Mortality From Myocardial Infarction-Reply

In Reply.— It would be rash to quarrel with Dr Monroe's statement that "The modern epidemic of cardiovascular disease will probably be controlled when its causes are thoroughly understood and when medicine and society act to prevent its occurrence." Our recent article was focused on efforts to illuminate the next sentence in Dr Monroe's letter: "This is already happening." Careful estimates 1,2 have concluded that the changes between the 1960s and 1970s in the United States in known coronary risk factors—reduced cigarette smoking among men, reductions in dietary saturated fat, some lowering of serum cholesterol levels, better control of hypertension—were not large enough to have produced the observed 25% change in mortality. Our report, therefore, sought to assess any evidence of better prognosis that might reasonably be ascribed to improved medical management. The data available to us permitted a comparison of long-term prognosis for patients after surviving a first acute MI,