Explaining the Decline in Coronary Heart Disease Mortality in Finland between 1982 and 1997

Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland.
American Journal of Epidemiology (Impact Factor: 5.23). 11/2005; 162(8):764-73. DOI: 10.1093/aje/kwi274
Source: PubMed


In Finland since the 1980s, coronary heart disease mortality has declined more than might be predicted by risk factor reductions
alone. The aim of this study was to assess how much of the decline could be attributed to improved treatments and risk factor
reductions. The authors used the cell-based IMPACT mortality model to synthesize effectiveness of treatments and risk factor
reductions with data on treatments administered to patients and trends in cardiovascular risk factors in the population. Cardiovascular
risk factors were measured in random samples of patients in 1982 (n = 8,501) and 1997 (n = 4,500). Mortality and treatment data were obtained from the National Causes of Death Register, Hospital Discharge Register,
social insurance data, and medical records. Estimated and observed changes in coronary heart disease mortality were used as
main outcome measures. Between 1982 and 1997, coronary heart disease mortality rates declined by 63%, with 373 fewer deaths
in 1997 than expected from baseline mortality rates in 1982. Improved treatments explained approximately 23% of the mortality
reduction, and risk factors explained some 53–72% of the reduction. These findings highlight the value of a comprehensive
strategy that promotes primary prevention programs and actively supports secondary prevention. It also emphasizes the importance
of maximizing population coverage of effective treatments.

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Available from: Julia Alison Critchley, Nov 12, 2015
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    • "Although some are simply nonmodifiable (e.g., age, sex, family history of CVD, genetic links, and ethnicity), others are modifiable. The risk of CVDs can be reduced by adopting a healthy lifestyle such as regular physical activity, consumption of fruits and vegetables, moderation of alcohol intake, dietary sodium reduction, avoiding tobacco use, avoiding foods rich in fat, and maintaining a healthy body weight [4] [5] [6] [7] [8]. About 80% of CHD and CVDs are linked to behavioral risk factors [2]. "
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    ABSTRACT: Objectives: To conduct a systematic literature review and assess the effectiveness of community pharmacists' interventions in reducing major risk factors for cardiovascular diseases. Methods: A comprehensive literature search from 2000 onwards was performed using MEDLINE (1946 to June 4, 2013), EMBASE (1947 to present), CINAHL, and Cochrane Library. The gray literature was also searched. Studies were classified as diabetes, hypertension, dyslipidemia, and tobacco dependence. Data abstracted from the articles included study design/participants, study duration, key components of intervention, primary outcome, and key findings. Study quality was assessed using a checklist appropriate to the study design. Results: A total of 1020 citations were initially identified, with 27 meeting inclusion criteria. Eight studies were randomized controlled trials, five were cluster randomized trials, two were randomized before-after design studies, five were nonrandomized controlled before-after design studies, and seven were uncontrolled before-after design studies. Interventions focused on diabetes (n = 8), hypertension (n = 9), dyslipidemia (n = 7), and tobacco dependence (n = 3). Effect sizes ranged from 7.8 to 17.7 mm Hg and from 0.2% to 2.2% reductions in systolic blood pressure and hemoglobin A1c, respectively, while reductions in total cholesterol ranged from 18.2 to 27.1 mg/dl. Study quality was generally poor. Conclusions: Available evidence suggests a potential for substantial benefit in diabetes and hypertension but clinical benefits in lipid management remain unclear. The true effect of interventions is uncertain due to poor study quality, inconsistent results, and potential for publication bias. Further well-designed studies are needed to determine the true impact of community pharmacists' interventions in reducing major risk factors for cardiovascular disease. © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR).
    Full-text · Article · Sep 2015
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    • "Studies from England and Wales [31], Scotland [32], Australia [51], Ireland [52] and Canada [33] have attributed 40-44 per cent of the decline to treatment effects and 48-58 per cent to population risk factor reductions. In Finland, a similar estimation attributed 23 per cent of the reduction to treatment effects and 53-72 per cent to risk factor reduction between 1982 and 1997 [34]. In international comparison the proportion attributed to risk factor reduction is unusually large. "
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    ABSTRACT: Growing mortality differences between socioeconomic groups have been reported in both Finland and elsewhere. While health behaviours and other lifestyle factors are important in contributing to health differences, some researchers have suggested that some of the mortality differences attributable to lifestyle factors could be preventable by health policy measures and that health care may play a role. It has also been suggested that its role is increasing due to better results in disease prevention, improved diagnostic tools and treatment methods. This study aimed to assess the impact of mortality amenable to health policy and health care on increasing income disparities in life expectancy in 1996-2007 in Finland. The study data were based on an 11% random sample of Finnish residents in 1988--2007 obtained from individually linked cause of death and population registries and an oversample of deaths. We examined differences in life expectancy at age 35 (e35) in Finland. We calculated e35 for periods 1996-97 and 2006-07 by income decile and gender. Differences in life expectancies and change in them between the richest and the poorest deciles were decomposed by cause of death group. Overall, the difference in e35 between the extreme income deciles was 11.6 years among men and 4.2 years among women in 2006-07. Together, mortality amenable to health policy and care and ischaemic heart disease mortality contributed up to two thirds to socioeconomic differences. Socioeconomic differences increased from 1996-97 by 3.4 years among men and 1.7 years among women. The main contributor to changes was mortality amenable through health policy measures, mainly alcohol related mortality, but also conditions amenable through health care, ischaemic heart disease among men and other diseases contributed to the increase of the differences. The results underline the importance of active health policy and health care measures in tackling socioeconomic health inequalities.
    Full-text · Article · Sep 2013 · BMC Public Health
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    • "The biggest contributions came from treatments delivered in the community for secondary prevention, hypertension and heart failure plus therapies for acute coronary syndromes. The effect of treatment on CHD mortality reduction are thus broadly similar to that reported for Iceland, Sweden and Finland [33] but lower than that reported for North America [34] and Europe [35], [36] in studies using the same methodology. "
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    ABSTRACT: In Tunisia, Cardiovascular Diseases are the leading causes of death (30%), 70% of those are coronary heart disease (CHD) deaths and population studies have demonstrated that major risk factor levels are increasing. To explain recent CHD trends in Tunisia between 1997 and 2009. Published and unpublished data were identified by extensive searches, complemented with specifically designed surveys. Data were integrated and analyzed using the previously validated IMPACT CHD policy model. Data items included: (i)number of CHD patients in specific groups (including acute coronary syndromes, congestive heart failure and chronic angina)(ii) uptake of specific medical and surgical treatments, and(iii) population trends in major cardiovascular risk factors (smoking, total cholesterol, systolic blood pressure (SBP), body mass index (BMI), diabetes and physical inactivity). CHD mortality rates increased by 11.8% for men and 23.8% for women, resulting in 680 additional CHD deaths in 2009 compared with the 1997 baseline, after adjusting for population change. Almost all (98%) of this rise was explained by risk factor increases, though men and women differed. A large rise in total cholesterol level in men (0.73 mmol/L) generated 440 additional deaths. In women, a fall (-0.43 mmol/L), apparently avoided about 95 deaths. For SBP a rise in men (4 mmHg) generated 270 additional deaths. In women, a 2 mmHg fall avoided 65 deaths. BMI and diabetes increased substantially resulting respectively in 105 and 75 additional deaths. Increased treatment uptake prevented about 450 deaths in 2009. The most important contributions came from secondary prevention following Acute Myocardial Infarction (AMI) (95 fewer deaths), initial AMI treatments (90), antihypertensive medications (80) and unstable angina (75). Recent trends in CHD mortality mainly reflected increases in major modifiable risk factors, notably SBP and cholesterol, BMI and diabetes. Current prevention strategies are mainly focused on treatments but should become more comprehensive.
    Full-text · Article · May 2013 · PLoS ONE
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