BACKGROUND: We aimed to quantify the contribution of treatments and risk factors to the decline in coronary heart disease (CHD) mortality in Portugal, 1995 to 2008. METHODS AND RESULTS: The IMPACT mortality model was used to integrate data on trends in uptake of treatments and exposure to risk factors to explain the CHD mortality variation. Between 1995 and 2008, CHD mortality rates in Portugal decreased by 29% in men and 21% in women aged 25 to 84 years, corresponding to 3760 fewer deaths in 2008 than expected if 1995 mortality rates had persisted. Approximately 92% of the estimated decrease in number of deaths could be explained by the model; the remaining 8% were attributed to changes in unmeasured factors. Approximately 50% of the decrease explained by the model was attributable to an increased uptake of treatments, mainly antihypertensive medication (12%) and initial treatments after an acute myocardial infarction (10%), and 42% to population risk factor reductions, mainly blood pressure (27% in men and 60% in women), total cholesterol (14% in men and 5% in women), and smoking (11% in men). However, these reductions were partially offset by adverse trends in diabetes mellitus (18% in men and 2% in women) and obesity (6% in men and 5% in women) and smoking (2% in women). CONCLUSIONS: In this low CHD risk population, modern treatments explained approximately half of the overall decline in CHD deaths. The biggest contributions to the CHD mortality decline came from secular decreases in blood pressure and increases in hypertension treatment.
BACKGROUND: We aimed to quantify the contribution of treatments and risk factors to the decline in coronary heart disease (CHD) mortality in Portugal, 1995 to 2008. METHODS AND RESULTS: The IMPACT mortality model was used to integrate data on trends in uptake of treatments and exposure to risk factors to explain the CHD mortality variation. Between 1995 and 2008, CHD mortality rates in Portugal decreased by 29% in men and 21% in women aged 25 to 84 years, corresponding to 3760 fewer deaths in 2008 than expected if 1995 mortality rates had persisted. Approximately 92% of the estimated decrease in number of deaths could be explained by the model; the remaining 8% were attributed to changes in unmeasured factors. Approximately 50% of the decrease explained by the model was attributable to an increased uptake of treatments, mainly antihypertensive medication (12%) and initial treatments after an acute myocardial infarction (10%), and 42% to population risk factor reductions, mainly blood pressure (27% in men and 60% in women), total cholesterol (14% in men and 5% in women), and smoking (11% in men). However, these reductions were partially offset by adverse trends in diabetes mellitus (18% in men and 2% in women) and obesity (6% in men and 5% in women) and smoking (2% in women). CONCLUSIONS: In this low CHD risk population, modern treatments explained approximately half of the overall decline in CHD deaths. The biggest contributions to the CHD mortality decline came from secular decreases in blood pressure and increases in hypertension treatment.
Authors: George A Mensah; Gina S Wei; Paul D Sorlie; Lawrence J Fine; Yves Rosenberg; Peter G Kaufmann; Michael E Mussolino; Lucy L Hsu; Ebyan Addou; Michael M Engelgau; David Gordon Journal: Circ Res Date: 2017-01-20 Impact factor: 17.367
Authors: Massimo F Piepoli; Arno W Hoes; Stefan Agewall; Christian Albus; Carlos Brotons; Alberico L Catapano; Marie-Therese Cooney; Ugo Corrà; Bernard Cosyns; Christi Deaton; Ian Graham; Michael Stephen Hall; F D Richard Hobbs; Maja-Lisa Løchen; Herbert Löllgen; Pedro Marques-Vidal; Joep Perk; Eva Prescott; Josep Redon; Dimitrios J Richter; Naveed Sattar; Yvo Smulders; Monica Tiberi; H Bart van der Worp; Ineke van Dis; W M Monique Verschuren; Simone Binno Journal: Eur Heart J Date: 2016-05-23 Impact factor: 29.983
Authors: Carla Koopman; Ilonca Vaartjes; Ineke van Dis; W M Monique Verschuren; Peter Engelfriet; Edith M Heintjes; Anneke Blokstra; Dorly J H Deeg; Marjolein Visser; Michiel L Bots; Martin O'Flaherty; Simon Capewell Journal: PLoS One Date: 2016-12-01 Impact factor: 3.240
Authors: Carmen Arroyo-Quiroz; Martin O'Flaherty; Maria Guzman-Castillo; Simon Capewell; Eduardo Chuquiure-Valenzuela; Carlos Jerjes-Sanchez; Tonatiuh Barrientos-Gutierrez Journal: PLoS One Date: 2020-12-03 Impact factor: 3.240
Authors: Pekka Jousilahti; Tiina Laatikainen; Markku Peltonen; Katja Borodulin; Satu Männistö; Antti Jula; Veikko Salomaa; Kennet Harald; Pekka Puska; Erkki Vartiainen Journal: BMJ Date: 2016-03-01