Association of Temporal Trends in Risk Factors and Treatment Uptake With Coronary Heart Disease Mortality, 1994-2005
Association of Temporal Trends in Risk Factors and Treatment Uptake With Coronary Heart Disease Mortality, 1994-2005
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DOI：
10.1001/jama.2010.580
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发表时间：
2010-05-12
影响因子：
120.7
通讯作者：
Capewell, Simon
中科院分区：
文献类型：
--
作者：
Wijeysundera, Harindra C.;Machado, Marcio;Capewell, Simon
自 1994 年以来，加拿大冠心病 (CHD) 死亡率大幅下降。目的 确定这种下降的比例与 CHD 危险因素的时间趋势和医疗进步相关。设计、环境和患者 对 1994 年至 2005 年间加拿大安大略省 25 至 84 岁人口进行前瞻性分析研究，使用经过验证的 IMPACT 模型的更新版本，该模型整合了人口规模、CHD 死亡率、风险因素和治疗吸收变化。已发表文献中的相对风险和回归系数量化了 CHD 死亡率与 (1) 8 个不同 CHD 亚群（急性心肌梗死 [AMI]、急性冠状动脉综合征、AMI 后二级预防、慢性冠状动脉疾病、医院心力衰竭与社区心力衰竭、高脂血症或高血压一级预防）的循证治疗和 (2) 6 个危险因素（吸烟、糖尿病、收缩压、血浆胆固醇）之间的关系主要成果指标 2005 年预防或延迟的死亡人数；次要结果指标是医疗治疗的改善和危险因素的趋势。 结果 1994 年至 2005 年间，安大略省按年龄调整的 CHD 死亡率下降了 35%，从每 10 万居民 191 例死亡降至 125 例，这意味着 2005 年 CHD 死亡估计减少了 7585 例。医疗和外科治疗的改善与 43% 相关（范围为 11% 至 124%）总死亡率下降的比例，最显着的是 AMI（8%；范围，-5% 至 40%）、慢性稳定性冠状动脉疾病（17%；范围，7% 至 35%）和社区内发生的心力衰竭（10%；范围，6% 至 31%）。风险因素趋势导致预防或延迟的冠心病死亡人数减少了 3660 例（占总数的 48%；范围为 28% 至 64%），具体而言，总胆固醇（23%；范围为 10% 至 33%）和收缩压（20%；范围为 13% 至 26%）的降低。糖尿病患病率和体重指数的增加与较高的冠心病死亡率呈反比关系，分别为 6%（范围为 4% 至 8%）和 2%（范围为 1% 至 4%）。 结论 1994 年至 2005 年间，安大略省冠心病死亡率下降，这主要与危险因素的趋势和医疗治疗的改进有关，两者均解释了大约一半的下降。贾马。 2010;303(18):1841-1847 www.jama.com
Context Coronary heart disease (CHD) mortality has declined substantially in Canada since 1994.Objective To determine what proportion of this decline was associated with temporal trends in CHD risk factors and advancements in medical treatments.Design, Setting, and Patients Prospective analytic study of the Ontario, Canada, population aged 25 to 84 years between 1994 and 2005, using an updated version of the validated IMPACT model, which integrates data on population size, CHD mortality, risk factors, and treatment uptake changes. Relative risks and regression coefficients from the published literature quantified the relationship between CHD mortality and (1) evidence-based therapies in 8 distinct CHD subpopulations (acute myocardial infarction [AMI], acute coronary syndromes, secondary prevention post-AMI, chronic coronary artery disease, heart failure in the hospital vs in the community, and primary prevention for hyperlipidemia or hypertension) and (2) population trends in 6 risk factors (smoking, diabetes mellitus, systolic blood pressure, plasma cholesterol level, exercise, and obesity).Main Outcome Measures The number of deaths prevented or delayed in 2005; secondary outcome measures were improvements in medical treatments and trends in risk factors.Results Between 1994 and 2005, the age-adjusted CHD mortality rate in Ontario decreased by 35% from 191 to 125 deaths per 100 000 inhabitants, translating to an estimated 7585 fewer CHD deaths in 2005. Improvements in medical and surgical treatments were associated with 43% (range, 11% to 124%) of the total mortality decrease, most notably in AMI (8%; range, -5% to 40%), chronic stable coronary artery disease (17%; range, 7% to 35%), and heart failure occurring while in the community (10%; range, 6% to 31%). Trends in risk factors accounted for 3660 fewer CHD deaths prevented or delayed (48% of total; range, 28% to 64%), specifically, reductions in total cholesterol (23%; range, 10% to 33%) and systolic blood pressure (20%; range, 13% to 26%). Increasing diabetes prevalence and body mass index had an inverse relationship associated with higher CHD mortality of 6% (range, 4% to 8%) and 2% (range, 1% to 4%), respectively.Conclusion Between 1994 and 2005, there was a decrease in CHD mortality rates in Ontario that was associated primarily with trends in risk factors and improvements in medical treatments, each explaining about half of the decrease. JAMA. 2010;303(18):1841-1847 www.jama.com