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September 10, 1982

Seeking Explanations for Secular Trends in Cardiovascular Mortality

JAMA. 1982;248(10):1178. doi:10.1001/jama.1982.03330100018012

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To the Editor.—  In his recent review of the downward trend in cardiovascular mortality (1982;247:877), Dr Kannel states that the combined impact of medical and surgical interventions would seem insufficient to produce a 25% improvement. While without question the improvement has been multifactorial, especially in coronary heart disease mortality, we are talking about 600,000 to 700,000 deaths per year with up to 200,000 primary or "salvage" operative procedures, an increasing role of thrombolysins and dilatation treatment, and the introduction of calcium antagonists and β-blockers. The role of the medical and surgical teams in affecting modification of risk factors is also significant, as both coronary bypass surgery and even a mild myocardial infarction can make the patient unusually susceptible to suggestions that he lose weight, stop smoking, take his medications, and increase his activity level. I refuse to operate on any patient who has not stopped smoking, and with a waiting