title: Explaining the decline in coronary heart disease mortality in Turkey between 1995 and 2008.
abstract: BACKGROUND
  Coronary heart disease (CHD) mortality rates have been decreasing in Turkey since the early 1990s. Our study aimed to determine how much of the CHD mortality decrease in Turkey between 1995 and 2008 could be attributed to temporal trends in major risk factors and how much to advances in medical and surgical treatments.
  
  
  METHODS
  The validated IMPACT CHD mortality model was used to combine and analyse data on uptake and effectiveness of CHD treatments and risk factor trends in Turkey in adults aged 35-84 years between 1995 and 2008.Data sources were identified, searched and appraised on population, mortality and major CHD risk factors for adults those aged 35-84 years. Official statistics, electronic databases, national registers, surveys and published trials were screened from 1995 onwards.
  
  
  RESULTS
  Between 1995 and 2008, coronary heart disease mortality rates in Turkey decreased by 34% in men and 28% in women 35 years and over. This resulted in 35,720 fewer deaths in 2008.Approximately 47% of this mortality decrease was attributed to treatments in individuals (including approximately 16% to secondary prevention, 3% angina treatments, 9% to heart failure treatments, 5% to initial treatments of acute myocardial infarction, and 5% to hypertension treatments) and approximately 42% was attributable to population risk factor reductions (notably blood pressure 29%; smoking 27%; and cholesterol 1%). Adverse trends were seen for obesity and diabetes (potentially increasing mortality by approximately 11% and 14% respectively). The model explained almost 90% of the mortality fall.
  
  
  CONCLUSIONS
  Reduction in major cardiovascular risk factors explained approximately 42% and improvements in medical and surgical treatments explained some 47% of the CHD mortality fall. These findings emphasize the complimentary value of primary prevention and evidence-based medical treatments in controlling coronary heart disease.
authors.affiliation: Department of Public Health, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey. belgin.unal@deu.edu.tr.
authors.forename: Belgin
authors.initials: B
authors.lastname: Unal
authors.forename: Kaan
authors.initials: K
authors.lastname: Sözmen
authors.forename: Hale
authors.initials: H
authors.lastname: Arık
authors.forename: Gül
authors.initials: G
authors.lastname: Gerçeklioğlu
authors.forename: Deniz Utku
authors.initials: DU
authors.lastname: Altun
authors.forename: Hatice
authors.initials: H
authors.lastname: Şimşek
authors.forename: Sinem
authors.initials: S
authors.lastname: Doganay
authors.forename: Yücel
authors.initials: Y
authors.lastname: Demiral
authors.forename: Özgür
authors.initials: Ö
authors.lastname: Aslan
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
authors.forename: Julia
authors.initials: J
authors.lastname: Critchley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000401:mortality* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009026:Mortality / Q000639:trends; D012307:Risk Factors; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology