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For industrialised countries, control of cardiovascular disease (CVD) is the most important achievement of biomedicine in the last half-century—certainly in terms of decrease in disease burden. The orderly sequence of research, surveillance, trials and implementation organised by cardiovascular scientists has led to a decline of 80% for both coronary heart disease and stroke in the USA and other countries since the 1960s.1 ,2 One crucial reason has been the discovery of successful interventions across the entire sequence of events from the source of risk factors to the patient with disease (figure 1). The biggest impact, however, has come through prevention at the population level and—to a lesser extent—prevention among high-risk individuals; collectively, they account for about two-thirds of the decline.3 Based on analyses in the USA, it is sobering to recognise that aspirin alone contributed more to the fall in death rates than all surgical and catheter-based interventions combined.3 Prevention was achieved by a broad spectrum of methods, from change in food manufacture, improvements in individual eating patterns and anti-smoking campaigns to the use of drugs for persons with established risk factors. Nonetheless, millions …
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