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Cited by 59Healthcare Systems and Public HealthCardiovascular Health and Risk FactorsHealth Promotion and Cardiovascular Prevention

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

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Pereira, Marta, Azevedo, Ana, Lunet, Nuno, Carreira, Helena, O’Flaherty, Martin, Capewell, Simon, Bennett, Kathleen·2013·Circulation: Cardiovascular Quality and Outcomes
DOI 10.1161/circoutcomes.113.000264
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Abstract

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.

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  • Over half of the decline in cardiovascular mortality during the last three decades is attributed to population-level changes in cardiovascular risk factors, mainly lower cholesterol, blood pressure, and smoking.

    “More than half of the reduction in CV mortality in the last three decades has been attributed to population-level changes in CV risk factors, primarily reductions in cholesterol and blood pressure levels and smoking. 13-16”

    From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [15]

  • Rising obesity and type 2 diabetes partly counteract the favourable cardiovascular mortality trend.

    “This favourable trend is partly offset by increases in other major risk factors, such as obesity and type 2 diabetes. 13-16”

    From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [15]

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  1. [15]15. Flores-Mateo G, Grau M, O'Flaherty M, Ramos R, Elosua R, Violan-Fors C, Quesada M, Martí R, Sala J, Marrugat J, Capewell S. Analyzing the coronary heart disease mortality decline in a Mediterranean population: Spain 1988-2005. Rev Esp Cardiol . 2011;64:988-996.
  2. [33]33. The INTERSALT Co-operative Research Group. Appendix tables. Centrespecific results by age and sex. J Hum Hypertens . 1989;3:331-407.

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Authors
Pereira, M., Azevedo, A., Lunet, N., Carreira, H., O’Flaherty, M., Capewell, S., & Bennett, K.
Affiliations
  • University of Liverpool (GB)
  • From the Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal (M.P., A.A., N.L., H.C.); Institute of Public Health, University of Porto (ISPUP), Porto, Portugal (M.P., A.A., N.L., H.C.); Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom (M.O.’F., S.C.); and Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St. James’s Hospital, Dublin, Ireland (K.B.).
ORCID
Venue
Circulation: Cardiovascular Quality and Outcomes
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2013-11
Volume
6
Issue
6
Pages
634-642
ISSN
  • 1941-7705 (ISSN-L)
  • 1941-7713
DOI
10.1161/circoutcomes.113.000264
OpenAlex
W2973377885
Cited by
59
References
35
Citations by year
2024: 3 · 2023: 1 · 2022: 4 · 2021: 8 · 2020: 3 · 2019: 6 · 2018: 4 · 2017: 14 · 2016: 14 · 2015: 2
FWCI
3.89
Type
journal article
Language
en
Open access
Locations
  • Circulation Cardiovascular Quality and Outcomes (publishedVersion)
  • PubMed (publishedVersion)
  • Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
Keywords
coronary heart disease mortality, mortality decline, antihypertensive drugs, acute myocardial infarction treatment, blood pressure reduction, total cholesterol, smoking, diabetes mellitus, obesity, cardiovascular risk factors, Portugal
MeSH terms
Adult, Aged, Aged, 80 and over, Antihypertensive Agents, Blood Pressure, Coronary Disease, Female, Humans, Male, Middle Aged, Models, Theoretical, Portugal, Risk Factors, Sex Factors, Survival Analysis

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