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a Cardiovascular
Research Unit, Department of Primary Care and Population Sciences,
Royal Free and UCL Medical School, Royal Free Campus, Rowland Hill
Street, London NW3 2PF, UK, b Department
of Public Health Sciences, St Georges Hospital Medical School, London
SW17 0RE, UK, c Department of
Social Medicine, University of Bristol, Bristol BS8 2PR, UK
Correspondence to: F Lampe f.lampe{at}pcps.ucl.ac.uk
Accepted 11 July 2001
OBJECTIVE
To assess whether long term
trends over time in acute coronary heart disease (CHD) event rates have
influenced the burden of prevalent CHD in British men.
DESIGNLongitudinal cohort study.
PARTICIPANTS7735 men, aged 40-59 at
entry (1978-80), selected from 24 British towns.
METHODSThe prevalences of current
angina symptoms and history of diagnosed CHD were ascertained by
questionnaire in 1978-80, 1983-85, 1992, and 1996. New major CHD events
(fatal and non-fatal) were ascertained throughout the study from
National Health Service central registers and general practice record
reviews. Age adjusted trends in CHD prevalence were compared with
trends in major CHD event rates.
RESULTSFrom 1978-1996 there
was a clear decline in the prevalence of current angina symptoms: the
age adjusted annual percentage change in odds was -1.8% (95%
confidence interval (CI) -2.8% to -0.8%). However, there was no
evidence of a trend in the prevalence of history of diagnosed CHD
(annual change in odds 0.1%, 95% CI -1.0% to 1.2%). Over the same
period, the CHD mortality rate fell substantially (annual change
-4.1%, 95% CI -6.5% to -1.6%); rates of non-fatal myocardial
infarction, all major CHD events, and first major CHD event fell by
-1.7% (95% CI -3.9% to 0.5%), -2.5% (95% CI -4.1% to
-0.8%), and -2.4% (95% CI% -4.3 to -0.4%), respectively.
CONCLUSIONSThese results suggest
that middle aged British men are less likely to experience symptoms of
angina than in previous decades but are just as likely to have a
history of diagnosed CHD. Despite falling rates of new major events and
falling symptom prevalence, the need for secondary prevention among
middle aged men with established CHD is as great as ever.
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