Decline in Mortality from Coronary Heart Disease in Poland After Socioeconomic Transformation: Modelling Study

Overview

Journal BMJ

Specialty General Medicine

Date 2012 Jan 27

PMID 22279114

Citations 52

Authors

Piotr Bandosz

Martin Oflaherty

Wojciech Drygas

Marcin Rutkowski

Jacek Koziarek

Bogdan Wyrzykowski

Kathleen Bennett

Tomasz Zdrojewski

Simon Capewell

Affiliations

Soon will be listed here.

Abstract

Objectives: To examine how much of the observed rapid decrease in mortality from coronary heart disease in Poland after the political, social, and economic transformation in the early 1990s could be explained by the use of medical and surgical treatments and how much by changes in cardiovascular risk factors.

Design: A modelling study.

Setting: Sources of data included controlled trials and meta-analyses, national surveys, and official statistics.

Participants: Population of adults aged 25-74 in Poland in 1991-2005.

Main Outcome Measures: Number of deaths prevented or postponed in 2005 attributable to specific treatments for coronary heart disease and changes in risk factors. A previously validated epidemiological model for coronary heart disease was used to combine and analyse data on the uptake and effectiveness of specific cardiac treatments and changes in risk factors. The observed fall in deaths from coronary heart disease from 1991 to 2005 was then partitioned among specific treatments and risk factor changes.

Results: From 1991 to 2005, the death rate from coronary heart disease in Poland halved, resulting in 26,200 fewer coronary deaths in 2005 in people aged 25-74. About 37% (minimum estimate 13%, maximum estimate 77%) of this decrease was attributable to treatments, including treatments for heart failure (12%), initial treatments for acute coronary syndrome (9%), secondary prevention treatments after myocardial infarction or revascularisation (7%), chronic angina treatments (3%), and other treatments (6%). About 54% of the fall was attributed to changes in risk factors (minimum estimate 41%, maximum estimate 65%), mainly reductions in total cholesterol concentration (39%) and an increase in leisuretime physical activity (10%); however, these were partially offset by increases in body mass index (-4%) and prevalence of diabetes (-2%). Blood pressure fell in women, explaining about 29% of their decrease in mortality, but rose in men generating a negative influence (-8%). About 15% of the observed decrease in mortality was attributable to reduced smoking in men but was negligible in women.

Conclusions: Over half of the recent fall in mortality from coronary heart disease in Poland can be attributed to reductions in major risk factors and about one third to evidence based medical treatments.

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References

Drygas W, Kwasniewska M, Szczesniewska D, Kozakiewicz K, Gluszek J, Wiercinska E . [Evaluation of physical activity levels in the adult population of Poland. Results of the WOBASZ program]. Kardiol Pol. 2010; 63(6 Suppl 4):S636-40. View

Polonski L, Gasior M, Gierlotka M, Kalarus Z, Cieslinski A, Dubiel J . Polish Registry of Acute Coronary Syndromes (PL-ACS). Characteristics, treatments and outcomes of patients with acute coronary syndromes in Poland. Kardiol Pol. 2007; 65(8):861-72. View

Zdrojewski T, Szpakowski P, Bandosz P, Pajak A, Wiecek A, Krupa-Wojciechowska B . Arterial hypertension in Poland in 2002. J Hum Hypertens. 2004; 18(8):557-62. DOI: 10.1038/sj.jhh.1001739. View

Wijeysundera H, Machado M, Farahati F, Wang X, Witteman W, van der Velde G . Association of temporal trends in risk factors and treatment uptake with coronary heart disease mortality, 1994-2005. JAMA. 2010; 303(18):1841-7. DOI: 10.1001/jama.2010.580. View

Capewell S, Morrison C, McMurray J . Contribution of modern cardiovascular treatment and risk factor changes to the decline in coronary heart disease mortality in Scotland between 1975 and 1994. Heart. 1999; 81(4):380-6. PMC: 1729021. DOI: 10.1136/hrt.81.4.380. View

Lewington S, Clarke R, Qizilbash N, Peto R, Collins R . Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002; 360(9349):1903-13. DOI: 10.1016/s0140-6736(02)11911-8. View

Rywik S, Sznajd J, Kurjata P, Malczewska-Malec M, Wagrowska H, Misiowiec P . [Monitoring trends in cardiovascular disease incidence and mortality and their determinants: "Pol-Monica" longitudinal study. V. Stroke register--methodology and application]. Przegl Lek. 1985; 42(2):299-304. View

Briggs A, Sculpher M, Buxton M . Uncertainty in the economic evaluation of health care technologies: the role of sensitivity analysis. Health Econ. 1994; 3(2):95-104. DOI: 10.1002/hec.4730030206. View

Capewell S, Oflaherty M . Rapid mortality falls after risk-factor changes in populations. Lancet. 2011; 378(9793):752-3. DOI: 10.1016/S0140-6736(10)62302-1. View

10.

Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F . Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004; 364(9438):937-52. DOI: 10.1016/S0140-6736(04)17018-9. View

11.

Jasinski B, Bandosz P, Wojtyniak B, Zdrojewski T, Rutkowski M, Koziarek J . Mortality from ischaemic heart disease in Poland in 1991-1996 estimated by the coding system used since 1997. Kardiol Pol. 2010; 68(5):520-7. View

12.

Zembala M, Maruszewski B, Wos S . [Cardiosurgery in Poland - 2005]. Kardiol Pol. 2006; 64(4):445-9. View

13.

Ford E, Ajani U, Croft J, Critchley J, Labarthe D, Kottke T . Explaining the decrease in U.S. deaths from coronary disease, 1980-2000. N Engl J Med. 2007; 356(23):2388-98. DOI: 10.1056/NEJMsa053935. View

14.

Unal B, Critchley J, Capewell S . Explaining the decline in coronary heart disease mortality in England and Wales between 1981 and 2000. Circulation. 2004; 109(9):1101-7. DOI: 10.1161/01.CIR.0000118498.35499.B2. View

15.

Stelmach W, Kaczmarczyk-Chalas K, Bielecki W, Drygas W . The impact of income, education and health on lifestyle in a large urban population of Poland (Cindi programme). Int J Occup Med Environ Health. 2005; 17(3):393-401. View

16.

Broda G, Rywik S . [Multicenter national Polish population health status tests--WOBASZ project with defined problems and treatment goals]. Kardiol Pol. 2010; 63(6 Suppl 4):S601-4. View

17.

Men T, Brennan P, Boffetta P, Zaridze D . Russian mortality trends for 1991-2001: analysis by cause and region. BMJ. 2003; 327(7421):964. PMC: 259165. DOI: 10.1136/bmj.327.7421.964. View

18.

Bots M, Grobbee D . Decline of coronary heart disease mortality in The Netherlands from 1978 to 1985: contribution of medical care and changes over time in presence of major cardiovascular risk factors. J Cardiovasc Risk. 1996; 3(3):271-6. View

19.

Zatonski W, Willett W . Changes in dietary fat and declining coronary heart disease in Poland: population based study. BMJ. 2005; 331(7510):187-8. PMC: 1179759. DOI: 10.1136/bmj.331.7510.187. View

20.

Nichol M, Venturini F, Sung J . A critical evaluation of the methodology of the literature on medication compliance. Ann Pharmacother. 1999; 33(5):531-40. DOI: 10.1345/aph.18233. View