摘要:

Abstract:An overview of randomised trials of cholesterol reduction (26 trials, 50,000 patients, net cholesterol reduction ˜10%) provides clear evidence of a reduction in the incidence of coronary heart disease (CHD) after just a few years of treatment. Overall, the observed reduction in CHD death (9%± 3) was only half as large as the reduction in non‐fatal myocardial infarction (19%±4), although both were statistically significant (2p<0.005). In these trials, 60% of all deaths were from CHD, and since treatment reduced these by about 9%, the expected reduction in total deaths was about 5–6%. This expected reduction falls within the 95% confidence interval of the observed effect of cholesterol reduction on total mortality in these trials. There were small excesses of deaths from cancer and deaths from trauma among patients allocated active treatment. However, in no single trial, nor in the trials collectively, were these increases individually statistically significant. Furthermore, the increases did not appear to be specific to any one agent nor were the increases consistent between trials of the same agent. These observations suggest that the small excesses of noncoronary deaths observed in the cholesterol reduction trials may have occurred by chance. Evidence from ongoing longer‐term studies of treatments producing larger cholesterol reductions will be useful in further delineating the effects, if any, of such treatments on non‐coronary

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb04447.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:After rising for many years in the mid‐to‐late 1960s the mortality from ischaemic heart disease (IHD) began to decline in many countries. This represents a decline in both out‐of‐hospital (community) and hospital deaths. Non‐fatal myocardial infarction (MI) has also declined. A literature review was conducted to examine lifestyle and environmental factors contributing to the decline. Half of the decline is attributable to changes in lifestyle and in the known major risk factors. Changes in nutrition appear relevant to the decline, in particular an increased ratio of polyunsaturated to saturated fat intake and a reduced saturated fat intake overall. There is little evidence to support a role of changing alcohol consumption, changing coffee consumption, changing exercise levels or reduction in excess weight in the declining incidence of IHD. While the benefit of smoking cessation is a clear one, its impact on the differing trends in various countries is not clear. Socio‐economic factors appear to influence the rate and extent of decline in IHD in different groups and may help explain some of the regional differences in IHD incidence. Reductions in blood pressure within the ‘normal range’ which may occur with lifestyle changes may also be an import

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb04448.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY