title: Analyzing recent coronary heart disease mortality trends in Tunisia between 1997 and 2009.
abstract: BACKGROUND
  In Tunisia, Cardiovascular Diseases are the leading causes of death (30%), 70% of those are coronary heart disease (CHD) deaths and population studies have demonstrated that major risk factor levels are increasing.
  
  
  OBJECTIVE
  To explain recent CHD trends in Tunisia between 1997 and 2009.
  
  
  METHODS
  
  
  
  METHODS
  Published and unpublished data were identified by extensive searches, complemented with specifically designed surveys.
  
  
  METHODS
  Data were integrated and analyzed using the previously validated IMPACT CHD policy model. Data items included: (i)number of CHD patients in specific groups (including acute coronary syndromes, congestive heart failure and chronic angina)(ii) uptake of specific medical and surgical treatments, and(iii) population trends in major cardiovascular risk factors (smoking, total cholesterol, systolic blood pressure (SBP), body mass index (BMI), diabetes and physical inactivity).
  
  
  RESULTS
  CHD mortality rates increased by 11.8% for men and 23.8% for women, resulting in 680 additional CHD deaths in 2009 compared with the 1997 baseline, after adjusting for population change. Almost all (98%) of this rise was explained by risk factor increases, though men and women differed. A large rise in total cholesterol level in men (0.73 mmol/L) generated 440 additional deaths. In women, a fall (-0.43 mmol/L), apparently avoided about 95 deaths. For SBP a rise in men (4 mmHg) generated 270 additional deaths. In women, a 2 mmHg fall avoided 65 deaths. BMI and diabetes increased substantially resulting respectively in 105 and 75 additional deaths. Increased treatment uptake prevented about 450 deaths in 2009. The most important contributions came from secondary prevention following Acute Myocardial Infarction (AMI) (95 fewer deaths), initial AMI treatments (90), antihypertensive medications (80) and unstable angina (75).
  
  
  CONCLUSIONS
  Recent trends in CHD mortality mainly reflected increases in major modifiable risk factors, notably SBP and cholesterol, BMI and diabetes. Current prevention strategies are mainly focused on treatments but should become more comprehensive.
authors: Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of Medicine of Tunis-Tunisia, Tunis, Tunisia.
authors: Olfa
authors: O
authors: Saidi
authors: Nadia
authors: N
authors: Ben Mansour
authors: Martin
authors: M
authors: O'Flaherty
authors: Simon
authors: S
authors: Capewell
authors: Julia A
authors: JA
authors: Critchley
authors: Habiba
authors: H
authors: Ben Romdhane
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000188:drug therapy / Q000401:mortality*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood*; D003327:Coronary Disease / Q000097:blood / Q000188:drug therapy / Q000401:mortality*; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking; D016019:Survival Analysis; D014416:Tunisia / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents; D002784:Cholesterol
references: Bull World Health Organ. 2005 Nov;83(11):820-9
references: 16302038
references: Ann Cardiol Angeiol (Paris). 2010 Jun;59(3):131-7
references: 20510914
references: Eur J Clin Nutr. 2007 Feb;61(2):160-5
references: 16900086
references: Circulation. 2008 Jul 22;118(4):428-64
references: 18591433
references: Am J Epidemiol. 2005 Oct 15;162(8):764-73
references: 16150890
references: East Mediterr Health J. 2000 Jul;6(4):678-86
references: 11794074
references: BMJ. 1995 Sep 23;311(7008):793-6
references: 7580444
references: Bull World Health Organ. 2002;80(5):350-6
references: 12077609
references: Circulation. 2004 Sep 7;110(10):1236-44
references: 15337690
references: Am J Public Health. 2010 Apr;100(4):684-92
references: 19608958
references: Lipids. 2003 Feb;38(2):103-8
references: 12733740
references: Indian Heart J. 2005 Nov-Dec;57(6):632-8
references: 16521628
references: Curr Probl Cardiol. 2010 Feb;35(2):72-115
references: 20109979
references: J Am Coll Cardiol. 2007 Nov 27;50(22):2128-32
references: 18036449
references: Hypertens Res. 2012 Mar;35(3):341-7
references: 22129519
references: Glob Heart. 2012 Dec;7(4):361-6
references: 25689945
references: BMJ. 1994 Feb 5;308(6925):367-72
references: 8043072
references: BMJ. 2005 Sep 17;331(7517):614
references: 16107431
references: Eur Heart J. 1999 Oct;20(19):1386-92
references: 10487799
references: BMJ. 1999 Jul 10;319(7202):120
references: 10398643
references: Eur Heart J. 2002 Jan;23(2):110-6
references: 11785992
references: Int J Obes (Lond). 2011 Jul;35(7):1001-9
references: 21079620
references: Lancet. 1997 May 24;349(9064):1498-504
references: 9167458
references: J Epidemiol Community Health. 2006 Apr;60(4):322-7
references: 16537349
references: Rev Epidemiol Sante Publique. 2009 Apr;57(2):87-92
references: 19345528