Reducing levels of smoking, cholesterol and blood pressure will halve current CHD mortality

A new Health Development Agency briefing paper, ‘Relative contributions of changes in risk factors and treatment to the reduction in coronary heart disease mortality’ highlights that even a small reduction in the current levels of cholesterol, smoking and blood pressure, could save approximately 50,000 lives annually in England and Wales. This would halve the current burden of around 100,000 deaths from coronary heart disease each year.

The risk factors for CHD have been well known for many years, and the effects of changing the risk factors on the incidence of the disease are now well documented.

In recent decades, secondary prevention - medical intervention for the treatment of established disease - has become more effective. But some of the risk factors can be reduced by primary prevention, in other words intervening before the disease causes a heart attack or angina. This means healthier behaviour concerning smoking, diet, and exercise.

Professor Mike Kelly, Health Development Agency Director of Evidence and Guidance, and co-author of the briefing paper said:

‘Reducing cholesterol levels by even a small amount would prevent approximately 25,000 fewer deaths each year. This is quite possible. These lower cholesterol levels were actually achieved in the USA and Scandinavia ten years ago. Reducing smoking prevalence to American levels would result in 17,000 fewer deaths annually. These two measures, along with a small reduction in the population’s blood pressure, would result in 50,000 fewer deaths annually, thereby halving current CHD mortality in Britain.’

Professor Simon Capewell, from the University of Liverpool, co-author, said

‘We could see very rapid benefits. A reduction in smoking, cholesterol and blood pressure will result in fewer deaths within 12-24 months.’

In most industrialised countries, age adjusted death rates have fallen by between 30 -70% in the last two decades. In England and Wales, there were 68,230 fewer CHD deaths in 2000 compared with 1981. Approximately 42% of the mortality decrease was attributable to medical and surgical treatments. However, about 58% of the decline in deaths was attributable to improvements in risk factors, particularly a fall in smoking prevalence.

However, the decline in CHD mortality attributable to risk factor reduction was partly offset by the additional deaths caused by increases in obesity, diabetes and lack of physical activity. These together contributed approximately 8,000 extra deaths.

Figures published in ‘The smoking epidemic in England’ by the HDA last November estimate that 11,500 deaths from ischaemic heart disease each year among those over 65 in England were due to smoking.

The briefing paper ‘Relative contributions of changes in risk factors and treatment to the reduction in coronary heart disease mortality’ is available at www.hda.nhs.uk.