The decline in ischemic heart disease mortality rates. An analysis of the comparative effects of medical interventions and changes in lifestyle

Ann Intern Med. 1984 Dec;101(6):825-36. doi: 10.7326/0003-4819-101-6-825.


Using reasonable assumptions gathered from the published literature, we estimated that more than half of the decline in ischemic heart disease mortality between 1968 and 1976 was related to changes in lifestyle, specifically to reductions in serum cholesterol levels and cigarette smoking. In comparison, about 40% of the decline can be directly attributed to specific medical treatment of clinical ischemic heart disease and hypertension being the leading estimated contributors. Because many of these interventions have not yet been applied to their maximum potential, a continued decline in mortality rates might be anticipated in the coming decades. However, the relative costs of these medical interventions and lifestyle changes and the extent to which they interact with each other must be considered before an optimal national health strategy can be derived.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Arrhythmias, Cardiac / therapy
  • Cholesterol / blood
  • Coronary Artery Bypass
  • Coronary Care Units
  • Coronary Disease / drug therapy
  • Coronary Disease / mortality*
  • Coronary Disease / prevention & control
  • Coronary Disease / therapy
  • Dietary Fats / administration & dosage
  • Emergency Medical Services / trends
  • Humans
  • Hypertension / therapy
  • Life Style*
  • Myocardial Infarction / therapy
  • Obesity / therapy
  • Physical Exertion
  • Resuscitation
  • Smoking
  • United States


  • Dietary Fats
  • Cholesterol