BMJ  2005;330:1046 (7 May), doi:10.1136/bmj.330.7499.1046

Paper

Trends in rates of different forms of diagnosed coronary heart disease, 1978 to 2000: prospective, population based study of British men

¹ Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London NW3 2PF, ² Department of Community Health Sciences, St George's Hospital Medical School, London SW17 ORE

Objective To examine trends over time in rates of different forms of diagnosed coronary heart disease among British men, during a period in which mortality due to coronary heart disease has been declining.

Design Prospective cohort study covering the period 1978-80 to 1998-2000.

Participants 7735 men, aged 40-59 at entry, randomly selected from one general practice in each of 24 British towns.

Main outcome measures Trends in the rates of major coronary events, first diagnosed angina and first diagnosed coronary heart disease (any fatal or non-fatal documented event or diagnosis). Events were ascertained from NHS central registers and reviews of medical records from general practices.

Results Over the 20 year period, 1561 major coronary events occurred; 1087 and 1816 men had new diagnoses of angina and coronary heart disease, respectively. The age adjusted annual relative changes were -3.6% (95% confidence interval -4.8% to -2.4%, P < 0.001) for all major coronary events, 2.6% (1.1% to 4.0%, P < 0.001) for first diagnosed angina and -0.8% (-1.8% to 0.3%, P = 0.18) for first diagnosed coronary heart disease. The fall in major coronary events occurred across all categories of event (fatal and non-fatal, first and recurrent). Similarly, first diagnosed angina increased for both uncomplicated angina and angina after myocardial infarction. The age adjusted annual relative change in case fatality at 28 days of first major coronary events was -1.4% (-3.1% to 0.4%, P = 0.12).

Conclusions Among British middle aged men, a substantial decline in the rate of major coronary events over the past two decades seems to have been largely offset by an increase in the incidence of diagnosed angina. Overall there was little change in the incidence of first diagnosed coronary heart disease. A continuing need exists for resources and services for coronary heart disease in general, and for new angina in particular.

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