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Trends in CVD
20-Year trends in major coronary risk factors in older British men: assessing the impact of medication use
  1. S. L. Hardoon1,
  2. P. H. Whincup2,
  3. S. G. Wannamethee1,
  4. O. Papacosta1,
  5. M. C. Thomas1,
  6. L. T. Lennon1,
  7. A. G. Thomson1,
  8. S. Capewell3,
  9. R. W. Morris1
  1. 1
    Department of Primary Care & Population Health, Division of Population Health, UCL Medical School, University College London, Royal Free Campus, Rowland Hill Street, London, UK
  2. 2
    Department of Community Health Sciences, St George’s, University of London, Cranmer Terrace, London, UK
  3. 3
    School of Population Community & Behavioural Sciences, Division of Public Health, University of Liverpool, Whelan Building (3rd Floor), Brownlow Hill, Quadrangle, Liverpool, UK

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    Background

    Favourable trends in blood pressure (BP) and blood lipids have contributed to the falling incidence of coronary heart disease (CHD) in recent decades. The role of medication in the BP and blood lipid trends is unknown.

    Objectives

    To investigate the impact of medication on 20-year trends in BP and blood lipids in older British men.

    Design

    Longitudinal study.

    Setting

    24 British towns.

    Participants

    4231 men from a socially and geographically representative cohort of older British men, examined at baseline (1978–80, aged 40–59 years) and after 20 years (1998–2000).

    Main Outcome Measures

    20-year trends in systolic blood pressure (SBP), diastolic blood pressure (DBP), and total, non-HDL and HDL cholesterol according to medication use, derived from linear regression with generalised estimating equations, adjusting for age and risk factors for dyslipidemia and hypertension.

    Results

    Over 20 years from 1978–80 to 1998–2000, overall age-adjusted mean SBP fell: mean change −7.6 mm Hg (95% CI −9.7 to −5.4), whilst mean DBP rose: mean change +3.3 mm Hg (+2.2 to +4.5). Among 1573 men (37%) who reported taking BP-lowering medication during the follow-up, mean SBP fell significantly by −12.3 mm Hg (−14.7 to −9.9) and DBP fell non-significantly by −1.2 mm Hg (−2.5 to +0.07). In contrast, men not using BP-lowering medication experienced a non-significant fall in SBP of −1.6 mm Hg (−3.7 to +0.5) and an increase in DBP of +7.7 mm Hg (+6.6 to +8.8) (p<0.001 for medication-time interaction for both SBP and DBP). Overall mean total cholesterol fell by −0.2 mmol/L (−0.3 to −0.08), and mean non-HDL cholesterol fell by −0.4 mmol/L (−0.5 to −0.2). Total and non-HDL cholesterol fell significantly by −1.6 mmol/L (−1.8 to −1.4) and −1.8 mmol/L (−2.0 to −1.6) respectively among 302 men (8%) reporting use of lipid-regulating drugs, but fell by only −0.1 mmol/L (−0.2 to +0.03) and −0.2 mmol/L (−0.4 to −0.1) respectively among men not using lipid-regulating medication (p<0.001 for medication-time interactions). Mean HDL cholesterol levels rose overall by +0.16 mmol/L (+0.13 to +0.19). The trend did not vary appreciably according to lipid-regulating drug use (p = 0.15 for interaction).

    Conclusions

    A marked cohort-wide increase in HDL levels occurred, independent of medication use, therefore probably reflecting changes in health behaviours. Decreases in SBP and total and non-HDL cholesterol were largely confined to medication users suggesting limited implementation of population-wide lifestyle strategies to reduce these coronary risk factors. Greater efforts are needed to reduce BP and cholesterol among the general population if the potential benefits of population strategies for CHD prevention are to be realised.

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