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Heart disease maintains its grip

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Heart disease remains a threat to British men, according to a study by Lampe et al, based on the data set of the British Regional Heart Study. Deaths from coronary heart disease (CHD) are falling in the developed world because of a drop in new major cardiac events and a decline in cases in which CHD causes death. Whether these trends have affected the prevalence of CHD in the population was previously unknown.

Lampe et al looked at time trends for two measures of prevalence of CHD—current symptoms of angina and history of medically diagnosed CHD—from questionnaire data collected at entry to the study (1978-80) and at three intervals up until 1996. These they compared with trends in new major CHD events—deaths from CHD, non-fatal myocardial infarction, all major CHD events, and first major CHD event —and case fatality during 15 years' follow up from baseline for each man.

During 1978–96 the prevalence of current symptoms of angina fell (overall age adjusted annual percentage change in odds (−1.8% (95% confidence interval −2.8% to−0.8%), p<0.001) whereas that of history of diagnosed CHD was unchanged (0.1% (−1.0% to 1.2%), p=0.83). The trends in rates of new major CHD events all showed a decline, as did case fatality.

Despite all the other trends the unchanged prevalence of diagnosed CHD in these men is a key finding and means that secondary preventive measures for CHD remain crucial.