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dc.contributor.authorAspelund, Thor
dc.contributor.authorGudnason, Vilmundur
dc.contributor.authorMagnusdottir, Bergrun Tinna
dc.contributor.authorAndersen, Karl
dc.contributor.authorSigurdsson, Gunnar
dc.contributor.authorThorsson, Bolli
dc.contributor.authorSteingrimsdottir, Laufey
dc.contributor.authorCritchley, Julia
dc.contributor.authorBennett, Kathleen
dc.contributor.authorO'Flaherty, Martin
dc.contributor.authorCapewell, Simon
dc.date.accessioned2012-05-03T13:59:14Z
dc.date.available2012-05-03T13:59:14Z
dc.date.issued2010
dc.date.submitted2012-05-03
dc.identifier.citationPLoS. ONE. 2010, 5(11):e13957en_GB
dc.identifier.issn1932-6203
dc.identifier.pmid21103050
dc.identifier.doi10.1371/journal.pone.0013957
dc.identifier.urihttp://hdl.handle.net/2336/221829
dc.descriptionTo access publisher full text version of this article. Please click on the hyperlink in Additional Links field.en_GB
dc.description.abstractBACKGROUND: 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. METHODOLOGY: 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. PRINCIPAL FINDINGS: 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%. CONCLUSIONS: 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.
dc.language.isoenen
dc.publisherPublic Library of Scienceen_GB
dc.relation.urlhttp://dx.doi.org/10.1371/journal.pone.0013957en_GB
dc.rightsArchived with thanks to PloS oneen_GB
dc.subject.meshAdulten_GB
dc.subject.meshAgeden_GB
dc.subject.meshCoronary Diseaseen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshIcelanden_GB
dc.subject.meshIncidenceen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshModels, Statisticalen_GB
dc.subject.meshMortalityen_GB
dc.subject.meshMyocardial Infarctionen_GB
dc.subject.otherRÍN, Hjartalæknisfræðien_GB
dc.titleAnalysing the large decline in coronary heart disease mortality in the Icelandic population aged 25-74 between the years 1981 and 2006.en
dc.typeArticleen
dc.contributor.departmentIcelandic Heart Association, Kopavogur, Iceland. Landspitali National University Hospital, Reykjavik, Iceland.en_GB
dc.identifier.journalPloS oneen_GB
html.description.abstractBACKGROUND: 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. METHODOLOGY: 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. PRINCIPAL FINDINGS: 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%. CONCLUSIONS: 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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