Changing patterns of coronary heart disease in the Hunter Region of New South Wales, Australia

Patrick Mcelduff, Annette J. Dobson, Patrick McElduff, Richard Heller, Hilary Alexander, Paula Colley, Kate D'Este

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    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. Copyright (C) 1999 Elsevier Science Inc.
    Original languageEnglish
    Pages (from-to)761-771
    Number of pages10
    JournalJournal of Clinical Epidemiology
    Issue number8
    Publication statusPublished - Aug 1999


    • Coronary death
    • Hospital treatment
    • Myocardial infarction
    • Primary prevention
    • Risk factors
    • Secondary prevention
    • WHO MONICA Project


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