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Secondary prevention of coronary heart disease in older patients after the national service framework: population based study

BMJ 2006; 332 doi: (Published 19 January 2006) Cite this as: BMJ 2006;332:144
  1. Sheena E Ramsay (s.ramsay{at}, research fellow,
  2. Peter H Whincup, professor of cardiovascular epidemiology,
  3. Debbie A Lawlor, senior lecturer in epidemiology and public health medicine,
  4. Olia Papacosta, research statistician,
  5. Lucy T Lennon, research administrator,
  6. Mary C Thomas, research assistant,
  7. Shah Ebrahim, professor in epidemiology of ageing,
  8. Richard W Morris, reader in medical statistics
  1. Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London NW3 2PF
  2. Department of Social Medicine, University of Bristol, Bristol BS8 2PR
  1. Correspondence to: S E Ramsay
  • Accepted 14 November 2005


Objective To examine the extent of uptake of medication for secondary prevention of coronary heart disease in older British men and women before (1998-2001) and after (2003) the implementation of the national service framework.

Design Two population based, longitudinal studies of men and women aged 60-79 in 1998-2001, based in one general practice in each of 24 British towns.

Participants Men and women with established coronary heart disease at the two time points (respectively 817 and 465 in 1998-2001, 857 and 548 in 2003), aged 60-79 in 1998-2001.

Main outcome measures Prevalence of use of antiplatelet medication, statins, β blockers, angiotensin converting enzyme (ACE) inhibitors, and other blood pressure lowering treatments (individually and in combination) assessed in 1998-2001 and 2003.

Results Between 1998-2001 and 2003, the use of all individual drugs had increased in both men and women, especially for statins (from 34% to 65% in men and from 48% to 67% in women with myocardial infarction). However, less than half received β blockers and ACE inhibitors, even by 2003. Prevalences of medication use were lower in patients with angina than in those with myocardial infarction. The proportions of patients receiving more than one drug increased over time; by 2003 about half of patients with myocardial infarction and a third of those with angina were receiving antiplatelet medication, statins, and blood pressure lowering treatments.

Conclusions Between 1998-2001 and 2003, statin uptake and the use of combined drug treatment in elderly men and women increased markedly. Further potential exists, however, for reducing the risk of recurrent coronary heart disease in older patients, particularly by improving the uptake of medication among angina patients, and by more extensive use of blood pressure lowering treatment (particularly with β blockers and ACE inhibitors).


  • This article was posted on on 9 January 2006:

  • Contributors SER, PHW, and RWM developed the original idea for the paper, and SER wrote the first draft. SER, OP, and DAL performed the analyses. PHW, RWM, MCT, LTL, and SE contributed to the design and execution of the British Regional Heart Study, and DAL and SE to the design and execution of the British women's heart and health study. All authors contributed to interpretation of data and the final version of the manuscript, and all are guarantors.

  • Funding The British regional heart study and the British women's heart and health study are funded by the Department of Health, England. The British Regional Heart Study is also a British Heart Foundation Research Group. DAL is funded by a career scientist award from the UK Department of Health.

  • Competing interests None declared.

  • Ethical approval The British regional heart study and the British women's heart and health study have local (from each of the districts in which the study was based) and multicentre ethical committee approvals.

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