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Research Article| Volume 56, ISSUE 6, P583-590, June 2003

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Life-years gained from coronary heart disease mortality reduction in Scotland

Prevention or treatment?
  • J.A. Critchley
    Correspondence
    Corresponding author. International Health Research Group, Liverpool School of Tropical Medicine, Pembroka Place. Liverpool, L3 5QA, UK. Tel.: +44-0151-705-3193; fax: +44-151-705-3364
    Affiliations
    Department of Public Health, University of Liverpool, Whelan Building, Quadrangle, United Kingdom
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  • S. Capewell
    Affiliations
    Department of Public Health, University of Liverpool, Whelan Building, Quadrangle, United Kingdom
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  • B. Unal
    Affiliations
    Department of Public Health, University of Liverpool, Whelan Building, Quadrangle, United Kingdom

    Department of Public Health, Dokuz Eylul University School of Medicine, Izmir, Turkey
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      Abstract

      Coronary Heart Disease (CHD) death rates have fallen considerably in many countries. We estimated the life-years-gained (LYG) in Scotland between 1975 and 1994 attributable to cardiology treatments, and population reductions in major CHD risk factors, using a previously validated mortality model. This combines published effectiveness data with information on uptake of CHD treatments; risk factor trends; and median survival by age and sex. Compared with 1975, there were 4,536 fewer CHD deaths in 1994, resulting in approximately 48,016 LYG among those aged 45–84 (maximum estimate 53,317; minimum estimate 36,867). Medical and surgical treatments for CHD patients gained approximately 12,025 life-years; the largest contribution coming from pharmacologic secondary prevention. Population reductions in major risk factors (smoking, cholesterol, and blood pressure) accounted for some 35,991 LYG, reductions in smoking accounted for over 50% of this. Modern cardiologic treatments gained many thousands of life-years in Scotland, but modest reductions in risk factors gained almost three times as many life-years.

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      References

        • Murray C.J.
        • Lopez A.D.
        Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study.
        Lancet. 1997; 349: 1498-1504
        • Department of Health
        “Saving lives” our healthier nation.
        Stationary Office, London1999
      1. General Register Office for Scotland. Scotland's Census; 2001. http://www.gro-scotland.gov.uk/grosweb/grosweb.nsf/pages/censushm.

      2. Scottish Information and Statistics Division (ISD). 2002. http://www.show.scot.nhs.uk/isd/heart_disease/heart_disease.htm.

      3. Scottish Office. Toward's a healthier Scotland—a white paper on health; 1999. http://www.scotland.gov.uk/library/documents-w7/tahs00.htm.

        • Critchley J.A.
        • Capewell S.
        Why model coronary heart disease?.
        Eur Heart J. 2002; 23: 110-116
        • Beaglehole R.
        Medical management and the decline in mortality from coronary heart disease.
        Br Med J Clin Res Ed. 1986; 292: 33-35
        • Goldman L.
        • Cook E.F.
        The decline in ischemic heart disease mortality rates. An analysis of the comparative effects of medical interventions and changes in lifestyle.
        Ann Intern Med. 1984; 101: 825-836
        • Capewell S.
        • Morrison C.E.
        • McMurray J.J.
        Contribution of modern cardiovascular treatment and risk factor changes to the decline in coronary heart disease mortality in Scotland between 1975 and 1994.
        Heart. 1999; 81: 380-386
        • Capewell S.
        • Beaglehole R.
        • Seddon M.
        • McMurray J.
        Explaining the decline in Coronary Heart Disease Mortality in Auckland, New Zealand between 1982 and 1993.
        Circulation. 2000; 102: 1151-1156
        • Hunink M.G.
        • Goldman L.
        • Tosteson A.N.
        • Mittleman M.A.
        • Goldman P.A.
        • Williams L.W.
        • et al.
        The recent decline in mortality from coronary heart disease, 1980–1990. The effect of secular trends in risk factors and treatment.
        JAMA. 1997; 277: 535-542
        • Wynne-Jones K.
        • Jackson M.
        • Grotte G.
        • Bridgewater B.
        • on behalf of the North West Regional Cardiac Surgery Audit Steering Group
        Limitations of the Parsonnet score for measuring risk stratified mortality in the north west of England.
        Heart. 2000; 84: 71-78
        • Kuulasmaa K.
        • Tunstall P.H.
        • Dobson A.J.
        • France M.
        • Sans S.
        • Tolonen H.
        • et al.
        Estimation of contribution of changes in classic risk factors to trends in coronary-event rates across the WHO MONICA Project.
        Lancet. 2000; 355: 675-687
        • Law M.R.
        • Wald N.J.
        • Thompson S.G.
        By how much and how quickly does reduction in serum cholesterol concentration lower risk of ischaemic heart disease?.
        BMJ. 1994; 308: 367-372
        • van den Hoogen P.C.
        • Feskens E.J.
        • Nagelkerke N.J.
        • Menotti A.
        • Nissinen A.
        • Kromhout D.
        The relation between blood pressure and mortality due to coronary heart disease among men in different parts of the world. Seven Countries Study Research Group.
        N Engl J Med. 2000; 342: 1-8
        • Critchley J.A.
        • Capewell S.
        • Reeve J.
        Is “saving lives” feasible? Estimating the potential for further reductions in UK coronary heart disease deaths.
        J Epidemiol Community Health. 2001; 54 ([abstract]): 774
      4. Gilbert GN, Arber S, Dale A. General Household Survey, Office Of Population Censuses And Surveys; 1973. University Of Surrey; 1980. Office of Population Censuses and Surveys Social Survey Division. General Household Survey, 1994–1995 [computer file]. Colchester, Essex: UK Data Archive [distributor]; 13 May 1996. SN: 3196, SN: 3538. SN: 3804.

        • Fichtenberg C.M.
        • Glantz S.A.
        Association of the California Tobacco Control Program with declines in cigarette consumption and mortality from heart disease.
        N Engl J Med. 2001; 343: 1772-1777
        • Capewell S.
        • Livingston B.M.
        • MacIntyre K.
        • Chalmers J.W.T.
        • Boyd J.
        • et al.
        Trends in case-fatality in 117 718 patients admitted with acute myocardial infarction in Scotland.
        Eur Heart J. 2000; 21: 1833-1840
        • MacIntyre K.
        • Capewell S.
        • Stewart S.
        • Chalmers J.W.T.
        • Boyd J.
        • Finlayson A.
        • et al.
        Evidence of improving prognosis in heart failure. Trends in case fatality in 66 547 patients hospitalized between 1986 and 1995.
        Circulation. 2000; 102: 1126-1131
        • Astbury J.
        Survival after coronary artery bypass surgery. 1–5 year survival. Data obtained from the SMR20 scheme Scotland 1983–1990.
        Information and Statistics Division, Edinburgh1991
        • Tunstall-Pedoe H.
        • Morrison C.
        • Woodward M.
        • Fitzpatrick B.
        • Watt G.
        Sex difference in myocardial infarction and coronary deaths in the Scottish MONICA population of Glasgow 1985 to 1991.
        Circulation. 1996; 93: 1981-1992
        • Isles C.G.
        • Walker L.M.
        • Beevers D.G.
        • Brown I.
        • Cameron H.L.
        • Clarke J.
        • et al.
        Mortality in patients of the glasgow blood pressure clinic.
        J Hypertens. 1986; 4: 141-156
        • Pell J.P.
        • MacIntyre K.
        • Walsh D.
        • Capewell S.
        • McMurray J.
        • Chalmers J.
        Time-trends in survival and readmission following coronary artery bypass grafting in Scotland between 1981 and 1996: a retrospective observational study.
        BMJ. 2002; 324: 201-202
        • Pocock S.J.
        • Henderson R.A.
        • Rickards A.F.
        • Hampton J.R.
        • King III, S.B.
        • Hamm C.W.
        Meta-analysis of randomized trials comparing coronary angioplasty with bypass-surgery.
        Lancet. 1995; 346: 1184-1189
        • Sigurdsson E.
        • Sigfusson N.
        • Agnarsson U.
        • Sigvaldason H.
        • Thorgeirsson G.
        Long-term prognosis of different forms of coronary heart disease: the Reykjavik Study.
        Int J Epidemiol. 1995; 24: 58-68
        • Lampe F.C.
        • Whincup P.H.
        • Wannamethee S.G.
        • Shaper A.G.
        • Walker M.
        • Ebrahim S.
        The natural history of prevalent ischaemic heart disease in middle-aged men.
        Eur Heart J. 2000; 21: 1052-1062
        • Ebrahim S.
        • Davey-Smith G.
        Multiple risk factor interventions for primary prevention of coronary heart disease (Cochrane review).
        Cochrane Library. Issue 2. Update Software Ltd, Oxford2002
      5. Annual Report of the Registrar General for Scotland. General Register Office for Scotland.
        General Register Office for Scotland, Edinburgh1995
        • Tsevat J.
        • Weinstein M.C.
        • Williams L.W.
        • Tosteson A.N.
        • Goldman L.
        Expected gains in life expectancy from various coronary heart disease risk factor modifications.
        Circulation. 1991; 83: 1194-1201
        • Yudkin J.S.
        How can we best prolong life? Benefits of coronary risk factor reduction in non-diabetic and diabetic subjects.
        BMJ. 1993; 306: 1313-1318
        • Briggs A.
        Economics notes: handling uncertainty in economic evaluation.
        BMJ. 1999; 319: 120
        • Critchley J.A.
        • Capewell S.
        Substantial potential for reductions in UK coronary heart disease deaths.
        J Epidemiol Community Health. 2003; 57: 243-247
        • Nissinen A.
        • Tuomilehto J.
        • Salomaa V.
        • Puska P.
        Hypertension control.
        in: Puska P. Tuomilehto J. Nissinen A. Vartiainen E. The North Karelia Project. 20 Year results and experiences. National Public Health Institute, KTL, Helsinki1995
        • Nissinen A.
        Cost-effectiveness of the North Karelia Hypertension Program 1972–1977.
        Med Care. 1986; 24: 767-780
      6. Expectation of life, by sex and selected age, Scotland, 1861 to 2000. General Register Office for Scotland, 2002. http://www.gro-scotland.gov.uk/grosweb/grosweb.nsf/pages/00sect5.

        • Menotti A.
        • Blackburn H.
        • Kromhout D.
        • Nissinen A.
        • Fidanza F.
        • Giampaoli S.
        • et al.
        Changes in population cholesterol levels and coronary heart disease deaths in seven countries.
        Eur Heart J. 1997; 18: 566-571
        • Vartiainen E.
        • Puska P.
        • Pekkanen J.
        • Tuomilehto J.
        • Jousilahti P.
        Changes in risk factors explain changes in mortality from ischaemic heart disease in Finland.
        BMJ. 1994; 309: 23-27
        • Sigfusson N.
        • Sigvaldson H.
        • Steingrimsdottir L.
        • Gudmundsdottir I.I.
        • Stefansdottir I.
        • Thorsteinsson T.
        Decline in ischaemic heart disease in Iceland and change in risk factor levels.
        BMJ. 1991; 302: 1371-1375
        • Dobson A.J.
        Relationship between risk factor trends and disease trends.
        Ann Med. 1994; 26: 67-71
        • Dobson A.
        • Filipiak B.
        • Kuulasmaa K.
        • Beaglehole R.
        • Stewart A.
        • Hobbs M.
        • et al.
        Relations of changes in coronary disease rates and changes in risk factor levels: methodological issues and a practical example.
        Am J Epidemiol. 1996; 143: 1025-1034
        • Bonneux L.
        • Looman C.
        • Barendregt J.
        • Van der Mass P.
        Regression analysis of recent changes in cardiovascular morbidity and mortality in the Netherlands.
        BMJ. 1997; 314: 789-791
        • MacMahon S.
        • Peto R.
        • Cutler J.
        • Collins R.
        • Sorlie P.
        • Neaton J.
        • et al.
        Blood pressure, stroke, and coronary heart disease.
        Lancet. 1990; 335: 765-774
        • Perry A.
        • Capewell S.
        • Walker A.
        • Chalmers J.
        • Redpath A.
        • Major K.
        • et al.
        Measuring the costs and benefits of heart disease monitoring.
        Heart. 2000; 83: 651-656
        • Pell J.P.
        • Sirel J.M.
        • Marsden A.K.
        • Ford I.
        • Cobbe S.M.
        Effect of reducing ambulance response times on deaths from out of hospital cardiac arrest: cohort study.
        BMJ. 2001; 322: 1385-1388
        • Tunstall Pedoe H.
        • Bailey L.
        • Chamberlain D.A.
        • Marsden A.K.
        • Ward M.E.
        • Zideman D.A.
        Survey of 3765 cardiopulmonary resuscitations in British hospitals (the BRESUS study): Methods and overall results.
        BMJ. 1992; 304: 1347-1351
        • Altman R.
        • Carreras L.
        • Diaz R.
        • Figueroa E.
        • Paolasso E.
        • Parodi J.C.
        Collaborative overview of randomised trials of antiplatelet therapy—1: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients.
        BMJ. 1994; 308: 81-106
        • Baigent C.
        • Collins R.
        • Appleby P.
        • Parish S.
        • Sleight P.
        • Peto R.
        ISIS-2: 10 year survival among patients with suspected acute myocardial infarction in randomised comparison of intravenous streptokinase, oral aspirin, both, or neither. The ISIS-2 (Second International Study of Infarct Survival) Collaborative Group.
        BMJ. 1998; 316: 1337-1343
        • Appleby P.
        • Baigent C.
        • Collins R.
        • Flather M.
        • Parish S.
        • Peto R.
        • et al.
        Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients.
        Lancet. 1994; 343: 311-322
        • Lau J.
        • Antman E.M.
        • Jiminez-Silva J.
        • Kuoelnick B.
        • et al.
        Cumulative meta-analysis of therapeutic trials for myocardial infarction.
        N Engl J Med. 1992; 327: 248-254
        • White C.M.
        Prevention of suboptimal beta-blocker treatment in patients with myocardial infarction.
        Ann Pharmacother. 1999; 33: 1063-1072
        • Garg R.
        • Yusuf S.
        Overview of randomized trails of angiotensinconverting enzyme inhibitors on mortality and morbidity in patients with heart failure.
        JAMA. 1995; 273: 1450-1456
        • Latini R.
        • Maggioni A.P.
        • Flather M.
        • Sleight P.
        • Tognoni G.
        ACE inhibitor use in patients with myocardial infarction: summary of evidence from clinical trials.
        Circulation. 1995; 92: 3132-3137
        • Shannon A.W.
        • Harrigan R.A.
        General pharmacologic treatment of acute myocardial infarction.
        Emerg Med Clin North Am. 2001; 19: 417-431
        • McAlister F.A.
        • Lawson F.M.E.
        • Teo K.K.
        • Armstrong P.W.
        Randomised trials of secondary prevention programmes in coronary heart disease: Systematic review.
        BMJ. 2001; 323: 957-962
        • Jolliffe J.A.
        • Rees K.
        • Taylor R.S.
        • Thompson D.
        • Oldridge N.
        • Ebrahim S.
        Exercise-based rehabilitation for coronary heart disease (Cochrane review).
        Cochrane Library. Issue 2. Update Software Ltd, Oxford2002
        • Sleight P.
        • Yusuf S.
        • Pogue J.
        • Tsuyuki R.
        • Diaz R.
        • Probstfield J.
        Blood-pressure reduction and cardiovascular risk in HOPE study.
        Lancet. 2001; 358: 2130-2131
      7. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S).
        Lancet. 1994; 344: 1383-1389
        • Collins R.
        • Baigent C.
        • Peto R.
        Benefit of Heparin plus Aspirin versus aspirin alone in unstable angina.
        JAMA. 1996; 276: 1873
        • Yusuf S.
        • Lessem J.
        • Jha P.
        • Lonn E.
        Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration.
        Lancet. 1994; 344: 563-570
        • Bowker T.J.
        • Clayton T.C.
        • Ingham J.
        • McLennan N.R.
        • Hobson H.L.
        • Pyke S.D.
        • et al.
        A British Cardiac Society Survey of the potential for the secondary prevention of coronary disease: (ASPIRE).
        Heart. 1996; 75: 334-342
        • Anon
        Coronary heart disease in Scotland. Report of a policy review.
        Scottish Office Public Health Policy Unit, HMSO Edinburgh1996
        • Collins R.
        • Peto R.
        • MacMahon S.
        Blood pressure, stroke and coronary heart disease.
        Lancet. 1990; 335: 827-838
        • Smith W.C.S.
        • Lee A.J.
        • Crombie I.K.
        • Tunstall Pedoe H.
        Control of blood pressure in Scotland: the rule of halves.
        BMJ. 1990; 300: 981-983
        • Staessen J.A.
        • Wang J.-G.
        • Thijs L.
        Cardiovascular protection and blood pressure reduction: a meta-analysis.
        Lancet. 2002; 358: 1305-1315
        • Mullen P.D.
        Compliance becomes concordance.
        BMJ. 1997; 314: 691-692