Although mortality rates from coronary heart disease (CHD) have dropped substantially since 1968, with better evidence-based therapies largely explaining this decrease, reductions in age-adjusted mortality from CHD seemed to slow in the 1990s. In this prospective study of men and women over 35 years of age, Ford and Capewell show that between 1980 and 2002, age-adjusted mortality rates decreased by 52% in men and 49% in women. However, compared to the estimated annual percent change in mortality rates between 1980 and 1989, the estimated annual percent change in mortality was found to be 4 times lower in women and 3 times lower in men from 1989 to 2000. These observations led the authors to conclude that the significant decrease in age-adjusted mortality rates in the 1980s was due largely to the effectiveness of evidence-based therapy. However, as CHD is still the leading cause of death in the U.S., the slower than expected decrease in age-adjusted mortality rates in the 1990s could be due to the increased prevalence of “emerging” risk factors caused by a sedentary lifestyle and poor nutritional habits, such as abdominal obesity, the metabolic syndrome, type 2 diabetes, and hypertension. This paper was accompanied by an editorial by Greenland and Lloyd-Jones who clearly state that Ford and Capewell’s paper should be a warning sign to the medical community that our battle against cardiovascular disease (CVD) is far from over, especially among young adults. Greenland and Lloyd-Jones also stressed the importance of CVD prevention and stated loud and clear that lifestyle modification is by far the most promising approach to prevent excess body weight-related risk factors that lead to CVD.
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