title: Variations in vascular mortality trends, 2001-2010, among 1.3 million women with different lifestyle risk factors for the disease.
abstract: OBJECTIVE
  Vascular disease mortality has declined rapidly in most Western countries, against a background of improved treatments and falling prevalence of smoking, but rising obesity. We examined whether this decline differed by lifestyle risk factors for vascular disease.
  
  
  RESULTS
  During 2001-2010, there were 9241 vascular disease deaths in a prospective study of 1.3 million women in middle age, about one-quarter of all UK women in the eligible age range (50-64 years in 1996-2001). We estimated percentage declines in mortality from coronary heart disease, cerebrovascular disease and other vascular diseases, overall and by age, smoking, alcohol consumption, adiposity, physical activity, socioeconomic status and age at leaving school. Over 10 years, coronary heart disease mortality fell by half (52%), cerebrovascular disease mortality by two-fifths (42%) and other vascular disease mortality by one-fifth (22%). Lean women experienced greater declines in coronary heart disease mortality than overweight or obese women (70%, 48% and 26%, respectively; P < 0.001 for heterogeneity) and women in the highest and middle thirds of socioeconomic status experienced greater declines in other (non-coronary, non-cerebrovascular) vascular disease mortality than women in the lowest third (41% and 42% and -9%, respectively; P = 0.001). After accounting for multiple testing, there were no other significant differences in vascular mortality trends by any lifestyle risk factor, including by smoking status.
  
  
  CONCLUSIONS
  Vascular disease mortality trends varied in this cohort by adiposity and socioeconomic status, but not by smoking status or other lifestyle risk factors. Prevention and treatment of vascular disease appear not to have been equally effective in all subgroups of UK women.
authors.affiliation: Cancer Epidemiology Unit, University of Oxford, Oxford, UK ben.cairns@ceu.ox.ac.uk.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Cairns
authors.affiliation: Cancer Epidemiology Unit, University of Oxford, Oxford, UK.
authors.forename: Angela
authors.initials: A
authors.lastname: Balkwill
authors.affiliation: Cancer Epidemiology Unit, University of Oxford, Oxford, UK.
authors.forename: Dexter
authors.initials: D
authors.lastname: Canoy
authors.affiliation: Cancer Epidemiology Unit, University of Oxford, Oxford, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Green
authors.affiliation: Cancer Epidemiology Unit, University of Oxford, Oxford, UK.
authors.forename: Gillian K
authors.initials: GK
authors.lastname: Reeves
authors.affiliation: Cancer Epidemiology Unit, University of Oxford, Oxford, UK.
authors.forename: Valerie
authors.initials: V
authors.lastname: Beral
mesh_terms: D050154:Adiposity; D017677:Age Distribution; D000367:Age Factors; D000428:Alcohol Drinking / Q000009:adverse effects / Q000401:mortality / Q000517:prevention & control; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D005260:Female; D006306:Health Surveys; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D009043:Motor Activity; D011314:Preventive Health Services; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D017678:Sex Distribution; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects / Q000401:mortality; D016540:Smoking Cessation; D000074606:Smoking Prevention; D012959:Socioeconomic Factors; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D016387:Women's Health
keywords: Coronary heart disease; cerebrovascular disease; mortality; obesity; secular trends; smoking