The magnitude and nature of the decrease in coronary heart disease mortality rate.

The age-adjusted cardiovascular mortality rate has fallen by 40% in the United States over the last 30 years, primarily since the late 1960s. Although cardiovascular disease is still the leading cause of death in this country, the rate of deaths from cardiovascular disease have dropped to below 50%, and the rate continues to decrease. In actual numbers, it has been estimated that as many as 300,000 people between the ages of 35 and 65 years would have died from coronary heart disease between 1968 and 1978 if the mortality rate had remained unchanged. The extent of the decline varies with different areas of the country and most dramatically affects the black population. Between 1970 and 1980, life expectancy increased by 2.7 years for white men, 2.5 years for white women, 3.7 years for black men, and 4.0 years for black women. Attempts to analyze the decline in mortality must take 2 features of mortality into consideration: incidence and case fatality, which reflect changes in primary prevention factors and in treatment methods, respectively. However, data on cardiovascular disease conflict and are difficult to interpret. Many methods of estimating the potential effect of altering or eliminating potential risk factors such as smoking, hypertension and cholesterol have been explored, with encouraging results.