Explaining the decline in coronary heart disease mortality in Turkey between 1995 and 2008

Abstract

BackgroundCoronary heart disease (CHD) mortality rates have been decreasing in Turkey since the early 1990s. Our study aimed to determine how much of the CHD mortality decrease in Turkey between 1995 and 2008 could be attributed to temporal trends in major risk factors and how much to advances in medical and surgical treatments.MethodsThe validated IMPACT CHD mortality model was used to combine and analyse data on uptake and effectiveness of CHD treatments and risk factor trends in Turkey in adults aged 35–84 years between 1995 and 2008.Data sources were identified, searched and appraised on population, mortality and major CHD risk factors for adults those aged 35–84 years. Official statistics, electronic databases, national registers, surveys and published trials were screened from 1995 onwards.ResultsBetween 1995 and 2008, coronary heart disease mortality rates in Turkey decreased by 34% in men and 28% in women 35 years and over. This resulted in 35,720 fewer deaths in 2008.Approximately 47% of this mortality decrease was attributed to treatments in individuals (including approximately 16% to secondary prevention, 3% angina treatments, 9% to heart failure treatments, 5% to initial treatments of acute myocardial infarction, and 5% to hypertension treatments) and approximately 42% was attributable to population risk factor reductions (notably blood pressure 29%; smoking 27%; and cholesterol 1%). Adverse trends were seen for obesity and diabetes (potentially increasing mortality by approximately 11% and 14% respectively). The model explained almost 90% of the mortality fall.ConclusionReduction in major cardiovascular risk factors explained approximately 42% and improvements in medical and surgical treatments explained some 47% of the CHD mortality fall. These findings emphasize the complimentary value of primary prevention and evidence-based medical treatments in controlling coronary heart disease.

Primary prevention and risk factor reduction in coronary heart disease mortality among working aged men and women in eastern Finland over 40 years: population based observational study

“…In IMPACT studies conducted in different countries (such as Sweden, Turkey, Portugal, and USA), the proportion of mortality decline attributed to treatment and secondary prevention varied between a quarter and a half. [42][43][44][45] strengths and limitations The main strengths of our study were the long and systematic monitoring of population based risk factors, which used the same standardised protocol over four decades and a practically complete set of mortality data. To our knowledge, risk factor monitoring in eastern Finland is the longest continuous system for population based risk factor monitoring in the world.…”

Noncommunicable Diseases: Three Decades Of Global Data Show A Mixture Of Increases And Decreases In Mortality Rates

“…Health System Factors Much has been written about declining cardiovascular disease mortality rates, 12,[18][19][20][21] which may at least partially explain overall declines in all-cause mortality. 2 Studies from the United States 18 and Canada, 19 Finland, 21 Poland, 22 Turkey, 23 the United Kingdom, 20 and twenty-six high-income countries combined 24 have shown that reductions in cardiovascular disease risk factors together account for 40-70 percent of observed declines in cardiovascular disease mortality in these countries. Medical care-particularly, coronary revascularization via bypass surgery or angioplasty-…”

Key Provisions of the New (2016) European Guidelines for Management of Dyslipidemias and Comments

“…Снижение смертности от ССЗ (более чем наполовину) в последние 30 лет объясняют уменьшением уровней ХС и снижением средних значений АД, а также уменьшением числа курящих [3][4][5]. Однако этой положительной тен-денции частично противостоит наблюдаемое в последнее десятилетие увеличение других ФР -ожирения и сахар-ного диабета (СД) 2-го типа.…”