Hey - glad to see my dear friend Victor playing the 'doctor in house' in my absence - at least someone, I can rely upon
Good find victor (the article from NEJM)
See the point they have highlighted is cleverly declining 'deaths'
not declining incidence
of coronary heart disease. I can put my money on the fact that if investigated, incidence might be on the rise.
So what has changed ? The outcome.
(I can speak for UK only) 20 yrs ago if you had a heart attack, there was not a lot of treatment. You just give supporting treatment and wait for body to mend itself. The only 'treatment' was that of heparin infusion, to keep the blood liquid, hoping that the clot in the coronary artery will dissolve.
Then came 'clot busters' - initially urokinase, then streptokinase, then tPA and now even newer ones.
Next - we started giving this treatment as soon as possible, even in the Accident & Emergency dept. Then in the ambulances.
Even more - now we have moved to primary angioplasty (- yes like US & France, where they have it for many years) - even in DGHs, if you come with a heart attack, we can offer primary angiography and angioplasty.
Result ? Fewer deaths from coronary heart disease.
That's how it is achieved.
A similar effort is in process in Cerebro Vascular Disease . . see what come of this effort in 20 yrs time.
Hence, friends, the true picture can only come out, when we look at the actual 'incidences' of CHD . . . whether that has fallen or not interests me more.