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Contributions of treatment and lifestyle to declining CVD mortality: why have CVD mortality rates declined so much since the 1960s?
  1. Martin O'Flaherty1,
  2. Iain Buchan2,
  3. Simon Capewell1
  1. 1Department of Public Health and Policy, University of Liverpool, Liverpool, UK
  2. 2North-west Institute for Bio-Health Informatics, School of Community Based Medicine, University of Manchester, Manchester, UK
  1. Correspondence to Dr Martin O'Flaherty, Division of Public Health and Policy, Whelan Building, Quadrangle, University of Liverpool, Liverpool L69 3GB, UK; moflaher{at}


Developed countries have enjoyed substantial falls in cardiovascular disease (CVD) mortality. However, low and middle income countries are drowning in a rising tide of CVD and other non-communicable diseases. Current and future trends in CVD mortality will therefore require increasing attention in the 21st century. The success of clinical cardiology in providing evidence-based cost-effective treatments should be celebrated. However, the growing understanding of CVD mortality trends highlights the crucial role of tobacco, diet, alcohol and inactivity as key drivers. Pro-active public health approaches focused on ‘upstream’ population-wide policies are increasingly recognised as being potentially powerful, rapid, equitable and cost-saving. However, the future political challenges could be substantial.

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  • Funding MOF was supported by the UK Medical Research Council and the MedCHAMPS project and funded by EC FP7 grant no. 223705. SC and IB are supported by the UK Higher Education Funding Council.

  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.