Cargando…
Explaining the Decline in Coronary Heart Disease Mortality in the Netherlands between 1997 and 2007
OBJECTIVE: We set out to determine what proportion of the mortality decline from 1997 to 2007 in coronary heart disease (CHD) in the Netherlands could be attributed to advances in medical treatment and to improvements in population-wide cardiovascular risk factors. METHODS: We used the IMPACT-SEC mo...
Autores principales: | , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2016
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5132334/ https://www.ncbi.nlm.nih.gov/pubmed/27906998 http://dx.doi.org/10.1371/journal.pone.0166139 |
_version_ | 1782471054846853120 |
---|---|
author | Koopman, Carla Vaartjes, Ilonca van Dis, Ineke Verschuren, W. M. Monique Engelfriet, Peter Heintjes, Edith M. Blokstra, Anneke Deeg, Dorly J. H. Visser, Marjolein Bots, Michiel L. O’Flaherty, Martin Capewell, Simon |
author_facet | Koopman, Carla Vaartjes, Ilonca van Dis, Ineke Verschuren, W. M. Monique Engelfriet, Peter Heintjes, Edith M. Blokstra, Anneke Deeg, Dorly J. H. Visser, Marjolein Bots, Michiel L. O’Flaherty, Martin Capewell, Simon |
author_sort | Koopman, Carla |
collection | PubMed |
description | OBJECTIVE: We set out to determine what proportion of the mortality decline from 1997 to 2007 in coronary heart disease (CHD) in the Netherlands could be attributed to advances in medical treatment and to improvements in population-wide cardiovascular risk factors. METHODS: We used the IMPACT-SEC model. Nationwide information was obtained on changes between 1997 and 2007 in the use of 42 treatments and in cardiovascular risk factor levels in adults, aged 25 or over. The primary outcome was the number of CHD deaths prevented or postponed. RESULTS: The age-standardized CHD mortality fell by 48% from 269 to 141 per 100.000, with remarkably similar relative declines across socioeconomic groups. This resulted in 11,200 fewer CHD deaths in 2007 than expected. The model was able to explain 72% of the mortality decline. Approximately 37% (95% CI: 10%-80%) of the decline was attributable to changes in acute phase and secondary prevention treatments: the largest contributions came from treating patients in the community with heart failure (11%) or chronic angina (9%). Approximately 36% (24%-67%) was attributable to decreases in risk factors: blood pressure (30%), total cholesterol levels (10%), smoking (5%) and physical inactivity (1%). Ten% more deaths could have been prevented if body mass index and diabetes would not have increased. Overall, these findings did not vary across socioeconomic groups, although within socioeconomic groups the contribution of risk factors differed. CONCLUSION: CHD mortality has recently halved in The Netherlands. Equally large contributions have come from the increased use of acute and secondary prevention treatments and from improvements in population risk factors (including primary prevention treatments). Increases in obesity and diabetes represent a major challenge for future prevention policies. |
format | Online Article Text |
id | pubmed-5132334 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-51323342016-12-21 Explaining the Decline in Coronary Heart Disease Mortality in the Netherlands between 1997 and 2007 Koopman, Carla Vaartjes, Ilonca van Dis, Ineke Verschuren, W. M. Monique Engelfriet, Peter Heintjes, Edith M. Blokstra, Anneke Deeg, Dorly J. H. Visser, Marjolein Bots, Michiel L. O’Flaherty, Martin Capewell, Simon PLoS One Research Article OBJECTIVE: We set out to determine what proportion of the mortality decline from 1997 to 2007 in coronary heart disease (CHD) in the Netherlands could be attributed to advances in medical treatment and to improvements in population-wide cardiovascular risk factors. METHODS: We used the IMPACT-SEC model. Nationwide information was obtained on changes between 1997 and 2007 in the use of 42 treatments and in cardiovascular risk factor levels in adults, aged 25 or over. The primary outcome was the number of CHD deaths prevented or postponed. RESULTS: The age-standardized CHD mortality fell by 48% from 269 to 141 per 100.000, with remarkably similar relative declines across socioeconomic groups. This resulted in 11,200 fewer CHD deaths in 2007 than expected. The model was able to explain 72% of the mortality decline. Approximately 37% (95% CI: 10%-80%) of the decline was attributable to changes in acute phase and secondary prevention treatments: the largest contributions came from treating patients in the community with heart failure (11%) or chronic angina (9%). Approximately 36% (24%-67%) was attributable to decreases in risk factors: blood pressure (30%), total cholesterol levels (10%), smoking (5%) and physical inactivity (1%). Ten% more deaths could have been prevented if body mass index and diabetes would not have increased. Overall, these findings did not vary across socioeconomic groups, although within socioeconomic groups the contribution of risk factors differed. CONCLUSION: CHD mortality has recently halved in The Netherlands. Equally large contributions have come from the increased use of acute and secondary prevention treatments and from improvements in population risk factors (including primary prevention treatments). Increases in obesity and diabetes represent a major challenge for future prevention policies. Public Library of Science 2016-12-01 /pmc/articles/PMC5132334/ /pubmed/27906998 http://dx.doi.org/10.1371/journal.pone.0166139 Text en © 2016 Koopman et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Koopman, Carla Vaartjes, Ilonca van Dis, Ineke Verschuren, W. M. Monique Engelfriet, Peter Heintjes, Edith M. Blokstra, Anneke Deeg, Dorly J. H. Visser, Marjolein Bots, Michiel L. O’Flaherty, Martin Capewell, Simon Explaining the Decline in Coronary Heart Disease Mortality in the Netherlands between 1997 and 2007 |
title | Explaining the Decline in Coronary Heart Disease Mortality in the Netherlands between 1997 and 2007 |
title_full | Explaining the Decline in Coronary Heart Disease Mortality in the Netherlands between 1997 and 2007 |
title_fullStr | Explaining the Decline in Coronary Heart Disease Mortality in the Netherlands between 1997 and 2007 |
title_full_unstemmed | Explaining the Decline in Coronary Heart Disease Mortality in the Netherlands between 1997 and 2007 |
title_short | Explaining the Decline in Coronary Heart Disease Mortality in the Netherlands between 1997 and 2007 |
title_sort | explaining the decline in coronary heart disease mortality in the netherlands between 1997 and 2007 |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5132334/ https://www.ncbi.nlm.nih.gov/pubmed/27906998 http://dx.doi.org/10.1371/journal.pone.0166139 |
work_keys_str_mv | AT koopmancarla explainingthedeclineincoronaryheartdiseasemortalityinthenetherlandsbetween1997and2007 AT vaartjesilonca explainingthedeclineincoronaryheartdiseasemortalityinthenetherlandsbetween1997and2007 AT vandisineke explainingthedeclineincoronaryheartdiseasemortalityinthenetherlandsbetween1997and2007 AT verschurenwmmonique explainingthedeclineincoronaryheartdiseasemortalityinthenetherlandsbetween1997and2007 AT engelfrietpeter explainingthedeclineincoronaryheartdiseasemortalityinthenetherlandsbetween1997and2007 AT heintjesedithm explainingthedeclineincoronaryheartdiseasemortalityinthenetherlandsbetween1997and2007 AT blokstraanneke explainingthedeclineincoronaryheartdiseasemortalityinthenetherlandsbetween1997and2007 AT deegdorlyjh explainingthedeclineincoronaryheartdiseasemortalityinthenetherlandsbetween1997and2007 AT vissermarjolein explainingthedeclineincoronaryheartdiseasemortalityinthenetherlandsbetween1997and2007 AT botsmichiell explainingthedeclineincoronaryheartdiseasemortalityinthenetherlandsbetween1997and2007 AT oflahertymartin explainingthedeclineincoronaryheartdiseasemortalityinthenetherlandsbetween1997and2007 AT capewellsimon explainingthedeclineincoronaryheartdiseasemortalityinthenetherlandsbetween1997and2007 |