Dobson A J, McElduff P, Heller R, Alexander H, Colley P, D'Este K
Department of Statistics and Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Callaghan, New South Wales, Australia.
J Clin Epidemiol. 1999 Aug;52(8):761-71. doi: 10.1016/s0895-4356(99)00052-9.
A population-based observational study of men and women aged 35-69 years in the Hunter Region of New South Wales, Australia, was conducted to assess the impact of risk-factor modification and increased drug therapy on the trends in major coronary events and case fatality. From 1985 to 1993, there were 3006 coronary deaths and 6450 nonfatal major coronary events. Rates of death and nonfatal myocardial infarction declined, but there was an increase in hospital admissions for prolonged chest pain. Reductions in cigarette smoking, diastolic blood pressure, total cholesterol, and increased use of aspirin can fully explain the 3.3% (95% confidence interval [CI] 2.4, 4.2) average annual reduction in rates of major coronary events for men and the 4.1% (95% CI 2.7, 5.5) reduction for women. In contrast, increased use of aspirin, beta-blockers, fibrinolytic therapy, and angiotensin-converting enzyme inhibitors explain less than half of the 8.9% (95% CI 5.9, 11.8) and 6.9% (95% CI 2.7, 10.9) average annual reduction in case fatality in hospital for men and women, respectively. These trends suggest a decline in severity of coronary heart disease consistent with reductions in risk-factor levels and improved acute medical treatment.
在澳大利亚新南威尔士州猎人地区开展了一项针对35至69岁男性和女性的基于人群的观察性研究，以评估风险因素修正和增加药物治疗对主要冠状动脉事件趋势和病死率的影响。1985年至1993年期间，有3006例冠状动脉死亡和6450例非致命性主要冠状动脉事件。死亡率和非致命性心肌梗死发生率下降，但因长时间胸痛住院的人数有所增加。吸烟率、舒张压、总胆固醇的降低以及阿司匹林使用的增加，能够充分解释男性主要冠状动脉事件发生率平均每年下降3.3%（95%置信区间[CI] 2.4, 4.2）以及女性下降4.1%（95% CI 2.7, 5.5）的原因。相比之下，阿司匹林、β受体阻滞剂、溶栓治疗和血管紧张素转换酶抑制剂使用的增加，分别仅解释了男性和女性住院病死率平均每年下降8.9%（95% CI 5.9, 11.8）和6.9%（95% CI 2.7, 10.9）的不到一半原因。这些趋势表明，冠心病严重程度下降，这与风险因素水平降低和急性医疗治疗改善相一致。
