How much of the recent decline in the incidence of myocardial infarction in British men can be explained by changes in cardiovascular risk factors? Evidence from a prospective population-based study.

Description

In the United Kingdom, there has been a 62% decline in the age-adjusted hazard of myocardial infarction (MI). Hardoon et al. have followed 7,735 men from the British Heart Study in order to quantify the extent to which this decline is due to changes in cardiovascular risk factors. It was found that the fall in cigarette smoking explained the bulk of the decline in MI incidence (23%). Almost half of the decline in MI incidence was explained when changes in cigarette smoking, blood pressure, HDL cholesterol, and non-HDL cholesterol were taken into account. However, a marked increase in mean body mass index is likely to have limited the magnitude of this decline. These results suggest that population-wide changes in risk factors have considerable potential for reducing MI incidence in the United Kingdom and perhaps in other parts of the developed world. This paper was accompanied by an editorial by Luepker who briefly reviewed the literature on the decline of incident coronary heart disease (CHD) in the U.S. and Europe. He also highlighted the strengths and limitations of Hardoon’s paper and concluded that both public health and clinical care strategies are important to target CHD risk factors and slow CHD incidence even further.