Death rates from ischaemic heart disease (IHD), stroke, and other cardiovascular diseases (CVDs) are decreasing in high-income and many Latin American countries, and this trend shows no signs of slowing
Declines in some behavioural risk factors, including smoking, and physiological risk factors, such as blood pressure and serum cholesterol, are likely to have helped to reduce CVDs
By contrast, the nearly universal increase in adiposity seems not to have modified the long-term declining trend in CVD mortality, although it might have had some slowing effect
Improved medical care, including effective treatment of physiological risk factors, diagnosis, treatment of acute CVDs, and post-hospital care, has also contributed to declining CVD events and mortality
Measured risk factor and treatment variables, while important, explain neither why the decline began when it did nor many of the similarities and differences between countries or between men and women
Substantial fluctuations in CVDs, and in alcohol intake, in former communist countries of Europe have followed times of massive political and social changes since the early 1990s
Ischaemic heart disease, stroke, and other cardiovascular diseases (CVDs) lead to 17.5 million deaths worldwide per year. Taking into account population ageing, CVD death rates are decreasing steadily both in regions with reliable trend data and globally. The declines in high-income countries and some Latin American countries have been ongoing for decades without slowing. These positive trends have broadly coincided with, and benefited from, declines in smoking and physiological risk factors, such as blood pressure and serum cholesterol levels. These declines have also coincided with, and benefited from, improvements in medical care, including primary prevention, diagnosis, and treatment of acute CVDs, as well as post-hospital care, especially in the past 40 years. These variables, however, explain neither why the decline began when it did, nor the similarities and differences in the start time and rate of the decline between countries and sexes. In Russia and some other former Soviet countries, changes in volume and patterns of alcohol consumption have caused sharp rises in CVD mortality since the early 1990s. An important challenge in reaching firm conclusions about the drivers of these remarkable international trends is the paucity of time-trend data on CVD incidence, risk factors throughout the life-course, and clinical care.
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WHO. Global Health Estimates: Deaths by Cause, Age, Sex and Country, 2000–2012 (WHO, 2014).
Moran, A. E. et al. Temporal trends in ischemic heart disease mortality in 21 world regions, 1980 to 2010: the Global Burden of Disease 2010 study. Circulation 129, 1483–1492 (2014).
Kontis, V. et al. Contribution of six risk factors to achieving the 25x25 non-communicable disease mortality reduction target: a modelling study. Lancet 384, 427–437 (2014).
Feigin, V. L. et al. Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet 383, 245–254 (2014).
Asaria, P. et al. Trends and inequalities in cardiovascular disease mortality across 7932 English electoral wards, 1982–2006: Bayesian spatial analysis. Int. J. Epidemiol. 41, 1737–1749 (2012).
Di Cesare, M. et al. Inequalities in non-communicable diseases and effective responses. Lancet 381, 585–597 (2013).
Harper, S., Lynch, J. & Smith, G. D. Social determinants and the decline of cardiovascular diseases: understanding the links. Annu. Rev. Public Health 32, 39–69 (2011).
Danaei, G. et al. The promise of prevention: the effects of four preventable risk factors on national life expectancy and life expectancy disparities by race and county in the United States. PLoS Med. 7, e1000248 (2010).
Keys, A. Coronary heart disease—the global picture. Atherosclerosis 22, 149–192 (1975).
Strom, A. & Jensen, R. A. Mortality from circulatory diseases in Norway 1940–1945. Lancet 1, 126–129 (1951).
Morris, J. N. Recent history of coronary disease. Lancet 1, 69–73 (1951).
Woolsey, T. D. & Moriyama, I. M. Statistical studies of heart diseases; important factors in heart disease mortality trends. Public Health Rep. 63, 1247–1273 (1948).
Moriyama, I. M. & Gover, M. Heart diseases and allied causes of death in relation to age changes in the population. Public Health Rep. 63, 537–545 (1948).
Stallones, R. A. The rise and fall of ischemic heart disease. Sci. Am. 243, 53–59 (1980).
Moriyama, I. M. & Woolsey, T. D. Statistical studies of heart disease. IX. Race and sex differences in the trend of mortality from the major cardiovascular-renal diseases. Public Health Rep. 66, 355–368 (1951).
Klebba, A. J., Maurer, J. D. & Glass, E. J. Mortality trends for leading causes of death: United States, 1950–1969. Vital Health Stat. 20, 1–79 (1974).
Borhani, N. O. & Hechter, H. H. Recent changes in CVR disease mortality in California. Public Health Rep. 79, 147–160 (1964).
Walker, W. J. Coronary mortality: what is going on? JAMA 227, 1045–1046 (1974).
Stern, M. P. The recent decline in ischemic heart disease mortality. Ann. Intern. Med. 91, 630–640 (1979).
Walker, W. J. Changing United States life-style and declining vascular mortality: cause or coincidence? N. Engl. J. Med. 297, 163–165 (1977).
Uemura, K. & Pisa, Z. Recent trends in cardiovascular disease mortality in 27 industrialized countries. World Health Stat. Q. 38, 142–162 (1985).
Uemura, K. & Pisa, Z. Trends in cardiovascular disease mortality in industrialized countries since 1950. World Health Stat. Q. 41, 155–178 (1988).
Lawlor, D. A., Smith, G. D., Leon, D. A., Sterne, J. A. & Ebrahim, S. Secular trends in mortality by stroke subtype in the 20th century: a retrospective analysis. Lancet 360, 1818–1823 (2002).
Havlik, R. J. & Feinleib, M. Proceedings of the Conference on the Decline in Coronary Heart Disease Mortality. October 24–25, 1978. (National Heart, Lung, and Blood Institute, US Department of Health, Education, and Welfare, 1979).
Stallones, R. A. Epidemiology of cerebrovascular disease. A review. J. Chronic Dis. 18, 859–872 (1965).
Charlton, J., Murphy, M., Khaw, K. T., Ebrahim, S. & Davey Smith, G. in The Health of Adult Britain 1841–1994, Vol. 2 (eds Charlton, J. & Murphy, M.) 60–81 (Stationary Office, 1997).
Wen, C. P. & Gershoff, S. N. Changes in serum cholesterol and coronary heart disease mortality associated with changes in the postwar Japanese diet. Am. J. Clin. Nutr. 26, 616–619 (1973).
Kodama, K. Stroke trends in Japan. Ann. Epidemiol. 3, 524–528 (1993).
Ueshima, H. Explanation for the Japanese paradox: prevention of increase in coronary heart disease and reduction in stroke. J. Atheroscler. Thromb. 14, 278–286 (2007).
Ueshima, H., Tatara, K. & Asakura, S. Declining mortality from ischemic heart disease and changes in coronary risk factors in Japan, 1956–1980. Am. J. Epidemiol. 125, 62–72 (1987).
Sarti, C., Rastenyte, D., Cepaitis, Z. & Tuomilehto, J. International trends in mortality from stroke, 1968 to 1994. Stroke 31, 1588–1601 (2000).
Liu, L., Ikeda, K. & Yamori, Y. Changes in stroke mortality rates for 1950 to 1997: a great slowdown of decline trend in Japan. Stroke 32, 1745–1749 (2001).
Moriyama, I. M., Woolsey, T. D. & Stamler, J. Observations on possible factors responsible for the sex and race trends in cardiovascular-renal mortality in the United States. J. Chronic Dis. 7, 401–412 (1958).
Stamler, J. Lectures on Preventive Cardiology (Grune & Stratton, 1967).
Katz, L. N., Stamler, J. & Pick, R. Nutrition and Arteriosclerosis (Lea & Febiger, 1958).
WHO MONICA Project Principal Investigators. The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. J. Clin. Epidemiol. 41, 105–114 (1988).
Levi, F., Lucchini, F., Negri, E. & La Vecchia, C. Trends in mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world. Heart 88, 119–124 (2002).
Latin American Mortality Database. Latin American Mortality Database [online], (2015).
Curioni, C., Cunha, C. B., Veras, R. P. & Andre, C. The decline in mortality from circulatory diseases in Brazil. Rev. Panam Salud Publica 25, 9–15 (2009).
Andre, C., Curioni, C. C., Braga da Cunha, C. & Veras, R. Progressive decline in stroke mortality in Brazil from 1980 to 1982, 1990 to 1992, and 2000 to 2002. Stroke 37, 2784–2789 (2006).
Rodriguez, T. et al. Trends in mortality from coronary heart and cerebrovascular diseases in the Americas: 1970–2000. Heart 92, 453–460 (2006).
Epstein, F. H. & Pisa, Z. in Proceedings of the Conference on the Decline in Coronary Heart Disease Mortality. October 24–25, 1978. NIH Publication No. 79–1610 (eds Havlik, R. J. & Feinleib, M.) 58–90 (National Heart, Lung, and Blood Institute, US Department of Health, Education, and Welfare, 1979).
Mesle, F., Shkolnikov, V. & Vallin, J. Mortality by cause in the USSR in 1970–1987: the reconstruction of time series. Eur. J. Popul. 8, 281–308 (1992).
Kesteloot, H., Sans, S. & Kromhout, D. Dynamics of cardiovascular and all-cause mortality in Western and Eastern Europe between 1970 and 2000. Eur. Heart J. 27, 107–113 (2006).
Shkolnikov, V., Mesle, F. & Vallin, J. Health crisis in Russia. II. Changes in causes of death: a comparison with France and England and Wales (1970 to 1993). Popul. 8, 155–189 (1996).
Shkolnikov, V., Mesle, F. & Vallin, J. Health crisis in Russia. I. Recent trends in life expectancy and causes of death from 1970 to 1993. Popul. 8, 123–154 (1996).
Leon, D. A. et al. Huge variation in Russian mortality rates 1984–1994: artefact, alcohol, or what? Lancet 350, 383–388 (1997).
Grigoriev, P. et al. The recent mortality decline in Russia: beginning of the cardiovascular revolution? Popul. Develop. Rev. 40, 107–129 (2014).
Razvodovsky, Y. E. Alcohol consumption and ischemic heart disease mortality in Russia. Adicciones 24, 23–29 (2012).
Leon, D. A., Shkolnikov, V. M., McKee, M., Kiryanov, N. & Andreev, E. Alcohol increases circulatory disease mortality in Russia: acute and chronic effects or misattribution of cause? Int. J. Epidemiol. 39, 1279–1290 (2010).
Truelsen, T. et al. Trends in stroke and coronary heart disease in the WHO MONICA Project. Stroke 34, 1346–1352 (2003).
Jiang, B. et al. Incidence and trends of stroke and its subtypes in China: results from three large cities. Stroke 37, 63–68 (2006).
Jiang, G. et al. Coronary heart disease mortality in China: age, gender, and urban-rural gaps during epidemiological transition. Rev. Panam. Salud Publica 31, 317–324 (2012).
Yu, T. S., Wong, S. L., Lloyd, O. L. & Wong, T. W. Ischaemic heart disease: trends in mortality in Hong Kong, 1970–1989. J. Epidemiol. Community Health 49, 16–21 (1995).
Stringhini, S. et al. Declining stroke and myocardial infarction mortality between 1989 and 2010 in a country of the African Region. Stroke 43, 2283–2288 (2012).
Mayosi, B. M. et al. Health in South Africa: changes and challenges since 2009. Lancet 380, 2029–2043 (2012).
Dawber, T. R., Kannel, W. B., Revotskie, N. & Kagan, A. The epidemiology of coronary heart disease—the Framingham enquiry. Proc. R. Soc. Med. 55, 265–271 (1962).
Doyle, J. T., Dawber, T. R., Kannel, W. B., Heslin, A. S. & Kahn, H. A. Cigarette smoking and coronary heart disease. Combined experience of the Albany and Framingham studies. N. Engl. J. Med. 26, 796–801 (1962).
Kannel, W. B., Dawber, T. R., Kagan, A., Revotskie, N. & Stokes, J., 3rd. Factors of risk in the development of coronary heart disease—six year follow-up experience. The Framingham Study. Ann. Intern. Med. 55, 33–50 (1961).
Howitt, M. R. & Garrett, W. S. A complex microworld in the gut: gut microbiota and cardiovascular disease connectivity. Nat. Med. 18, 1188–1189 (2012).
Tremaroli, V. & Backhed, F. Functional interactions between the gut microbiota and host metabolism. Nature 489, 242–249 (2012).
Emerging Risk Factors Collaboration. Major lipids, apolipoproteins, and risk of vascular disease. JAMA 302, 1993–2000 (2009).
Murray, C. J., Ezzati, M., Lopez, A. D., Rodgers, A. & Vander Hoorn, S. Comparative quantification of health risks conceptual framework and methodological issues. Popul. Health Metr. 1, 1 (2003).
Ezzati, M., Lopez, A. D., Rodgers, A. & Murray, C. J. L. Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors. 2248 (WHO, 2004).
Oza, S., Thun, M. J., Henley, S. J., Lopez, A. D. & Ezzati, M. How many deaths are attributable to smoking in the United States? Comparison of methods for estimating smoking-attributable mortality when smoking prevalence changes. Prev. Med. 52, 428–433 (2011).
Pell, J. P. et al. Smoke-free legislation and hospitalizations for acute coronary syndrome. N. Engl. J. Med. 359, 482–491 (2008).
Bartecchi, C. et al. Reduction in the incidence of acute myocardial infarction associated with a citywide smoking ordinance. Circulation 114, 1490–1496 (2006).
Law, M. R., Wald, N. J. & Thompson, S. G. By how much and how quickly does reduction in serum cholesterol concentration lower risk of ischaemic heart disease? BMJ 308, 367–372 (1994).
Holmes, J., Meier, P. S., Booth, A., Guo, Y. & Brennan, A. The temporal relationship between per capita alcohol consumption and harm: a systematic review of time lag specifications in aggregate time series analyses. Drug Alcohol Depend. 123, 7–14 (2012).
Law, M. R., Frost, C. D. & Wald, N. J. By how much does dietary salt reduction lower blood pressure? III—Analysis of data from trials of salt reduction. BMJ 302, 819–824 (1991).
Xin, X. et al. Effects of alcohol reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension 38, 1112–1117 (2001).
Whelton, P. K. et al. Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). TONE Collaborative Research Group. JAMA 279, 839–846 (1998).
Aburto, N. J. et al. Effect of lower sodium intake on health: systematic review and meta-analyses. BMJ 346, f1326 (2013).
Rose, G. Incubation period of coronary heart disease. Br. Med. J. (Clin. Res. Ed.) 284, 1600–1601 (1982).
McNamara, J. J., Molot, M. A., Stremple, J. F. & Cutting, R. T. Coronary artery disease in combat casualties in Vietnam. JAMA 216, 1185–1187 (1971).
Enos, W. F., Holmes, R. H. & Beyer, J. Coronary disease among United States soldiers killed in action in Korea; preliminary report. J. Am. Med. Assoc. 152, 1090–1093 (1953).
Katanoda, K. & Matsumura, Y. National Nutrition Survey in Japan—its methodological transition and current findings. J. Nutr. Sci. Vitaminol. 48, 423–432 (2002).
Yoshiike, N., Matsumura, Y., Iwaya, M., Sugiyama, M. & Yamaguchi, M. National Nutrition Survey in Japan. J. Epidemiol. 6 (Suppl.), S189–S200 (1996).
WHO. Chronic disease and health promotion. STEPwise approach to surveillance (STEPS) [online], (2015).
Metabolic Risk Factors of Chronic Diseases Collaboration. Global Burden of Metabolic Risk Factors of Chronic Diseases [online], (2015).
Finucane, M. M., Paciorek, C. J., Danaei, G. & Ezzati, M. Bayesian estimation of population-level trends in measures of health status. Stat. Sci. 29, 18–25 (2014).
Finucane, M. M. et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 377, 557–567 (2011).
Danaei, G. et al. National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5.4 million participants. Lancet 377, 568–577 (2011).
Danaei, G. et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet 378, 31–40 (2011).
Farzadfar, F. et al. National, regional, and global trends in serum total cholesterol since 1980: systematic analysis of health examination surveys and epidemiological studies with 321 country-years and 3.0 million participants. Lancet 377, 578–586 (2011).
Stevens, G. A. et al. National, regional, and global trends in adult overweight and obesity prevalences. Popul. Health Metr. 10, 22 (2012).
WHO. Tobacco or Health: A Global Status Report (WHO, 1997).
Shafey, O., Dolwick, S. & Guindon, G. Tobacco Control Country Profiles. (American Cancer Society, 2003).
Bilano, V. et al. Global trends and projections for tobacco use, 1990–2025: an analysis of smoking indicators from the WHO Comprehensive Information Systems for Tobacco Control. Lancet 385, 966–976 (2015).
Ezzati, M. & Riboli, E. Behavioral and dietary risk factors for noncommunicable diseases. N. Engl. J. Med. 369, 954–964 (2013).
Burns, D. M. et al. in Changes in Cigarette-Related Disease Risks and Their Implications for Prevention and Control. Smoking and Tobacco Control Monograph No. 8 (eds Burns, D. M., Garfinkel, L. & Samet, J. M.) 13–112 (National Cancer Institute, 1997).
Kluger, R. Ashes to Ashes: America's Hundred-Year Cigarette War, the Public Health, and the Unabashed Triumph of Philip Morris (Vintage Books, 1997).
Brandt, A. M. The Cigarette Century: the Rise, Fall, and Deadly Persistence of the Product That Defined America (Basic Books, 2007).
Wald, N. & Nicolaides-Bouman, A. UK smoking statistics (Oxford University Press, 1991).
WHO. Global status report on noncommunicable diseases 2010 (WHO, 2011).
WHO. Global Status Report on Noncommunicable Diseases 2014: Attaining the Nine Global Noncommunicable Diseases Targets; a Shared Responsibility (WHO, 2014).
Wald, N., Doll, R. & Copeland, G. Trends in tar, nicotine, and carbon monoxide yields of UK cigarettes manufactured since 1934. Br. Med. J. (Clin. Res. Ed.) 282, 763–765 (1981).
Jarvis, M. J. Trends in sales weighted tar, nicotine, and carbon monoxide yields of UK cigarettes. Thorax 56, 960–963 (2001).
Parish, S. et al. Cigarette smoking, tar yields, and non-fatal myocardial infarction: 14,000 cases and 32,000 controls in the United Kingdom. The International Studies of Infarct Survival (ISIS) Collaborators. BMJ 311, 471–477 (1995).
US Department of Health and Human Services. A Report of the Surgeon General: How Tobacco Smoke Causes Disease: the Biology and Behavioral Basis for Smoking-Attributable Disease, 2010. Report No. DHHS Publication No (CDC) 89-8411 (USDHHS, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010).
US Department of Health and Human Services. A Report of the Surgeon General: the Health Consequences of Smoking—50 years of progress. Report No. DHHS Publication No (CDC) 89-8411, (USDHHS, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014).
Simpura, J. Mediterranean mysteries: mechanisms of declining alcohol consumption. Addiction 93, 1301–1304 (1998).
Simpura, J. Trends in alcohol consumption and drinking patterns: sociological and economic explanations and alcohol policies. Nordic Studies on Alcohol and Drugs 18 (Suppl.), S3–S13 (2001).
Mäkelä, K. et al. Alcohol, society, and the state: 1. A comparative history of alcohol control (Addiction Research Foundation, 1981).
Rehm, J. et al. in Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors (eds Ezzati, M., Lopez, A. D., Rodgers, A. & Murray, C. J. L.) 959–1108 (WHO, 2004).
WHO. Global status report on alcohol and health 2014 (WHO, 2014).
Allamani, A. & Prina, F. Why the decrease in consumption of alcoholic beverages in Italy between the 1970s and the 2000s? Shedding light on an Italian mystery. Contemp. Drug Probl. 34, 187–198 (2007).
Cipriani, F. & Prina, F. The research outcome: summary and conclusions on the reduction in wine consumption in Italy. Contemp. Drug Probl. 34, 361–378 (2007).
Shield, K. D. et al. Global alcohol exposure estimates by country, territory and region for 2005—a contribution to the Comparative Risk Assessment for the 2010 Global Burden of Disease Study. Addiction 108, 912–922 (2013).
Poznyak, V. et al. The world health organization's global monitoring system on alcohol and health. Alcohol Res. 35, 244–249 (2013).
Rehm, J. et al. A systematic review of the epidemiology of unrecorded alcohol consumption and the chemical composition of unrecorded alcohol. Addiction 109, 880–893 (2014).
Rehm, J., Kanteres, F. & Lachenmeier, D. W. Unrecorded consumption, quality of alcohol and health consequences. Drug Alcohol Rev. 29, 426–436 (2010).
Stickley, A. et al. Alcohol poisoning in Russia and the countries in the European part of the former Soviet Union, 1970 2002. Eur. J. Public Health 17, 444–449 (2007).
Bergmann, M. M. et al. The association of pattern of lifetime alcohol use and cause of death in the European prospective investigation into cancer and nutrition (EPIC) study. Int. J. Epidemiol. 42, 1772–1790 (2013).
Rehm, J. et al. The relation between different dimensions of alcohol consumption and burden of disease: an overview. Addiction 105, 817–843 (2010).
Rehm, J. et al. On the emerging paradigm of drinking patterns and their social and health consequences. Addiction 91, 1615–1621 (1996).
Roerecke, M. & Rehm, J. Irregular heavy drinking occasions and risk of ischemic heart disease: a systematic review and meta-analysis. Am. J. Epidemiol. 171, 633–644 (2010).
Makela, P. et al. Episodic heavy drinking in four Nordic countries: a comparative survey. Addiction 96, 1575–1588 (2001).
He, F. J., Li, J. & Macgregor, G. A. Effect of longer-term modest salt reduction on blood pressure. Cochrane Database of Systematic Reviews Issue 4. Art. No.: CD004937. http://dx.doi.org/10.1002/14651858.CD004937.pub2.
Mozaffarian, D. et al. Global sodium consumption and death from cardiovascular causes. N. Engl. J. Med. 371, 624–634 (2014).
Cook, N. R. et al. Joint effects of sodium and potassium intake on subsequent cardiovascular disease: the Trials of Hypertension Prevention follow-up study. Arch. Intern. Med. 169, 32–40 (2009).
Cook, N. R. et al. Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP). BMJ 334, 885–888 (2007).
Sacks, F. M. & Campos, H. Dietary therapy in hypertension. N. Engl. J. Med. 362, 2102–2112 (2010).
Mozaffarian, D., Appel, L. J. & Van Horn, L. Components of a cardioprotective diet: new insights. Circulation 123, 2870–2891 (2011).
Mozaffarian, D., Micha, R. & Wallace, S. Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials. PLoS Med. 7, e1000252 (2010).
Howard, B. V. et al. Low-fat dietary pattern and risk of cardiovascular disease: the Women's Health Initiative Randomized Controlled Dietary Modification Trial. JAMA 295, 655–666 (2006).
Chowdhury, R. et al. Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis. Ann. Intern. Med. 160, 398–406 (2014).
Nordmann, A. J. et al. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch. Intern. Med. 166, 285–293 (2006).
Estruch, R. et al. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann. Intern. Med. 145, 1–11 (2006).
Estruch, R. et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N. Engl. J. Med. 368, 1279–1290 (2013).
Kahn, H. A. Change in serum cholesterol associated with changes in the United States civilian diet, 1909–1965. Am. J. Clin. Nutr. 23, 879–882 (1970).
Antar, M. A., Ohlson, M. A. & Hodges, R. E. Changes in retail market food supplies in the United States in the last seventy years in relation to the incidence of coronary heart disease, with special reference to dietary carbohydrates and essential fatty acids. Am. J. Clin. Nutr. 14, 169–178 (1964).
Jackson, R. & Beaglehole, R. Trends in dietary fat and cigarette smoking and the decline in coronary heart disease in New Zealand. Int. J. Epidemiol. 16, 377–382 (1987).
Winkler, G., Doring, A. & Keil, U. Trends in dietary sources of nutrients among middle-aged men in southern Germany. Results of the MONICA Project Augsburg: dietary surveys 1984/1985 and 1994/1995. MONItoring trends and determinants in CArdiovascular disease. Appetite 34, 37–45 (2000).
Pietinen, P., Vartiainen, E., Seppanen, R., Aro, A. & Puska, P. Changes in diet in Finland from 1972 to 1992: impact on coronary heart disease risk. Prev. Med. 25, 243–250 (1996).
Laatikainen, T. et al. Sodium in the Finnish diet: 20-year trends in urinary sodium excretion among the adult population. Eur. J. Clin. Nutr. 60, 965–970 (2006).
Krachler, B., Eliasson, M. C., Johansson, I., Hallmans, G. & Lindahl, B. Trends in food intakes in Swedish adults 1986–1999: findings from the Northern Sweden MONICA (Monitoring of Trends and Determinants in Cardiovascular Disease) Study. Public Health Nutr. 8, 628–635 (2005).
Waskiewicz, A., Piotrowski, W., Sygnowska, E., Rywik, S. & Jasinski, B. Did favourable trends in food consumption observed in the 1984–2001 period contribute to the decrease in cardiovascular mortality?—Pol.-MONICA Warsaw Project. Kardiol. Pol. 64, 16–23 (2006).
Stephen, A. M. & Sieber, G. M. Trends in individual fat consumption in the UK 1900–1985. Br. J. Nutr. 71, 775–788 (1994).
Stephen, A. M. & Wald, N. J. Trends in individual consumption of dietary fat in the United States, 1920–1984. Am. J. Clin. Nutr. 52, 457–469 (1990).
Du, S. F., Wang, H. J., Zhang, B., Zhai, F. Y. & Popkin, B. M. China in the period of transition from scarcity and extensive undernutrition to emerging nutrition-related non-communicable diseases, 1949–1992. Obes. Rev. 15 (Suppl. 1), 8–15 (2014).
Wolmarans, P. Background paper on global trends in food production, intake and composition. Ann. Nutr. Metab. 55, 244–272 (2009).
Micha, R. et al. Global, regional, and national consumption levels of dietary fats and oils in 1990 and 2010: a systematic analysis including 266 country-specific nutrition surveys. BMJ 348, g2272 (2014).
Leth, T., Jensen, H. G., Mikkelsen, A. A. & Bysted, A. The effect of the regulation on trans fatty acid content in Danish food. Atheroscler. Suppl. 7, 53–56 (2006).
Angell, S. Y. et al. Cholesterol control beyond the clinic: New York City's trans fat restriction. Ann. Intern. Med. 151, 129–134 (2009).
Zatonski, W., Campos, H. & Willett, W. Rapid declines in coronary heart disease mortality in Eastern Europe are associated with increased consumption of oils rich in alpha-linolenic acid. Eur. J. Epidemiol. 23, 3–10 (2008).
Zatonski, W. A. & Willett, W. Changes in dietary fat and declining coronary heart disease in Poland: population based study. BMJ 331, 187–188 (2005).
Butt, M. S. & Sultan, M. T. Levels of trans fats in diets consumed in developing economies. J. AOAC Int. 92, 1277–1283 (2009).
Institute of Medicine. Sodium intake in populations: assessment of evidence (National Academies Press, 2013).
Cobb, L. K. et al. Methodological issues in cohort studies that relate sodium intake to cardiovascular disease outcomes: a science advisory from the American Heart Association. Circulation 129, 1173–1186 (2014).
Ikeda, N., Gakidou, E., Hasegawa, T. & Murray, C. J. Understanding the decline of mean systolic blood pressure in Japan: an analysis of pooled data from the National Nutrition Survey, 1986–2002. Bull. World Health Organ. 86, 978–988 (2008).
Ueshima, H., Tatara, K., Asakura, S. & Okamoto, M. Declining trends in blood pressure level and the prevalence of hypertension, and changes in related factors in Japan, 1956–1980. J. Chronic Dis. 40, 137–147 (1987).
Du, S. et al. Understanding the patterns and trends of sodium intake, potassium intake, and sodium to potassium ratio and their effect on hypertension in China. Am. J. Clin. Nutr. 99, 334–343 (2014).
Vartiainen, E. et al. Thirty-five-year trends in cardiovascular risk factors in Finland. Int. J. Epidemiol. 39, 504–518 (2010).
He, F. J. & MacGregor, G. A. Reducing population salt intake worldwide: from evidence to implementation. Prog. Cardiovasc. Dis. 52, 363–382 (2010).
He, F. J., Pombo-Rodrigues, S. & Macgregor, G. A. Salt reduction in England from 2003 to 2011: its relationship to blood pressure, stroke and ischaemic heart disease mortality. BMJ Open 4, e004549 (2014).
He, F. J., Brinsden, H. C. & MacGregor, G. A. Salt reduction in the United Kingdom: a successful experiment in public health. J. Hum. Hypertens. 28, 345–352 (2014).
Tuomilehto, J., Geboers, J., Joossens, J. V., Salonen, J. T. & Tanskanen, A. Trends in stomach cancer and stroke in Finland. Comparison to northwest Europe and USA. Stroke 15, 823–828 (1984).
Powles, J. et al. Global, regional and national sodium intakes in 1990 and 2010: a systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide. BMJ Open 3, e003733 (2013).
Brown, I. J., Tzoulaki, I., Candeias, V. & Elliott, P. Salt intakes around the world: implications for public health. Int. J. Epidemiol. 38, 791–813 (2009).
Sacks, F. M. & Kass, E. H. Low blood pressure in vegetarians: effects of specific foods and nutrients. Am. J. Clin. Nutr. 48, 795–800 (1988).
He, F. J., Nowson, C. A., Lucas, M. & MacGregor, G. A. Increased consumption of fruit and vegetables is related to a reduced risk of coronary heart disease: meta-analysis of cohort studies. J. Hum. Hypertens. 21, 717–728 (2007).
Drewnowski, A. & Popkin, B. M. The nutrition transition: new trends in the global diet. Nutr. Rev. 55, 31–43 (1997).
Pan, W. H. et al. Diet and health trends in Taiwan: comparison of two nutrition and health surveys from 1993–1996 and 2005–2008. Asia Pac. J. Clin. Nutr. 20, 238–250 (2011).
Blanck, H. M., Gillespie, C., Kimmons, J. E., Seymour, J. D. & Serdula, M. K. Trends in fruit and vegetable consumption among, U. S. men and women, 1994–2005. Prev. Chronic Dis. 5, A35 (2008).
Welsh, S. O. & Marston, R. M. Review of trends in food use in the United States, 1909 to 1980. J. Am. Diet. Assoc. 81, 120–128 (1982).
Cavadini, C., Siega-Riz, A. M. & Popkin, B. M. US adolescent food intake trends from 1965 to 1996. West. J. Med. 173, 378–383 (2000).
Wang, D. D. et al. Trends in dietary quality among adults in the United States, 1999 through 2010. JAMA Intern. Med. 174, 1587–1595 (2014).
Lee, S. et al. Trends in diet quality for coronary heart disease prevention between 1980–1982 and 2000–2002: The Minnesota Heart Survey. J. Am. Diet. Assoc. 107, 213–222 (2007).
Singh, G. M. et al. The age-specific quantitative effects of metabolic risk factors on cardiovascular diseases and diabetes: a pooled analysis. PLoS ONE 8, e65174 (2013).
Di Cesare, M. et al. The contributions of risk factor trends to cardiometabolic mortality decline in 26 industrialized countries. Int. J. Epidemiol. 42, 838–848 (2013).
Goff, D. C., Howard, G., Russell, G. B. & Labarthe, D. R. Birth cohort evidence of population influences on blood pressure in the United States, 1887–1994. Ann. Epidemiol. 11, 271–279 (2001).
Sakata, K. & Labarthe, D. R. Changes in cardiovascular disease risk factors in three Japanese national surveys 1971–1990. J. Epidemiol. 6, 93–107 (1996).
McCarron, P., Smith, G. D. & Okasha, M. Secular changes in blood pressure in childhood, adolescence and young adulthood: systematic review of trends from 1948 to 1998. J. Hum. Hypertens. 16, 677–689 (2002).
Tunstall-Pedoe, H., Connaghan, J., Woodward, M., Tolonen, H. & Kuulasmaa, K. Pattern of declining blood pressure across replicate population surveys of the WHO MONICA project, mid-1980s to mid-1990s, and the role of medication. BMJ 332, 629–635 (2006).
Hardoon, S. L. et al. Assessing the impact of medication use on trends in major coronary risk factors in older British men: a cohort study. Eur. J. Cardiovasc. Prev. Rehabil. 17, 502–508 (2010).
Bovet, P. et al. Divergent fifteen-year trends in traditional and cardiometabolic risk factors of cardiovascular diseases in the Seychelles. Cardiovasc. Diabetol. 8, 34 (2009).
Danaei, G. et al. The global cardiovascular risk transition: associations of four metabolic risk factors with national income, urbanization, and Western diet in 1980 and 2008. Circulation 127, 1493–1502 (2013).
Okayama, A. et al. Changes in total serum cholesterol and other risk factors for cardiovascular disease in Japan 1980–1989. Int. J. Epidemiol. 22, 1038–1047 (1993).
Okayama, A. et al. Different trends in serum cholesterol levels among rural and urban populations aged 40–59 in Japan from 1960 to 1990. J. Clin. Epidemiol. 48, 329–337 (1995).
Sjol, A., Grunnet, K. & Schroll, M. Secular trends in serum cholesterol, high density lipoproteins and triglycerides 1964–1987. Int. J. Epidemiol. 20, 105–113 (1991).
Capewell, S. & Ford, E. S. Why have total cholesterol levels declined in most developed countries? BMC Public Health 11, 641 (2011).
Manson, J. E. et al. Estrogen plus progestin and the risk of coronary heart disease. N. Engl. J Med. 349, 523–534 (2003).
Sigfusson, N. et al. Decline in ischaemic heart disease in Iceland and change in risk factor levels. BMJ 302, 1371–1375 (1991).
Dwyer, T. & Hetzel, B. S. A comparison of trends of coronary heart disease mortality in Australia, USA and England and Wales with reference to three major risk factors-hypertension, cigarette smoking and diet. Int. J. Epidemiol. 9, 65–71 (1980).
Williams, R. R., Lyon, J. L., Brockert, J. E. & Maness, T. in Proceedings of the Conference on the Decline in Coronary Heart Disease Mortality. October 24–25, 1978. NIH Publication No. 79–1610 (eds Havlik, R. J. & Feinleib, M.) 48–57 (National Heart, Lung, and Blood Institute, US Department of Health, Education, and Welfare, 1979).
[No authors listed] Why the American decline in coronary heart-disease? Lancet 1, 183–184 (1980).
Nicolosi, A., Casati, S., Taioli, E. & Polli, E. Death from cardiovascular disease in Italy, 1972–1981: decline in mortality rates and possible causes. Int. J. Epidemiol. 17, 766–772 (1988).
Menotti, A. & Scanga, M. Trends in coronary risk factors in Italy. Responsible Investigators of the RF2, OB43 and MICOL Research Groups. Int. J. Epidemiol. 21, 883–892 (1992).
Tunstall-Pedoe, H. et al. Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease. Lancet 353, 1547–1557 (1999).
Babyak, M. A. What you see may not be what you get: a brief, nontechnical introduction to overfitting in regression-type models. Psychosom. Med. 66, 411–421 (2004).
Kuulasmaa, K. et al. Estimation of contribution of changes in classic risk factors to trends in coronary-event rates across the WHO MONICA Project populations. Lancet 355, 675–687 (2000).
Lu, Y. et al. Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1.8 million participants. Lancet 383, 970–983 (2014).
Gregg, E. W. et al. Secular trends in cardiovascular disease risk factors according to body mass index in US adults. JAMA 293, 1868–1874 (2005).
Pell, S. & D'Alonzo, G. A. Immediate mortality and five-year survival of employed men with a first myocardial infarction. N. Engl. J Med. 270, 915–922 (1964).
Pell, S. & Fayerweather, W. E. Trends in the incidence of myocardial infarction and in associated mortality and morbidity in a large employed population, 1957–1983. N. Engl. J Med. 312, 1005–1011 (1985).
Rosamond, W. D. et al. Trends in the incidence of myocardial infarction and in mortality due to coronary heart disease, 1987 to 1994. N. Engl. J Med. 339, 861–867 (1998).
McGovern, P. G. et al. Trends in acute coronary heart disease mortality, morbidity, and medical care from 1985 through 1997: the Minnesota heart survey. Circulation 104, 19–24 (2001).
McGovern, P. G. et al. Recent trends in acute coronary heart disease—mortality, morbidity, medical care, and risk factors. The Minnesota Heart Survey Investigators. N. Engl. J Med. 334, 884–890 (1996).
Roger, V. L. et al. Trends in the incidence and survival of patients with hospitalized myocardial infarction, Olmsted County, Minnesota, 1979 to 1994. Ann. Intern. Med. 136, 341–348 (2002).
Goldberg, R. J., Yarzebski, J., Lessard, D. & Gore, J. M. A two-decades (1975 to 1995) long experience in the incidence, in-hospital and long-term case-fatality rates of acute myocardial infarction: a community-wide perspective. J. Am. Coll. Cardiol 33, 1533–1539 (1999).
Morris, R. W. et al. Geographic variation in incidence of coronary heart disease in Britain: the contribution of established risk factors. Heart 86, 277–283 (2001).
Hardoon, S. L., Whincup, P. H., Petersen, I., Capewell, S. & Morris, R. W. Trends in longer-term survival following an acute myocardial infarction and prescribing of evidenced-based medications in primary care in the UK from 1991: a longitudinal population-based study. J. Epidemiol. Community Health 65, 770–774 (2011).
Capewell, S. et al. Short-term and long-term outcomes in 133,429 emergency patients admitted with angina or myocardial infarction in Scotland, 1990–2000: population-based cohort study. Heart 92, 1563–1570 (2006).
Grey, C. et al. Twenty-eight day and one-year case fatality after hospitalisation with an acute coronary syndrome: a nationwide data linkage study. Aust. N. Z. J. Public Health 38, 216–220 (2014).
Hammar, N. et al. A national record linkage to study acute myocardial infarction incidence and case fatality in Sweden. Int. J. Epidemiol. 30 (Suppl. 1), S30–S34 (2001).
Krumholz, H. M., Normand, S.-L. T. & Wang, Y. Trends in hospitalizations and outcomes for acute cardiovascular disease and stroke: 1999–2011. Circulation 130, 966–975 (2014).
Schmidt, M., Bonde, J., Lash, T. L., Bøtker, H. E. & Sørensen, H. T. 25 year trends in first time hospitalisation for acute myocardial infarction, subsequent short and long term mortality, and the prognostic impact of sex and comorbidity: a Danish nationwide cohort study. BMJ 356, 1–12 (2012).
Smolina, K., Wright, F. L., Rayner, M. & Goldacre, M. J. Determinants of the decline in mortality from acute myocardial infarction in England between 2002 and 2010: linked national database study. BMJ 344, d8059 (2012).
Ezzati, M., Lopez, A. D., Rodgers, A., Vander Hoorn, S. & Murray, C. J. Selected major risk factors and global and regional burden of disease. Lancet 360, 1347–1360 (2002).
Hunink, M. G. et al. The recent decline in mortality from coronary heart disease, 1980–1990. The effect of secular trends in risk factors and treatment. JAMA 277, 535–542 (1997).
Goldman, L. et al. The effect of risk factor reductions between 1981 and 1990 on coronary heart disease incidence, prevalence, mortality and cost. J. Am. Coll. Cardiol. 38, 1012–1017 (2001).
Unal, B., Critchley, J. A. & Capewell, S. Modelling the decline in coronary heart disease deaths in England and Wales, 1981–2000: comparing contributions from primary prevention and secondary prevention. BMJ 331, 614 (2005).
Unal, B., Capewell, S. & Critchley, J. A. Coronary heart disease policy models: a systematic review. BMC Public Health 6, 213 (2006).
Goldman, L. & Cook, E. F. The decline in ischemic heart disease mortality rates. An analysis of the comparative effects of medical interventions and changes in lifestyle. Ann. Intern. Med. 101, 825–836 (1984).
Mathers, C. D., Stevens, G. A., Boerma, T., White, R. A. & Tobias, M. I. Causes of international increases in older age life expectancy. Lancet 385, 540–548 (2014).
Lim, S. S. et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 2224–2260 (2012).
Danaei, G. et al. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med. 6, e1000058 (2009).
Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration. Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment. Lancet Diabetes Endocrinol. 2, 634–647 (2014).
Ezzati, M. et al. Estimates of global and regional potential health gains from reducing multiple major risk factors. Lancet 362, 271–280 (2003).
Woodward, M. et al. A comparison of the associations between risk factors and cardiovascular disease in Asia and Australasia. Eur. J. Cardiovasc. Prev. Rehabil. 12, 484–491 (2005).
Walter, S. D. Prevention of multifactorial disease. Am. J. Epidemiol. 112, 409–416 (1980).
Yerushalmy, J. & Palmer, C. E. On the methodology of investigations of etiologic factors in chronic diseases. J. Chronic Dis. 108, 27–40 (1959).
Thorolfsdottir, R. B. et al. Population assessment of future trajectories in coronary heart disease mortality. PLoS ONE 9, e85800 (2014).
Wang, Y. C., McPherson, K., Marsh, T., Gortmaker, S. L. & Brown, M. Health and economic burden of the projected obesity trends in the USA and the UK. Lancet 378, 815–825 (2011).
Webber, L. et al. The future burden of obesity-related diseases in the 53 WHO European-Region countries and the impact of effective interventions: a modelling study. BMJ Open 4, e004787 (2014).
Leon, D. A., Shkolnikov, V. M. & McKee, M. Alcohol and Russian mortality: a continuing crisis. Addiction 104, 1630–1636 (2009).
McKee, M., Shkolnikov, V. & Leon, D. A. Alcohol is implicated in the fluctuations in cardiovascular disease in Russia since the 1980s. Ann. Epidemiol. 11, 1–6 (2001).
Leon, D. A. et al. Hazardous alcohol drinking and premature mortality in Russia: a population based case-control study. Lancet 369, 2001–2009 (2007).
Tomkins, S. et al. Identifying the determinants of premature mortality in Russia: overcoming a methodological challenge. BMC Public Health 7, 343 (2007).
Zaridze, D. et al. Alcohol and cause-specific mortality in Russia: a retrospective case-control study of 48,557 adult deaths. Lancet 373, 2201–2214 (2009).
Zaridze, D. et al. Alcohol and mortality in Russia: prospective observational study of 151,000 adults. Lancet 383, 1465–1473 (2014).
Franco, M. et al. Population-wide weight loss and regain in relation to diabetes burden and cardiovascular mortality in Cuba 1980–2010: repeated cross sectional surveys and ecological comparison of secular trends. BMJ 346, f1515 (2013).
Peto, R., Lopez, A. D., Boreham, J., Thun, M. & Heath, C. Jr. Mortality from tobacco in developed countries: indirect estimation from national vital statistics. Lancet 339, 1268–1278 (1992).
Preston, S. H., Glei, D. A. & Wilmoth, J. R. A new method for estimating smoking-attributable mortality in high-income countries. Int. J. Epidemiol. 39, 430–438 (2010).
Beaglehole, R. Medical management and the decline in mortality from coronary heart disease. Br. Med. J. (Clin. Res. Ed.) 292, 33–35 (1986).
Rose, G. The contribution of intensive coronary care. Br. J. Prev. Soc. Med. 29, 147–150 (1975).
Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico (GISSI). Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet 1, 397–402 (1986).
ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 2, 349–360 (1988).
Gunnar, R. M. et al. Guidelines for the early management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee to Develop Guidelines for the Early Management of Patients with Acute Myocardial Infarction). J. Am. Coll. Cardiol 16, 249–292 (1990).
Rogers, W. J. et al. Temporal trends in the treatment of over 1.5 million patients with myocardial infarction in the US from 1990 through 1999: the National Registry of Myocardial Infarction 1, 2 and 3. J. Am. Coll. Cardiol. 36, 2056–2063 (2000).
Nabel, E. G. & Braunwald, E. A tale of coronary artery disease and myocardial infarction. N. Engl. J. Med. 366, 54–63 (2012).
Kumbhani, D. J. et al. Temporal trends for secondary prevention measures among patients hospitalized with coronary artery disease. Am. J. Med. 128, 426.e1–426.e9 (2014).
[No authors listed] Effects of treatment on morbidity in hypertension. Results in patients with diastolic blood pressures averaging 115 through 129 mm Hg. JAMA 202, 1028–1034 (1967).
Medical Research Council Working Party. MRC trial of treatment of mild hypertension: principal results. Br. Med. J. (Clin. Res. Ed.) 291, 97–104 (1985).
[No authors listed] The Australian therapeutic trial in mild hypertension. Report by the Management Committee. Lancet 1, 1261–1267 (1980).
SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 265, 3255–3264 (1991).
Beckett, N. S. et al. Treatment of hypertension in patients 80 years of age or older. N. Engl. J. Med. 358, 1887–1898 (2008).
Law, M. R., Morris, J. K. & Wald, N. J. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 338, b1665 (2009).
Stott, D. J. in Handbook of Hypertension, Vol. 20, Epidemiology of Hypertension (ed. Bulpitt, C. J.) (Elsevier, 2000).
Blood Pressure Lowering Treatment Trialists' Collaboration. Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet 362, 1527–1535 (2003).
Egan, B. M., Zhao, Y. & Axon, R. N. US trends in prevalence, awareness, treatment, and control of hypertension, 1988–2008. JAMA 303, 2043–2050 (2010).
Hajjar, I. & Kotchen, T. A. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA 290, 199–206 (2003).
Chobanian, A. V. et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 42, 1206–1252 (2003).
Andersen, U. O. & Jensen, G. B. Trends and determinant factors for population blood pressure with 25 years of follow-up: results from the Copenhagen City Heart Study. Eur. J. Cardiovasc. Prev. Rehabil. 17, 655–659, (2010).
Andersen, U. O. & Jensen, G. B. Trends and determinant factors in hypertension control in a population study with 25 years of follow-up. J. Hypertens. 28, 1091–1096 (2010).
Fasce, E. et al. Trends in prevalence, awareness, treatment and control of hypertension in urban communities in Chile. J. Hypertens. 25, 1807–1811 (2007).
Chow, C. K. et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA 310, 959–968 (2013).
Tobert, J. A. Lovastatin and beyond: the history of the HMG-CoA reductase inhibitors. Nat. Rev. Drug Discov. 2, 517–526 (2003).
Ford, E. S., Li, C., Pearson, W. S., Zhao, G. & Mokdad, A. H. Trends in hypercholesterolemia, treatment and control among United States adults. Int. J. Cardiol. 140, 226–235 (2010).
Wald, N. J. & Law, M. R. A strategy to reduce cardiovascular disease by more than 80%. BMJ 326, 1419 (2003).
Cholesterol Treatment Trialists (CTT) Collaborators. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 380, 581–590 (2012).
National Cholesterol Education Program (NCEPT) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 106, 3143–3421 (2002).
Carleton, R. A. et al. Report of the Expert Panel on Population Strategies for Blood Cholesterol Reduction. A statement from the National Cholesterol Education Program, National Heart, Lung, and Blood Institute, National Institutes of Health. Circulation 83, 2154–2232 (1991).
Roth, G. A. et al. High total serum cholesterol, medication coverage and therapeutic control: an analysis of national health examination survey data from eight countries. Bull. World Health Organ. 89, 92–101 (2011).
Cholesterol Treatment Trialists' (CTT) Collaboration. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90 056 participants in 14 randomised trials of statins. Lancet 366, 1267–1278 (2010).
Yusuf, S. et al. Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries (the PURE Study): a prospective epidemiological survey. Lancet 378, 1231–1243 (2011).
Pell, S. & D'Alonzo, C. A. Factors associated with long-term survival of diabetics. JAMA 214, 1833–1840 (1970).
Holman, R. R., Sourij, H. & Califf, R. M. Cardiovascular outcome trials of glucose-lowering drugs or strategies in type 2 diabetes. Lancet 383, 2008–2017 (2014).
Holman, R. R., Paul, S. K., Bethel, M. A., Matthews, D. R. & Neil, H. A. 10-year follow-up of intensive glucose control in type 2 diabetes. N. Engl. J. Med. 359, 1577–1589, (2008).
Riddle, M. C. et al. Epidemiologic relationships between A1C and all-cause mortality during a median 3.4-year follow-up of glycemic treatment in the ACCORD trial. Diabetes Care 33, 983–990 (2010).
Skyler, J. S. et al. Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA diabetes trials: a position statement of the American Diabetes Association and a scientific statement of the American College of Cardiology Foundation and the American Heart Association. Circulation 119, 351–357 (2009).
Ismail-Beigi, F. et al. Individualizing glycemic targets in type 2 diabetes mellitus: implications of recent clinical trials. Ann. Intern. Med. 154, 554–559 (2011).
Cefalu, W. T. Glycemic targets and cardiovascular disease. N.Engl. J. Med. 358, 2633–2635 (2008).
Ali, M. K. et al. Achievement of goals in U.S. diabetes care, 1999–2010. N. Engl. J. Med. 368, 1613–1624 (2013).
Tunstall-Pedoe, H. et al. Estimation of contribution of changes in coronary care to improving survival, event rates, and coronary heart disease mortality across the WHO MONICA Project populations. Lancet 355, 688–700 (2000).
Tunstall-Pedoe, H. in Coronary Heart Disease Epidemiology: From Aetiology to Public Health (eds Marmot, M. & Elliott, P.) 850–864 (Oxford University Press, 2005).
Arciero, T. J. et al. Temporal trends in the incidence of coronary disease. Am. J. Med. 117, 228–233 (2004).
Levy, D. & Thom, T. J. Death rates from coronary disease—progress and a puzzling paradox. N. Engl. J. Med. 339, 915–917 (1998).
Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. Eur. Heart J. 21, 1502–1513 (2000).
Tunstall-Pedoe, H. Comment on the ESC/ACC redefinition of myocardial infarction by a consensus dissenter. Eur. Heart J. 22, 613–616 (2001).
Myerson, M. et al. Declining severity of myocardial infarction from 1987 to 2002: the Atherosclerosis Risk in Communities (ARIC) Study. Circulation 119, 503–514 (2009).
Rosamond, W. D. et al. Twenty-two-year trends in incidence of myocardial infarction, coronary heart disease mortality, and case fatality in 4 US communities, 1987–2008. Circulation 125, 1848–1857 (2012).
Hamm, C. W. et al. The prognostic value of serum troponin T in unstable angina. N. Engl. J. Med. 327, 146–150 (1992).
Mills, N. L. et al. Implementation of a sensitive troponin I assay and risk of recurrent myocardial infarction and death in patients with suspected acute coronary syndrome. JAMA 305, 1210–1216 (2011).
Yusuf, S., Reddy, S., Ounpuu, S. & Anand, S. Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation 104, 2746–2753 (2001).
Khatibzadeh, S., Farzadfar, F., Oliver, J., Ezzati, M. & Moran, A. Worldwide risk factors for heart failure: a systematic review and pooled analysis. Int. J. Cardiol. 168, 1186–1194 (2013).
Lozano, R. et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 2095–2128 (2012).
Mayosi, B. M. in Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th edn (eds Mann, D. L., Zipes, D. P., Libby, P. & Bonow, R. O.) (Elsevier Saunders, 2015).
Kaplan, E. L. T. Duckett Jones Memorial Lecture. Global assessment of rheumatic fever and rheumatic heart disease at the close of the century. Influences and dynamics of populations and pathogens: a failure to realize prevention? Circulation 88, 1964–1972 (1993).
Moriyama, I. M., Baum, W. S., Haenszel, W. M. & Mattison, B. F. Inquiry into diagnostic evidence supporting medical certifications of death. Am. J. Public Health Nations Health 48, 1376–1387 (1958).
Tibazarwa, K. B., Volmink, J. A. & Mayosi, B. M. Incidence of acute rheumatic fever in the world: a systematic review of population-based studies. Heart 94, 1534–1540 (2008).
Seckeler, M. D. & Hoke, T. R. The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease. Clin. Epidemiol. 3, 67–84 (2011).
Gordis, L. The virtual disappearance of rheumatic fever in the United States: lessons in the rise and fall of disease. T. Duckett Jones memorial lecture. Circulation 72, 1155–1162 (1985).
Madden, S. & Kelly, L. Update on acute rheumatic fever: it still exists in remote communities. Can. Fam. Physician 55, 475–478 (2009).
White, H. et al. Rheumatic heart disease in indigenous populations. Heart Lung Circ. 19, 273–281 (2010).
Arguedas, A. & Mohs, E. Prevention of rheumatic fever in Costa Rica. J. Pediatr. 121, 569–572 (1992).
Nordet, P., Lopez, R., Duenas, A. & Sarmiento, L. Prevention and control of rheumatic fever and rheumatic heart disease: the Cuban experience (1986–1996–2002). Cardiovasc. J. Afr. 19, 135–140 (2008).
Bach, J. F. et al. 10-year educational programme aimed at rheumatic fever in two French Caribbean islands. Lancet 347, 644–648 (1996).
Karthikeyan, G. & Mayosi, B. M. Is primary prevention of rheumatic fever the missing link in the control of rheumatic heart disease in Africa? Circulation 120, 709–713 (2009).
Omurzakova, N. A. et al. Rheumatologic services in Central Asian countries: current state of development of rheumatology in Central Asia. Int. J. Rheum. Dis. 12, 288–292 (2009).
Omurzakova, N. A. et al. High incidence of rheumatic fever and rheumatic heart disease in the republics of Central Asia. Int. J. Rheum. Dis. 12, 79–83 (2009).
Alfieri, O., Mayosi, B. M., Park, S. J., Sarrafzadegan, N. & Virmani, R. Exploring unknowns in cardiology. Nat. Rev. Cardiol. 11, 664–670 (2014).
Mocumbi, A. O. & Falase, A. O. Recent advances in the epidemiology, diagnosis and treatment of endomyocardial fibrosis in Africa. Heart 99, 1481–1487 (2013).
Sliwa, K. & Mayosi, B. M. Recent advances in the epidemiology, pathogenesis and prognosis of acute heart failure and cardiomyopathy in Africa. Heart 99, 1317–1322 (2013).
Roivainen, M. et al. Infections, inflammation, and the risk of coronary heart disease. Circulation 101, 252–257 (2000).
Barnighausen, T. et al. Hiding in the shadows of the HIV epidemic: obesity and hypertension in a rural population with very high HIV prevalence in South Africa. J. Hum. Hypertens. 22, 236–239 (2008).
Ntsekhe, M. & Mayosi, B. M. Cardiac manifestations of HIV infection: an African perspective. Nat. Clin. Pract. Cardiovasc. Med. 6, 120–127 (2009).
Zanni, M. V., Schouten, J., Grinspoon, S. K. & Reiss, P. Risk of coronary heart disease in patients with HIV infection. Nat. Rev. Cardiol. 11, 728–741 (2014).
Farzadfar, F. et al. Effectiveness of diabetes and hypertension management by rural primary health-care workers (Behvarz workers) in Iran: a nationally representative observational study. Lancet 379, 47–54 (2012).
Bennett, J. E. et al. The future of life expectancy and life expectancy inequalities in England and Wales: Bayesian spatiotemporal forecasting. Lancet http://dx.doi.org/10.1016/S0140-6736(15)60296-3.
WHO. WHO methods and data sources for global causes of death, 2000–2012 [online], (2014).
Knowler, W. C. et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N. Engl. J. Med. 346, 393–403 (2002).
Look Ahead Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N. Engl. J. Med. 369, 145–154 (2013).
Paffenbarger, R. S. J. in Proceedings of the Conference on the Decline in Coronary Heart Disease Mortality. October 24–25, 1978. NIH Publication No. 79–1610 (eds Havlik, R. J. & Feinleib, M.) 298–311 (National Heart, Lung, and Blood Institute, US Department of Health, Education, and Welfare, 1979).
Kuller, L. H., Laporte, R. E. & Weinberg, G. B. in Proceedings of the Conference on the Decline in Coronary Heart Disease Mortality. October 24–25, 1978. NIH Publication No. 79–1610 (eds Havlik, R. J. & Feinleib, M.) 312–339 (National Heart, Lung, and Blood Institute, US Department of Health, Education, and Welfare, 1979).
Luepker, R. V. WHO MONICA project: what have we learned and where to go from here? Public Health Rev. 33, 373–396 (2012).
Tunstall-Pedoe, H. et al. Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation 90, 583–612 (1994).
Griffiths, C., Brock, A. & Rooney, C. The impact of introducing ICD-10 on trends in mortality from circulatory diseases in England and Wales. Health Stat. Q. 22, 14–20 (2004).
Murray, C. J., Kulkarni, S. C. & Ezzati, M. Understanding the coronary heart disease versus total cardiovascular mortality paradox: a method to enhance the comparability of cardiovascular death statistics in the United States. Circulation 113, 2071–2081 (2006).
Stevens, G. A., King, G. & Shibuya, K. Deaths from heart failure: using coarsened exact matching to correct cause-of-death statistics. Popul. Health Metr. 8, 6 (2010).
WHO. The Global Burden of Disease: 2004 Update (WHO, 2008).
We thank Colin Mathers and Gretchen Stevens (WHO, Switzerland), and Vasilis Kontis (Imperial College London, UK) for data and figures on mortality trends; Juergen Rehm (University of Toronto, Canada) for data on trends in alcohol consumption in Russia; Yasaman Vali (Imperial College London, UK) for assistance with references; and Mohammed Ali (Emory University, GA, USA), Perviz Asaria (Imperial College London, UK), Robert Beaglehole (University of Auckland, New Zealand), Peter Burney (Imperial College London, UK), Zhengming Chen (University of Oxford, UK), Goodarz Danaei (Harvard School of Public Health, MA, USA), Darwin Labarathe (Northwestern University, IL, USA), Juergen Rehm (University of Toronto, Canada), and Jonathan Samet (University of Southern California, CA, USA) for discussions on materials covered in the Review. M.E. is supported by a strategic grant from the UK Medical Research Council (MRC), and by the MRC and Public Health England (PHE) through support to the MRC–PHE Centre for Environment and Health. Z.O. is supported by a grant from the Common Fund of the US National Institutes of Health. P.E. has received funding from the National Institute for Health Research (NIHR) Biomedical Research Centre at Imperial College Healthcare NHS Trust and Imperial College London, the NIHR Health Protection Research Unit on the Impact of Environmental Hazards, and from the MRC and PHE in support of the MRC-PHE Centre for Environment and Health.
The authors declare no competing financial interests.
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Ezzati, M., Obermeyer, Z., Tzoulaki, I. et al. Contributions of risk factors and medical care to cardiovascular mortality trends. Nat Rev Cardiol 12, 508–530 (2015). https://doi.org/10.1038/nrcardio.2015.82
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