Coronary Heart Disease Deaths Fall Due to Population Decreases in Blood Pressure and Cholesterol Interview with:
Dr. Maria Guzman-Castill
Department of Public Health and Policy
University of Liverpool, Liverpool, UK

Medical Research: What is the background for this study? What are the main findings?

Dr. Guzman-Castillo: The UK has experienced a remarkable 60% reduction in coronary heart disease (CHD) mortality since the 1970s. However CHD remains the leading cause of premature death.

The aim of our study was to analyse the recent falls in coronary heart disease mortality and quantify the relative contributions from preventive medications and from population-wide changes in blood pressure and cholesterol levels, particularly exploring the potential effects on socioeconomic inequalities, an aspect not well explored in the past.

Our study found that, approximately 22,500 fewer deaths were attributable to reductions in blood pressure and cholesterol in the English population between 2000-2007.

The substantial decline in blood pressure was responsible for approximately 13,000 fewer deaths. Approximately 1,800 fewer deaths came from medications and some 11,200 fewer deaths from population-wide changes. Reduction in population blood pressure fewer deaths in the most deprived quintile compared with the most affluent.

Reduction in cholesterol resulted in substantially smaller gains, approximately 7,400 fewer deaths; approximately 5,300 fewer deaths were attributable to statin use and approximately 2,100 DPPs to population-wide changes. Interestingly, statins prevented more deaths in the most affluent quintile compared with the most deprived. Conversely, population-wide changes in cholesterol prevented threefold more deaths in the most deprived quintile compared with the most affluent.

Medical Research: What should clinicians and patients take away from your report?

Dr. Guzman-Castillo: Severely limited health care budgets are now forcing planning systems to consider how best to allocate future resources. Our results strengthen the case for greater emphasis on preventive approaches, but focusing on population based policies to reduce blood pressure and cholesterol, targeting primarily our diets. Such strategies might be more powerful, rapid, cost-effective, and more equitable than relying mostly on lipid lowering medications.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Guzman-Castillo: It is important to replicate these findings in other populations and over different time periods, to understand better the role of statins on primary prevention of cardiovascular disease. Also, to explore what is the optimal combination of strategies, including both population level and high-risk approaches, to maximize population gains while reducing the pressure on already overstressed health systems.


Guzman-Castillo, R. Ahmed, N. Hawkins, S. Scholes, E. Wilkinson, J. Lucy, S. Capewell, M. O’Flaherty, R. Raine, M. Bajekal. The contribution of primary prevention medication and dietary change in coronary mortality reduction in England between 2000 and 2007: a modelling study. BMJ Open, 2015; 5 (1): e006070
DOI: 10.1136/bmjopen-2014-006070

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