The sharp drop-off in UK heart disease deaths in recent decades may owe much more to prevention than to advances in treatment, a new study suggests.

Researchers estimate that “risk factor changes,” such as lower smoking rates and improved blood pressure and cholesterol levels, were largely responsible for the decline in heart disease deaths in England and Wales between 1981 and 2000.

Medical treatments - from drugs and surgical procedures for existing heart conditions, to prescription medicines for overt high blood pressure and High cholesterol - also prevented many deaths, the study authors found.

But the reduction in risk factors for heart disease appeared to play a much bigger role, according to findings published in the American Journal of Public Health.

Statistics show that over the 1980s and 90s, deaths from heart disease fell by half in England and Wales. The new study, which is based on the cumulative data from past research, found that there were 68,230 fewer heart disease deaths in 2000 than in 1981.

This, the study authors estimate, added nearly a million years, in total, to the lives of English and Welsh adults between the ages of 25 and 84.

Changes in risk factors for heart disease accounted for a “massive” 79 percent of those added years, said the study’s lead author, Dr. Belgin Unal of Dokuz Eylul University School of Medicine in Izmir, Turkey.

These changes included a substantial decline in smoking, and lower average levels of blood pressure and blood cholesterol in the general population - a measurement that excludes people treated for high blood pressure and High cholesterol

The gains in longevity came in spite of a steep increase in obesity, declining physical activity, and an escalating diabetes rate during the same time period - trends, Unal told Reuters Health, that caused “considerable loss in life years.”

It’s likely, he noted, that many more years would have been added to people’s lives were it not for the negative trends in obesity, exercise and diabetes. “These risk factors,” Unal and his colleagues write in the report, “represent a major public health target for coronary heart disease in the new millennium.”

SOURCE: American Journal of Public Health, January 2005.