The greatest decline in heart attacks and deaths was in the middle-aged with the smallest decrease among younger and older people, a study published in the BMJ conducted at Oxford University and commissioned by The British Heart Foundation found.
There were 18,576 fewer deaths from heart attacks in 2010 compared with 2002, and 76,978 fewer deaths in total over those years. The study investigated all heart attacks in England between 2002 and 2010. In this period, a total of 840,175 people were admitted to hospital with a heart attack.
Researchers said there had been fewer heart attacks due to improvements in lifestyle such as increasing numbers giving up smoking, better diets and preventive drugs for raised cholesterol and high blood pressure. More lives of heart attack victims are now being saved thanks to new emergency procedures to reopen blocked arteries, faster ambulance response times, quicker diagnosis and drugs such as statins and aspirin. Sadly other lifestyle factors such as drinking pattern and consumption levels were not followed.
However, the researchers said the rapid decline in heart attacks deaths is slowing, especially in younger people and this is probably due to increasing obesity and diabetes in those groups.
“Clearly to date the benefits are substantially outstripping the adverse trends. There is an important question though, about how long that will continue. The very substantial decline looks to be levelling off in the very young.”
The National Service Framework for Coronary Heart Disease (CHD) that was introduced in 2000 revolutionised the treatment of heart attacks with faster diagnosis and access to clot-busting drugs and then procedures to reopen blocked arteries. Health Minister Simon Burns said: “These improvements are welcome and demonstrate the progress made in tackling heart disease in recent years. But we know we can do better and some areas still lag behind... That is why this Government has begun work to develop a Cardiovascular Disease Outcomes Strategy. We will continue to work hard to reduce heart attack deaths all across the country.”
Main report findings:
The researchers found that between 2000 and 2007, death rates from coronary heart disease fell from 229 to 147 deaths per 100,000—a decrease of 36% or 6.1% per year. In 2007, there were 74,174 CHD deaths, 56% of these were in men. However, CHD remains the leading cause of mortality and is a major contributor to social inequalities in premature mortality in England, as in the USA.
Important population-wide public health measures such as the ban on tobacco advertising (2003); and comprehensive smoke-free legislation introduced in 2007, and voluntary agreements to reduce salt and artificial trans-fats in processed food in 2006/7 may have contributed to the decline.
Researchers found that overall, about half of the decrease in death rates was attributable to improvements in uptake of medical and surgical treatments. In contrast, population-level risk factor changes accounted for approximately 12,990 fewer deaths. The model could not explain some 14% of the overall mortality fall (i.e., a shortfall of 5,300 deaths).
Mortality gains due to positive trends in smoking, fruit and vegetable consumption, and physical activity risk factors were negated by increases in BMI and diabetes (together contributing 3,460 additional deaths, equivalent to an 9% increase in mortality). Even over the relatively short period of this analysis, the social gradient in diabetes became more pronounced resulting in three times as many additional diabetes-related deaths in the most deprived quintile compared with the most affluent.
The biggest contribution came from a substantial fall in systolic blood pressure in the population not on hypertension medication more so in deprived (37%) than in affluent (25%) areas. Other risk factor contributions were relatively modest across all social groups: total cholesterol (6%), smoking (3%), and physical activity (2%).
Furthermore, these benefits were partly negated by mortality increases attributable to rises in body mass index and diabetes, particularly in more deprived quintiles. Treatments accounted for approximately 52% of the mortality decline, equitably distributed across all social groups. Lipid reduction (14%), chronic angina treatment (13%), and secondary prevention (11%) made the largest medical contributions.