International Journal of Epidemiology, Vol 18, S217-S222, Copyright © 1989 by International Epidemiological Association
TA Pearson
The possible role of medical management of risk factors as an explanation
of international trends in coronary heart disease (CHD) mortality has been
reviewed. In general, hypertension, hypercholesterolaemia and smoking are
the only risk factors that can be detected and treated, with a significant
effect on CHD risk. Few organized international data are available to
relate to international CHD trends. It appears that the rates of
hypertension detection and control are improving, but for many countries,
they are still quite low. Less is known about the relative contribution of
lifestyle versus medical management as a cause for blood pressure change.
Despite these caveats, it appears that blood pressure control may have
played a role in CHD mortality trends; further impact of newer
antihypertensive agents is likely. The increased medical management of
hyperlipidaemia is a relatively recent phenomenon and is unlikely to
explain past CHD trends. However, the increased use of these agents and the
introduction of more effective agents makes a future effect on CHD likely.
The impact of the medical system on smoking cessation is unclear; medical
care providers clearly have a major potential role in smoking cessation,
but it is difficult to measure. Thus, it appears that medical management of
risk factors has had a minor impact on international CHD trends, though the
data are sketchy at best. Future research should better delineate the
detection and management of risk factors as an increasingly potent source
of risk factor change and subsequent reduced CHD mortality.
ARTICLES
Influences on CHD incidence and case fatality: medical management of risk factors
Research Institute, Mary Imogene Bassett Hospital, Cooperstown, New York 13326.
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