Explaining the decrease in coronary heart disease mortality in Italy between 1980 and 2000.
OBJECTIVE
We examined the extent to which the decrease in coronary heart disease (CHD) mortality rates in Italy could be explained by changes in cardiovascular risk factors versus the use of medical and surgical treatments.


METHODS
We used a validated model to combine data on changes in risk factors and uptake and effectiveness of cardiac treatments among adult men and women in Italy between 1980 and 2000. Data sources included results of published trials, meta-analyses, official statistics, longitudinal studies, and national surveys. The difference between observed and expected CHD deaths in 2000 was partitioned among treatments and risk factors.


RESULTS
From 1980 to 2000, the age-adjusted CHD mortality rate in Italy fell among persons aged 25 to 84 years, resulting in 42 930 fewer CHD deaths in 2000. Approximately 40% of this decrease was attributed to treatments and 55% to changes in risk factors.


CONCLUSIONS
Over half of the CHD mortality fall in Italy between 1980 and 2000 was attributable to reductions in major risk factors, mainly cholesterol and blood pressure, and less than half to evidence-based medical therapies. These results are becoming increasingly important, both for understanding past trends and for planning future prevention and treatment strategies.
Palmieri
Luigi
L
National Centre of Epidemiology, Surveillance, and Promotion of Health, National Institutes of Health, 00162 Rome, Italy. luigi.palmieri@iss.it
Bennett
Kathleen
K
Giampaoli
Simona
S
Capewell
Simon
S
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D003327:Coronary Disease / Q000401:mortality* / Q000517:prevention & control / Q000601:surgery / Q000628:therapy; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009026:Mortality / Q000639:trends; D012307:Risk Factors; D012737:Sex Factors
D002784:Cholesterol