Drop In Heart Disease Credited
to Healthy Lifestyle Habits

Research has shown that since the 1980s, heart disease deaths have fallen by roughly one-half in many industrialized countries. The relative importance of the various reasons for this decline is not fully clear, however.

A central question is whether "primary" or "secondary" prevention is more important. Primary prevention refers to the prevention of heart disease in healthy people, while secondary prevention means reducing potentially fatal complications like heart attack in people with diseased heart arteries.

Right now, the priority in the UK and the U.S. seems to be on the latter, according to Dr. Belgin Unal of Dokuz Eylul University in Izmir, Turkey.

But in their study, Unal and his colleagues found that primary prevention was responsible for about half of the steep decline in heart disease deaths in England and Wales since 1981 -- with diet changes and a reduction in smoking getting most of the credit.

All told, primary prevention was four times more effective at preventing deaths compared with treatment of existing heart disease, according to the researchers' estimates, which were published online by the British Medical Journal.

Primary prevention works, Unal stated, because it targets people who are generally healthy, encouraging smoking cessation and lifestyle changes to cut cholesterol and blood pressure before they rise too high. Medications are also part of preventing heart disease, but they are prescribed only after cholesterol and blood pressure climb to a concerning level.

Unal and his colleagues arrived at their estimates using a statistical model that synthesized data on more than 35 million adults in England and Wales. The data came from various sources, including official statistics, national surveys and clinical trials.

Overall, the researchers found, heart disease deaths fell by 54 percent between 1981 and 2000. The single largest factor, they say, was the concurrent 35 percent decline in smoking prevalence. They estimate that this trend prevented nearly 30,000 deaths from heart disease -- mostly among people who had no known heart problems at the time they quit.

During the same period, there were more modest dips in adults' cholesterol levels and blood pressure, which the researchers credit with an accordingly smaller reduction in heart disease deaths. For people without existing heart disease, the study authors estimate, the biggest factor here seems to be changes in diet -- including higher intakes of fruit, fiber and unsaturated fat, and declining consumption of saturated fat and salt.

Overall, more than 45,000 deaths were prevented by reductions in smoking, cholesterol and blood pressure, according to the researchers, and 81 percent of these were among people without recognized heart disease.

"Lifestyle changes saved more lives," Unal said. The findings, according to the researcher, argue for a stronger focus on primary prevention of heart disease.

SOURCE: British Medical Journal online, August 16, 2005.

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