title: Analysing the large decline in coronary heart disease mortality in the Icelandic population aged 25-74 between the years 1981 and 2006.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
authors.affiliation: Icelandic Heart Association, Kopavogur, Iceland.
authors.forename: Thor
authors.initials: T
authors.lastname: Aspelund
authors.forename: Vilmundur
authors.initials: V
authors.lastname: Gudnason
authors.forename: Bergrun Tinna
authors.initials: BT
authors.lastname: Magnusdottir
authors.forename: Karl
authors.initials: K
authors.lastname: Andersen
authors.forename: Gunnar
authors.initials: G
authors.lastname: Sigurdsson
authors.forename: Bolli
authors.initials: B
authors.lastname: Thorsson
authors.forename: Laufey
authors.initials: L
authors.lastname: Steingrimsdottir
authors.forename: Julia
authors.initials: J
authors.lastname: Critchley
authors.forename: Kathleen
authors.initials: K
authors.lastname: Bennett
authors.forename: Martin
authors.initials: M
authors.lastname: O'Flaherty
authors.forename: Simon
authors.initials: S
authors.lastname: Capewell
mesh_terms: D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000401:mortality* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009026:Mortality / Q000639:trends*; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control