Modelling the decreasing coronary heart disease mortality in Sweden between 1986 and 2002.
OBJECTIVE
Coronary heart disease (CHD) mortality rates have been falling in Sweden since the 1980s. We used the previously validated IMPACT CHD model to examine how much of the mortality decrease in Sweden between 1986 and 2002 could be attributed to medical and surgical treatments, and how much to changes in cardiovascular risk factors.


RESULTS
The IMPACT mortality model was used to combine and analyse data on uptake and effectiveness of cardiological treatments and risk factor trends in Sweden. The main data sources were official statistics, national quality of care registers, published trials and meta-analyses, and national population surveys. Between 1986 and 2002, CHD mortality rates in Sweden decreased by 53.4% in men and 52.0% in women aged 25-84 years. This resulted in 13 180 fewer deaths in 2002. Approximately 36% of this decrease was attributed to treatments in individuals and 55% to population risk factor reductions. Adverse trends were seen for diabetes and overweight.


CONCLUSIONS
More than half of the substantial CHD mortality decrease in Sweden between 1986 and 2002 was attributable to reductions in major risk factors, mainly a large decrease in total serum cholesterol. These findings emphasize the value of a comprehensive strategy that promotes primary prevention and evidence-based medical treatments, especially secondary prevention.
Björck
Lena
L
Department of Emergency and Cardiovascular Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. lena.m.bjorck@vgregion.se
Rosengren
Annika
A
Bennett
Kathleen
K
Lappas
George
G
Capewell
Simon
S
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000401:mortality* / Q000517:prevention & control; D003925:Diabetic Angiopathies / Q000401:mortality / Q000517:prevention & control; D004812:Epidemiologic Methods; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000401:mortality; D011379:Prognosis; D055502:Secondary Prevention / Q000379:methods; D012907:Smoking / Q000401:mortality; D013548:Sweden / Q000453:epidemiology