Explaining the recent decrease in coronary heart disease mortality rates in Ireland, 1985-2000
Explaining the recent decrease in coronary heart disease mortality rates in Ireland, 1985-2000
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DOI：
10.1136/jech.2005.038638
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发表时间：
2006-04-01
影响因子：
6.3
通讯作者：
Capewell, S
中科院分区：
文献类型：
--
作者：
Bennett, K;Kabir, Z;Capewell, S
研究目的：研究爱尔兰冠心病（CHD）死亡率近期下降的比例，归因于（a）“循证”的内科和外科治疗，和（B）主要心血管危险因素的变化。设计设置：IMPACT，一个以前验证过的模型，用于联合收割机和分析特定心脏病治疗和危险因素趋势的使用和有效性数据，按年龄和性别分层。主要的数据来源发表的试验和荟萃分析，官方统计，临床审计，和观察study.Results：1985年至2000年，冠心病死亡率在爱尔兰下降了47%，在那些年龄在25 - 84。在观察到的死亡率下降中，约43.6%归因于治疗效果，48.1%归因于有利的人群风险因素趋势;特别是吸烟率下降（25.6%），平均胆固醇浓度（30.2%），血压水平（6.0%），但被与肥胖、糖尿病和不活动相关的不利人口趋势的增加所抵消（-13.8%）。结论：结果强调了一项综合战略的重要性，该战略最大限度地扩大了有效治疗的人口覆盖面，并积极促进初级预防，特别是烟草控制和保护心脏的饮食。
Study objectives: To examine the proportion of the recent decline in coronary heart disease (CHD) deaths in Ireland attributable to ( a) "evidence based'' medical and surgical treatments, and (b) changes in major cardiovascular risk factors.Design setting: IMPACT, a previously validated model, was used to combine and analyse data on the use and effectiveness of specific cardiology treatments and risk factor trends, stratified by age and sex. The main data sources were published trials and meta-analyses, official statistics, clinical audits, and observational studies.Results: Between 1985 and 2000, CHD mortality rates in Ireland fell by 47% in those aged 25 - 84. Some 43.6% of the observed decrease in mortality was attributed to treatment effects and 48.1% to favourable population risk factor trends; specifically declining smoking prevalence (25.6%), mean cholesterol concentrations (30.2%), and blood pressure levels (6.0%), but offset by increases in adverse population trends related to obesity, diabetes, and inactivity (-13.8%).Conclusions: The results emphasise the importance of a comprehensive strategy that maximises population coverage of effective treatments, and that actively promotes primary prevention, particularly tobacco control and a cardioprotective diet.