Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2011;64:988-96 - Vol. 64 Num.11 DOI: 10.1016/j.rec.2011.05.035

Analyzing the Coronary Heart Disease Mortality Decline in a Mediterranean Population: Spain 1988-2005

Gemma Flores-Mateo a,b, María Grau c, Martin O’Flaherty d, Rafel Ramos a,e, Roberto Elosua c,f, Concepción Violan-Fors a, Miquel Quesada a,e, Ruth Martí a,e, Joan Sala g, Jaume Marrugat c, Simon Capewell d,

a Institut d’Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
b CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Madrid, Spain
c Grupo de Epidemiología y Genética Cardiovascular, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares, Institut de Recerca Hospital del Mar (IMIM), Barcelona, Spain
d Division of Public Health, University of Liverpool, Liverpool, United Kingdom
e Unitat de Suport a la Recerca de Girona, Institut d’Investigació en Atenció Primària Jordi Gol, Institut Català de la Salut, Barcelona, Spain
f CIBER de Epidemiología y Salud Pública, Instituto Salud Carlos III, Madrid, Spain
g Departamento de Cardiología, Hospital Universitari Dr. Josep Trueta, Girona, Spain

Refers to

Keywords

Coronary disease. Mortality. Drugs. Risk factors. Population.

Abstract

Introduction and objectives

To examine the extent to which the decrease in mortality rates in Spain between 1988 and 2005 could be explained by changes in cardiovascular risk factors and by the use of medical and surgical treatments.

Methods

We used the previously validated IMPACT model to examine the contributions of exposure factors (risk factors and treatments) to the main outcome, changes in the mortality rates of death from coronary heart disease, among adults 35 to 74 years of age. Main data sources included official mortality statistics, results of longitudinal studies, national surveys, randomized controlled trials, and meta-analyses. The difference between observed and expected coronary heart disease deaths in 2005 was then partitioned between treatments and risk factors.

Results

From 1988 to 2005, the age-adjusted coronary heart disease mortality rates fell by almost 40%, resulting in 8530 fewer coronary heart disease deaths in 2005. Approximately 47% of the fall in deaths was attributed to treatments. The major treatment contributions came from initial therapy for acute coronary syndromes (11%), secondary prevention (10%), and heart failure (9%).

About 50% of the fall in mortality was attributed to changes in risk factors. The largest mortality benefit came from changes in total cholesterol (about 31% of the mortality fall) and in systolic blood pressure (about 15%). However, some substantial gender differences were observed in risk factor trends with an increase in diabetes and obesity in men and an increase in smoking in young women. These generated additional deaths.

Conclusions

Approximately half of the coronary heart disease mortality fall in Spain was attributable to reductions in major risk factors, and half to evidence-based therapies. These results increase understanding of past trends and will help to inform planning for future prevention and treatment strategies in low-risk populations.

1885-5857/© 2011 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

Cookies
x
To improve our services and products, we use cookies (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.
Cookies policy
x
To improve our services and products, we use cookies (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.