HEART attacks have fallen by 74% in Scotland as a direct result of smoking rates more than halving and improvements in blood pressure and cholesterol levels, a landmark study found.

The smoking ban and increased uptake of cholesterol testing and statin drugs are said to have contributed to a dramatic reduction in the incidence of Scotland’s biggest killer over the past 25 years.

Researchers said the figures equated to 42,000 heart attacks being prevented or delayed. The number of strokes fell by 68% over the same period.

Scotland was the first country in the UK to introduce a ban on smoking in public places in 2006 under Labour's Jack McConnell. Only the Tories voted against the ban. 

"It’s a massive good news story from that point of view"

Data found rates more than halved from 58 per cent to 25 per cent from 1990 to 2014, average systolic blood pressure fell from 140mmHg to 129mmHg and cholesterol levels fell from 6.4mmol/L to 5.0.

In 1990 just under a third of heart attacks resulted in death and this had dropped to a fifth by the end of the study period.

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However, the British Heart Foundation funded study also found that two newer risk factors have emerged. Average BMI rose from from 27.2kg/m2 to 28.1kg/m2)while diabetes prevalence more than doubled, from 4 to 9 per cent of the population. 

Around 66 per cent of adults in Scotland are now said to be obese or overweight.

Researchers said increased diabetes prevalence contributed to nearly as many heart attacks as the decline in smoking prevented.

The team  calculated the change in numbers of heart attacks and strokes in Scotland between 1990 and 2014 in people aged 30 and over.

The number of heart attacks fell from 1,069 per 100,000 people to 276 per 100,000. Ischaemic strokes, which are caused by a blood clot, fell from 608 per 100,000 to 188 per 100,000 people.

The figures showed that the inequality gap is narrowing. The percentage of people experiencing heart attacks and stroke steadily decreased, (from 28% to 25% and 27% to 24% respectively) in the most deprived group but increased, from 12% to 15% and13% to 16%, in the most affluent group, who were more likely to live longer.

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Dr Anoop Shah, of the London School of Hygiene & Tropical Medicine, who led the research said: “”From our study, we think that on average about 14,000  ischaemic strokes and 42,000 heart attacks have been delayed or prevented because of changes in smoking status and blood pressure and cholesterol levels.

"It’s a massive good news story from that point of view.  

“We have made marked changes in our health system to tackle major cardiovascular risk factors and that’s reduced one of the biggest killers in the west. That improvement could have been greater if weight and diabetes had not increased."

Whilst smoking rates fell across age groups, the greatest reductions were observed in younger people and particularly women,

Smoking increases the risk of heart attack  6-fold in women, compared to 3-fold in men.

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Changes in systolic blood pressure, cholesterol and smoking rates contributed equally to a reduction in heart attacks, whereas change in systolic blood pressure was the major determinant of the reduction in incident  of stroke. 

Heart attack patients were more likely to be younger and male.  

The researchers concluded that public health efforts now need to urgently focus on managing obesity and diabetes to further curb cardiovascular disease. Heart disease claims 41 lives every day.

James Jopling, Head of British Heart Foundation Scotland, said: “These findings show the need for urgency in tackling obesity in Scotland, which could help prevent thousands of deaths from heart disease and stroke, two of Scotland’s leading killers. 

“The Scottish Government’s long anticipated Price Promotion Bill needs to be tabled urgently to help address some of the root causes of the increase in obesity and to make the healthy choice the easy choice in Scotland.”