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September 10, 1982

Seeking Explanations for Secular Trends in Cardiovascular Mortality-Reply

JAMA. 1982;248(10):1178-1179. doi:10.1001/jama.1982.03330100018013

In Reply.—  Among those who have made a study of the issue, opinion is divided as to how much of the decline in cardiovascular mortality has resulted from an altered life-style and how much is a consequence of innovations in medical care. To provide a supportable answer, certain currently unavailable information is required. It is necessary to know whether the incidence (attack rate) has declined along with mortality; whether reinfarction rates have decreased; whether the ratio of sudden to nonsudden deaths has changed; and whether there has been a decrease in incidence of myocardial infarction following angina. Unfortunately, data on these points are sparse and inconsistent.The case for either improved treatment or risk-factor modification is difficult to sustain. A substantial part of coronary heart disease (CHD) mortality progresses from inapparent disease to death rather precipitously. Much of the premature coronary mortality comes on with little warning, in a population