The impact of pharmaceuticals on the decline of cardiovascular mortality in Germany.
OBJECTIVE
The effect of innovative medicines and surgical interventions on the decline of (cardiovascular) mortality is often called into question. The increase in general economic prosperity is often seen as the main reason for the continuous increase in life expectancy. The purpose of this study is to investigate the extent to which mortality from cardiovascular diseases has been affected by pharmaceuticals and other medical interventions over the last 30 years in Germany.


METHODS
Main outcome measures were the time series of direct method death rates (DMDR) of cardiovascular and non-cardiovascular mortalities. To control for socioeconomic and secular trends the difference between both time series was calculated. The impact of interventions on mortality was analysed by developing two linear regression models: The onset model analyses whether the introduction of interventions influences mortality or not. The consumption model estimates the quantitative impact of interventions in two phases.


RESULTS
Cardiovascular mortality as a percentage of total mortality fell from 40 to 38% over the study period. All investigated interventions had statistically significant effects on the decline of cardiovascular diseases, which is expressed by the standardised regression coefficient: onset model: preventive behaviour index (PBI) -8.3, angioplasty/CABG -0.6, antithrombotic agents -1.5, diuretics -0.9, beta-blockers -1.0, calcium channel blockers -0.8 and ACE inhibitors -1.1 (all interventions p < 0.01); consumption model: innovative drugs phase I -7.5 (p = 0.017), innovative drugs phase II -6.9 (p < 0.01), PBI -13.1 (p < 0.01) and angioplasty/CABG -9.9 (p < 0.01).


CONCLUSIONS
All innovative drug classes and surgical interventions had a positive effect on the decline of cardiovascular mortality.
Häussler
Bertram
B
IGES--institut für Gesundheits- und Sozialforschung GmbH, Berlin, Germany. bh@iges.de
Schiffhorst
Guido
G
Gothe
Holger
H
Hempel
Elke
E
D001241:Aspirin / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D005858:Germany / Q000453:epidemiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use
D002317:Cardiovascular Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001241:Aspirin