Preventie beter dan genezen voor CHZ
Prevention better than cure for CHD
Researchers report that recent declines in death from coronary heart disease (CHD) in the US are largely attributable to reductions in modifiable risk factors such as systolic blood pressure (SBP).
Although secondary prevention accounted for some of the observed reduction in mortality rates, the majority (79%) of improvement was due to the primary prevention of CHD by reducing risk factors among healthy individuals, explain Fiona Young from Newcastle University in the UK, and colleagues.
The researchers used the IMPACT model (Estimating the Effect of Population Risk Factor Trends on Coronary Heart Disease Mortality) to determine risk factor decline and subsequent CHD mortality rates among US patients with and without CHD, from 1980 to 2000.The contribution of three risk factors - smoking, systolic blood pressure (SBP), and cholesterol - to a decline in CHD mortality over the 20-year period was estimated using a regression model and data from the National Center for Health Statistics in 1980 and in 2000.
Writing in the American Journal of Preventive Medicine, Young and colleagues report that 341,745 fewer deaths occurred in 2000 than in 1980 (43% reduction). Of these, 316,100 were attributed to reductions in the three assessed CHD risk factors.
The team found that risk factor modification by existing CHD patients and asymptomatic individuals contributed to 21% and 79% of the observed improvement in mortality rates, respectively.
The researchers also found that cholesterol reduction produced the greatest fall in mortality of the assessed risk factors, with 22,210 and 107,300 fewer deaths in 2000 compared with 1980, among CHD patients and asymptomatic individuals, respectively.
SBP reduction produced 34,330 and 97,555 fewer deaths among CHD patients and asymptomatic individuals, respectively, and smoking reduction accounted for the smallest decline in CHD mortality, with a respective 8390 and 46,315 fewer deaths.
"Primary prevention tends to be underexploited and undervalued in comparison with other methods of reducing CHD mortality," comment Young et al.
They conclude: "The large recent reductions in CHD mortality attributable to primary prevention in the US suggest that population-based intervention, state, and federal policies, and societal changes might substantially reduce future coronary deaths."