[Decrease in @entity301 mortality in 1974-1992 largely explainable by changes in XXXX and smoking risk factors].

@entity1 @entity165 @entity301
OBJECTIVE: To ascertain to what extent the dramatic decrease in @entity301 ( @entity301 ) mortality from 1972 to the present can be attributed to a change in risk factors. DESIGN: Descriptive study based on literature data. SETTING: The Netherlands. METHODS: Changes in four risk factors were assessed: a survey on trends in average systolic and diastolic blood pressure and serum @entity165 from three national screening projects, conducted 1974-1980, among 30,000 @entity1 and @entity1 aged 37-43 years, 1981-1986 among 80,000 @entity1 aged 33-37 years, and 1987-1992 among 42,000 @entity1 and @entity1 aged 20-59 years, and the percentage of smokers observed by the Foundation on Public Health and Smoking in yearly surveys among 20,000 @entity1 from the age of 15. Using a preventable proportion calculation, the effect on mortality was estimated of the observed changes in these risk factors, applying published relative risks and regression coefficients for these risk factors for @entity1 . The estimated curves were compared with the coronary mortality curves observed by the Netherlands Central Bureau of Statistics. RESULTS: From 1974 to 1992 a substantial decrease in the percentage of smokers and in @entity1 a moderate decrease in average serum @entity165 level were observed. Serum @entity165 decreased little in @entity1 . Changes in blood pressure were not consistent. The calculations predicted a 33% decrease in @entity301 mortality; the decrease actually observed was 48% for @entity1 aged 20-69 and 42% for @entity1 . CONCLUSION: It appears that by far the largest proportion of the decrease in @entity301 mortality can be explained by a decrease in the values of relevant risk factors ( @entity165 and smoking) and only a small part by improved therapy.
