Decreases in blood pressure (BP) and cholesterol prevented or postponed more than 20,000 deaths in England between 2000 and 2007, new data published in BMJ Open indicate, although health care disparities may persist between socioeconomic classes.

“Primary prevention medications to lower blood pressure and cholesterol … have been a standard UK health policy for almost two decades. However, while their quantitative benefits to whole populations are accepted, their potential contributions to reduce inequalities are less clear,” the researchers wrote.

“The aim of this study was, therefore, to analyze the recent falls in [coronary heart disease] mortality and quantify the relative contributions from preventive medications and from population-wide changes in blood pressure and cholesterol levels, particularly exploring the potential effects on different socioeconomic groups.”


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From 2000 to 2007, the number of deaths from coronary heart disease (CHD) decreased by 38,000. Of these, 20,400 were attributable to reductions in BP and total cholesterol, according to the researchers’ findings.

Overall, reductions in BP accounted for approximately 13,000 of the total prevented or postponed deaths — 1,800 of which were attributable to medications and 11,200 of which resulted from population-wide changes.

When evaluated by socioeconomic status, results showed that BP reductions prevented nearly twice as many deaths in poorest quintile of the population vs. the most affluent quintile, according to the data.

Similarly, reductions in cholesterol appeared to help drive the decrease in number of CHD-related deaths, accounting for approximately 7,400 of the 20,400 prevented or postponed deaths. Of these, 5,300 were attributable to statin use and 2,100 to population-wide changes.

The researchers also noted, however, that statins prevented almost 50% more deaths in the most affluent quintile vs. the poorest quintile, whereas population-wide changes prevented three times as many deaths in the poorest quintile vs. the most affluent quintile.

Absolute mortality reductions were greatest among the poorest quintile of the population, which was representative of their bigger initial burden of disease, according to the researchers.

“Targeting high-risk individuals with medication appears less effective and may also widen socioeconomic inequalities in CHD mortality,” they wrote.

“Any intervention that requires people to mobilize their own resources (material and psychological) will understandably favor those who have greater resources, and thus widen social inequalities.”

Reference

  1. Guzman-Castillo M et al. BMJ Open. 2015;doi:10.1136/bmjopen-2014-006070.