BMJ. UK: Falls in blood pressure and total
cholesterol staved off more than 20,000 deaths from coronary heart
disease in England between 2000 and 2007, shows a mathematical analysis
published in the online journal BMJ Open. The
impact of statins was greatest among the most affluent in the
population, suggesting that these drugs have helped maintain health
inequalities between rich and poor, say the researchers.
The
researchers wanted to quantify the contributions made by drug treatment
(primary prevention) and changes in population risk factors (blood
pressure and total cholesterol) to the falling rates of coronary heart
disease deaths, stratified by socioeconomic background.
They
used trial data, analyses of published evidence, national surveys, and
official statistics to calculate the number of deaths postponed or
prevented across the population of England.
The
analysis showed that between 2000 and 2007 deaths from coronary heart
disease fell by 38,000, of which 20,400 lives were saved as a direct
result of reductions in blood pressure and total cholesterol.
In
absolute terms, a higher proportion of lives were saved among the least
affluent sectors of the population, which is to be expected given their
much higher prevalence of risk factors, say the researchers.
The
substantial fall in blood pressure accounted for well over half of the
total, the calculations indicated, with around 13,000 deaths prevented
or postponed.
But
only a small proportion (1800) of these were attributable to drug
treatment, with the rest accounted for by changes in risk factors at the
population level.
Falls in blood pressure prevented almost twice as many deaths among the population’s poorest as among the richest.
Falls
in total cholesterol accounted for some 7400 deaths prevented or
postponed, of which (5300 or 14% of the total) were attributable to
statins, with the remainder attributable to changes in risk factors at
the population level.
Statins
prevented almost 50% more deaths among the richest compared with the
poorest, whereas changes at the population level prevented three times
as many deaths among the poorest as among the richest.
The
researchers were not able to account for 14% of the total fall in
coronary heart disease deaths between 2000 and 2007 (17,600 lives
saved). These might be attributable to other risk factors for heart
disease, such as stress, they suggest.
They
conclude that population-wide approaches, focusing on prevention, such
as public health initiatives to curb salt and trans fat levels in
processed and take-away foods may have more of an impact than
prescribing drugs to individuals.
“Targeting
high-risk individuals with medication appears less effective and may
also widen socioeconomic inequalities in [coronary heart disease]
mortality,” they write.
“Any
intervention that requires people to mobilise their own resources
(material and psychological) will understandably favour those who have
greater resources, and thus widen social inequalities,” they add.
When healthcare budgets are stretched, as now, preventive approaches are a better way to get results, they suggest.