OP54 Explaining the decline in coronary heart disease mortality in the Slovak Republic between 1993–2008

Abstract

<h3>Background</h3> Although cardiovascular diseases remain the most important cause of death in the Slovak Republic, mortality rates from coronary heart disease (CHD) have substantially decreased in the last two decades. The aim of this modelling study was therefore to try and quantify the main contributions to this mortality decline. <h3>Methods</h3> Data covering adults aged 25–74 years in the Slovak Republic (population 3.5 million) between the years 1993–2008 were identified, obtained and scrutinised. These data detailed trends in major population cardiovascular risk factors (smoking, blood pressure, total cholesterol, diabetes prevalence, body mass index (BMI) and physical activity levels), and also the uptake of all standard CHD treatments. The main data sources were official statistics, national representative studies, published trials and meta-analyses, and the Slovak CINDI studies. The previously validated IMPACT policy model was then used to combine and integrate these data with effect sizes from published meta-analyses quantifying the effectiveness of specific evidence based treatments, and population-wide changes in cardiovascular risk factors. Results were expressed as deaths prevented or postponed (DPPs). Uncertainties were explored using probabilistic sensitivity analyses. <h3>Results</h3> Between 1993 and 2008 age-adjusted CHD mortality rates in the Slovak Republic decreased by 23% in men and 26% in women aged 25–74 years, representing 1950 fewer CHD deaths in 2008. Improvements in the uptake of evidence based treatments explained approximately 48% of the mortality fall (mainly reflecting contributions from treatments for acute coronary syndrome, acute and chronic heart failure and primary prevention, ie. statins and anti-hypertensives). Changes in CHD risk factors explained approximately 43% of the total mortality decrease (resulting mainly from positive changes in total serum cholesterol). However, most other risk factors demonstrated adverse trends and thus generated approximately 575 additional deaths. Results remained relatively stable under a range of sensitivity analyses. <h3>Conclusion</h3> This preliminary analysis suggests that approximately half the coronary heart disease mortality fall recently observed in the Slovak Republic may be attributable to evidence based treatments, with much of the remainder coming from large falls in total serum cholesterol. The adverse trends observed in all the other major cardiovascular risk factors (smoking, blood pressure, BMI, diabetes and physical inactivity) in the Slovak Republic are deeply worrying, and emphasise the need for more energetic population-wide prevention policies.