., Zeng, Z., Critchley, J., Liu, J., Wang, W., Sun, J., & Capewell, S. (2009) · BMC Public Health · doi:10.1186/1471-2458-9-30 · Cited by 45 · see citing works
Self-citationTHE ONSET OF DECLINE IN ISCHEMIC HEART DISEASE MORTALITY IN THE UNITED STATES
Ragland, K. E., Selvin, S., & MERRILL, D. W. (1988) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a114827 · Cited by 40 · see citing works
Eliminating the Use of Partially Hydrogenated Oil in Food Production and Preparation
Dietz, W. H., & Scanlon, K. S. (2012) · JAMA · doi:10.1001/jama.2012.7379 · Cited by 30 · see citing works
Potential Reductions in United States Coronary Heart Disease Mortality by Treating More Patients
Capewell, S., O’Flaherty, M., Ford, E. S., & Critchley, J. (2009) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2009.02.036 · Cited by 21 · see citing works
Self-citationThe decline in coronary heart disease; did it fall or was it pushed?
Tunstall‐Pedoe, H. (2012) · BMJ · doi:10.1136/bmj.d7809 · Cited by 17 · see citing works
A system-wide challenge for UK food policy
Jebb, S. A. (2012) · BMJ · doi:10.1136/bmj.e3414 · Cited by 4 · see citing works
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Demographic and epidemiologic drivers of global cardiovascular mortality
Roth, G. A., Forouzanfar, M. H., Moran, A. E., Barber, R., Nguyen, G., Feigin, V. L., Naghavi, M., Mensah, G. A., & Murray, C. J. L. (2015) · New England Journal of Medicine · doi:10.1056/nejmoa1406656 · Cited by 1,188 · see citing works
Cardiovascular risk and events in 17 low-, middle-, and high-income countries
Yusuf, S., Rangarajan, S., Teo, K., Islam, S., Li, W., Liu, L., Bo, J., Lou, Q., Lu, F., Liu, T., et al. (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1311890 · Cited by 983 · see citing works
Asogwa, O. A., Boateng, D., Marzà-Florensa, A., Peters, S., Levitt, N., van Olmen, J., & Klipstein-Grobusch, K. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-049133 · Cited by 221 · see citing works
Jones, P. J., Senanayake, V. K., Pu, S., Jenkins, D. J., Connelly, P. W., Lamarche, B., Couture, P., Charest, A., Baril-Gravel, L., West, S. G., et al. (2014) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.113.081133 · Cited by 115 · see citing works
Tsolekile, L. P., Abrahams-Gessel, S., & Puoane, T. (2015) · Current Cardiology Reports · doi:10.1007/s11886-015-0672-y · Cited by 52 · see citing works
Towards 3D in vitro models for the study of cardiovascular tissues and disease
Ryan, A. J., Brougham, C. M., Garciarena, C. D., Kerrigan, S. W., & O’Brien, F. J. (2016) · Drug Discovery Today · doi:10.1016/j.drudis.2016.04.014 · Cited by 42 · see citing works
McNaughton, R. J., & Shucksmith, J. (2015) · Journal of Public Health · doi:10.1093/pubmed/fdu066 · Cited by 30 · see citing works
- Authors
- O'Flaherty, M., Buchan, I., & Capewell, S.
- Affiliations
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
- University of Manchester (GB)
- University of Liverpool (GB)
- Venue
- Heart
- Publisher
- BMJ
- Published
- 2012-09-09
- Volume
- 99
- Issue
- 3
- Pages
- 159-162
- ISSN
- 1355-6037 (ISSN-L)
- 1468-201X
- OpenAlex
- W2163519808
- Cited by
- 165
- References
- 47
- Citations by year
- 2026: 1 · 2025: 9 · 2024: 7 · 2023: 10 · 2022: 13 · 2021: 9 · 2020: 11 · 2019: 14 · 2018: 12 · 2017: 17 · 2016: 18 · 2015: 22 · 2014: 17 · 2013: 5
- FWCI
- 2.22
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Heart (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Medical Research Council (MR/K006665/1, MC_PC_13042)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- cardiovascular mortality, mortality trends, lifestyle risk factors, tobacco, diet, alcohol consumption, physical inactivity, non-communicable diseases, public health policy, upstream prevention, low- and middle-income countries
- MeSH terms
- Cardiology, Cardiovascular Diseases, Forecasting, Humans, Life Style, Public Health, Risk Factors, Global Health, Survival Rate
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