title: Explaining the Decline in Coronary Heart Disease Mortality in the Netherlands between 1997 and 2007.
abstract: OBJECTIVE
  We set out to determine what proportion of the mortality decline from 1997 to 2007 in coronary heart disease (CHD) in the Netherlands could be attributed to advances in medical treatment and to improvements in population-wide cardiovascular risk factors.
  
  
  METHODS
  We used the IMPACT-SEC model. Nationwide information was obtained on changes between 1997 and 2007 in the use of 42 treatments and in cardiovascular risk factor levels in adults, aged 25 or over. The primary outcome was the number of CHD deaths prevented or postponed.
  
  
  RESULTS
  The age-standardized CHD mortality fell by 48% from 269 to 141 per 100.000, with remarkably similar relative declines across socioeconomic groups. This resulted in 11,200 fewer CHD deaths in 2007 than expected. The model was able to explain 72% of the mortality decline. Approximately 37% (95% CI: 10%-80%) of the decline was attributable to changes in acute phase and secondary prevention treatments: the largest contributions came from treating patients in the community with heart failure (11%) or chronic angina (9%). Approximately 36% (24%-67%) was attributable to decreases in risk factors: blood pressure (30%), total cholesterol levels (10%), smoking (5%) and physical inactivity (1%). Ten% more deaths could have been prevented if body mass index and diabetes would not have increased. Overall, these findings did not vary across socioeconomic groups, although within socioeconomic groups the contribution of risk factors differed.
  
  
  CONCLUSIONS
  CHD mortality has recently halved in The Netherlands. Equally large contributions have come from the increased use of acute and secondary prevention treatments and from improvements in population risk factors (including primary prevention treatments). Increases in obesity and diabetes represent a major challenge for future prevention policies.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.|Dutch Heart Foundation, The Hague, the Netherlands.
authors.forename: Carla
authors.initials: C
authors.lastname: Koopman
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.|Dutch Heart Foundation, The Hague, the Netherlands.
authors.forename: Ilonca
authors.initials: I
authors.lastname: Vaartjes
authors.affiliation: Dutch Heart Foundation, The Hague, the Netherlands.
authors.forename: Ineke
authors.initials: I
authors.lastname: van Dis
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.|National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
authors.forename: W M Monique
authors.initials: WM
authors.lastname: Verschuren
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Engelfriet
authors.affiliation: PHARMO Institute for drug research, Utrecht, the Netherlands.
authors.forename: Edith M
authors.initials: EM
authors.lastname: Heintjes
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
authors.forename: Anneke
authors.initials: A
authors.lastname: Blokstra
authors.affiliation: EMGO Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Dorly J H
authors.initials: DJ
authors.lastname: Deeg
authors.affiliation: EMGO Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands.|Department of Health Sciences, VU University, Amsterdam, The Netherlands.|Department of Dietetics and Nutrition Sciences, Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Visser
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.affiliation: Department of Public Health & Policy, Institute of Psychology, Health & Society, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: O'Flaherty
authors.affiliation: Department of Public Health & Policy, Institute of Psychology, Health & Society, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Capewell
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D003327:Coronary Disease / Q000097:blood / Q000401:mortality* / Q000503:physiopathology; D015444:Exercise; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D012923:Social Class
chemical_list: D002784:Cholesterol