In the linked study (doi:10.1136/bmj.b2613), O’Flaherty and colleagues examine trends in mortality from coronary heart disease in Scotland according to age and deprivation, from 1986 to 2006.1 The study adds to these authors’ previous work on the role of risk factors and advances in medical care in explaining the decline of mortality from coronary heart disease in several countries. The study shows that mortality from this disease has flattened in younger adults (age 35-54) in the most socially deprived groups. This work shows how changes in population levels of traditional risk factors have led to the impressive decline in mortality from coronary heart disease in recent decades.2

Mortality has fallen and age standardised rates are down in all social groups. This is good news, but, on the negative side, the favourable trends are flattening in younger men and perhaps women, although the authors caution not to overstate the importance of these changes. This is an example of the usefulness of examining …