The recent decrease in cardiovascular mortality in the U.S.A. Hard facts and soft interpretations

The following factors have been claimed to influence these favorable trends: 1. Declining incidence of influenza and pneumonia, with the decline in cardiovascular deaths a secondary phenomenon. 2. Improved chronic and intensive care for cardiovascular disease patients. 3. Measured decreases in cigarette smoking among adults. 4. Evidence of altered dietary intake of saturated fat, cholesterol and salt. 5. Enhanced detection, treatment and control of hypertension. 6. Weight loss facilities, increased participation in exercise, and greater health awareness. These factors do not satisfactorily explain the changes observed in mortality. For example, IDH rates have continued to fall sharply among whites, whereas influenza death rates have leveled off since 1972. Whites have greater access to medical services in many areas of the United States, yet IHD and CVD rates are falling more sharply in nonwhites. Marked decreases in cigarette smoking have been measured in middle-aged men but similar changes in women have not been documented despite their rapidly falling IHD mortality. Mass changes in eating patterns, decreasing serum cholesterol and better hypertension control in the general population have probably occurred though they are inadequately documented. But despite recent improvements in hypertension detection and treatment, declines in mortality for stroke and all major cardiovascular diseases long preceded the availability and mass application of effective anti-hypertensive drugs. The operation of mass psycho-social factors to alter health behavior and risk factor levels or independently affect disease rates is, for the moment, pure speculation.