Analysing the large decline in coronary heart disease mortality in the Icelandic population aged 25-74 between the years 1981 and 2006.
Analysing the large decline in coronary heart disease mortality in the Icelandic population aged 25-74 between the years 1981 and 2006.
复制标题
分析 1981 年至 2006 年间冰岛 25-74 岁人群冠心病死亡率的大幅下降。
DOI：
10.1371/journal.pone.0013957
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发表时间：
2010-11-12
期刊：
影响因子：
3.7
通讯作者：
Capewell S
中科院分区：
文献类型：
--
作者：
Aspelund T;Gudnason V;Magnusdottir BT;Andersen K;Sigurdsson G;Thorsson B;Steingrimsdottir L;Critchley J;Bennett K;O'Flaherty M;Capewell S
自 20 世纪 80 年代以来，冰岛的冠心病 (CHD) 死亡率一直在下降。我们研究了 1981 年至 2006 年间的下降有多少可归因于内科和外科治疗，以及有多少可归因于心血管危险因素的变化。先前验证的 IMPACT CHD 死亡率模型已应用于冰岛人群。数据来源是官方统计数据、国家质量登记册、已发表的试验和荟萃分析、临床审计和一系列全国人口调查。 1981年至2006年间，冰岛25岁至74岁男性和女性的冠心病死亡率下降了80%，这导致2006年的死亡人数比1981年的死亡率减少了295人。心肌梗死 (MI) 的发病率下降了 66%，每年心肌梗塞病例减少约 500 例，这是心肌梗塞可能导致死亡的一个主要决定因素。根据 IMPACT 模型，大约 73%（下限和上限估计值：54%–93%）的死亡率下降归因于危险因素的降低：胆固醇 32%；吸烟 22%；收缩压 22%，身体缺乏活动 5%，有糖尿病 (-5%) 和肥胖 (-4%) 的不利趋势。大约 25%（估计下限和上限：8%–40%）的死亡率下降归因于个体治疗：二级预防 8%；心力衰竭治疗 6%；急性冠状动脉综合征治疗 5%；血运重建 3%；高血压治疗 2%，他汀类药物 0.5%。 1981年至2006年间，冰岛冠心病死亡率大幅下降，近四分之三归因于人口中主要心血管危险因素的减少。这些发现强调了促进烟草控制和健康饮食以减少心肌梗死发病率的综合预防策略的价值，并强调了有效、循证医学治疗的潜在重要性。
Coronary heart disease (CHD) mortality rates have been decreasing in Iceland since the 1980s. We examined how much of the decrease between 1981 and 2006 could be attributed to medical and surgical treatments and how much to changes in cardiovascular risk factors. The previously validated IMPACT CHD mortality model was applied to the Icelandic population. The data sources were official statistics, national quality registers, published trials and meta-analyses, clinical audits and a series of national population surveys. Between 1981 and 2006, CHD mortality rates in Iceland decreased by 80% in men and women aged 25 to 74 years, which resulted in 295 fewer deaths in 2006 than if the 1981 rates had persisted. Incidence of myocardial infarction (MI) decreased by 66% and resulted in some 500 fewer incident MI cases per year, which is a major determinant of possible deaths from MI. Based on the IMPACT model approximately 73% (lower and upper bound estimates: 54%–93%) of the mortality decrease was attributable to risk factor reductions: cholesterol 32%; smoking 22%; systolic blood pressure 22%, and physical inactivity 5% with adverse trends for diabetes (−5%), and obesity (−4%). Approximately 25% (lower and upper bound estimates: 8%–40%) of the mortality decrease was attributable to treatments in individuals: secondary prevention 8%; heart failure treatments 6%; acute coronary syndrome treatments 5%; revascularisation 3%; hypertension treatments 2%, and statins 0.5%. Almost three quarters of the large CHD mortality decrease in Iceland between 1981 and 2006 was attributable to reductions in major cardiovascular risk factors in the population. These findings emphasize the value of a comprehensive prevention strategy that promotes tobacco control and a healthier diet to reduce incidence of MI and highlights the potential importance of effective, evidence based medical treatments.
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