title: Explaining the decline in coronary heart disease mortality in Portugal between 1995 and 2008.
abstract: BACKGROUND
  We aimed to quantify the contribution of treatments and risk factors to the decline in coronary heart disease (CHD) mortality in Portugal, 1995 to 2008.
  
  
  RESULTS
  The IMPACT mortality model was used to integrate data on trends in uptake of treatments and exposure to risk factors to explain the CHD mortality variation. Between 1995 and 2008, CHD mortality rates in Portugal decreased by 29% in men and 21% in women aged 25 to 84 years, corresponding to 3760 fewer deaths in 2008 than expected if 1995 mortality rates had persisted. Approximately 92% of the estimated decrease in number of deaths could be explained by the model; the remaining 8% were attributed to changes in unmeasured factors. Approximately 50% of the decrease explained by the model was attributable to an increased uptake of treatments, mainly antihypertensive medication (12%) and initial treatments after an acute myocardial infarction (10%), and 42% to population risk factor reductions, mainly blood pressure (27% in men and 60% in women), total cholesterol (14% in men and 5% in women), and smoking (11% in men). However, these reductions were partially offset by adverse trends in diabetes mellitus (18% in men and 2% in women) and obesity (6% in men and 5% in women) and smoking (2% in women).
  
  
  CONCLUSIONS
  In this low CHD risk population, modern treatments explained approximately half of the overall decline in CHD deaths. The biggest contributions to the CHD mortality decline came from secular decreases in blood pressure and increases in hypertension treatment.
authors.affiliation: Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.
authors.forename: Marta
authors.initials: M
authors.lastname: Pereira
authors.forename: Ana
authors.initials: A
authors.lastname: Azevedo
authors.forename: Nuno
authors.initials: N
authors.lastname: Lunet
authors.forename: Helena
authors.initials: H
authors.lastname: Carreira
authors.forename: Martin
authors.initials: M
authors.lastname: O'Flaherty
authors.forename: Simon
authors.initials: S
authors.lastname: Capewell
authors.forename: Kathleen
authors.initials: K
authors.lastname: Bennett
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D003327:Coronary Disease / Q000188:drug therapy / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011174:Portugal / Q000453:epidemiology; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis
chemical_list: D000959:Antihypertensive Agents
keywords: coronary artery disease; decision modeling; mortality; risk factors; therapeutics