Reduction In Coronary Heart Disease Mortality Research Articles

Quantifying benefits of the Danish transfat ban for coronary heart disease mortality 1991-2007: Socioeconomic analysis using the IMPACTsec model.

Denmark has experienced a remarkable reduction in CVD mortality over recent decades. The scale of the health contribution from the Danish regulation on industrially produced trans fatty acid (ITFA) has therefore long been of interest. Thus the objective was to determine health and equity benefits of the Danish regulation on ITFA content in Danish food, by quantifying the relative contributions of changes in ITFA intake, other risk factors and treatments on coronary heart disease (CHD) mortality decline from 1991 to 2007 in Denmark, stratified by socioeconomic group. To evaluate the effects of the ITFA ban (Danish Order no. 160 of March 2003) the Danish IMPACTSEC model was extended to quantify reductions in CHD deaths attributable to changes in ITFA (%E) intake between 1991-2007. Population counts were obtained from the Danish Central Office of Civil Registration, financial income from Statistics Denmark and ITFA intake from Dan-MONICA III (1991) and DANSDA (2005-2008). Participants were adults aged 25-84 years living in Denmark in 1991 and 2007, stratified by socioeconomic quintiles. The main outcome measure was CHD deaths prevented or postponed (DPP). Mean energy intake from ITFA was decimated between 1991 and 2007, falling from 1.1%E to 0.1%E in men and from 1·0%E to 0·1%E in women. Approximately 1,191 (95% CI 989-1,409) fewer CHD deaths were attributable to the ITFA reduction, representing some 11% of the overall 11,100 mortality fall observed in the period. The greatest attributable mortality falls were seen in the most deprived quintiles. Adding ITFA data to the original IMPACTsec model improved the overall model fit from 64% to 73%. In conclusion: Denmark's mandatory elimination of ITFA accounted for approximately 11% of the substantial reduction in CHD deaths observed between 1991 and 2007. The most deprived groups benefited the most, thus reducing inequalities. Adopting the Danish ITFA regulatory approach elsewhere could substantially reduce CHD mortality while improving health equity.

Hyperlipidemia management in diabetes: First line or supportive therapy?

Background & Aims: Coronary heart disease (CHD) is the most important cause of morbidity and mortality in type 2 diabetes. Current therapeutic approach has changed from glucocentric to vasculoprotective. This brief review highlights importance of management of hyperlipidemia (raised LDL cholesterol and triglycerides) on CHD outcomes in diabetes.Methods: Literature seach was done till March 2022 (Pubmed, Google scholar) using following search words; lipids, cholesterol, statins, triglycerides, fibrates, omega-3 polyunsaturated fatty (Omega-3 PUFAs) acids, LDL, diabetes, coronary heart disease.Results: Meta-analyses of randomized controlled trials have reported that LDL cholesterol lowering using moderate to high intensity statins significantly reduces adverse CHD outcomes in diabetes. Evidence of triglyceride reduction using fenofibrate or omega-3 PUFAs is not very robust although a trial of a purified omega-3 PUFAs has shown significant benefit.Conclusion: Lipid lowering with statins along with comprehensive lifestyle changes in addition to glucose control is recommended as first-line therapy to reduce CHD mortality and morbidity in diabetes.

Trends and predictors in all-cause and cause-specific mortality in diabetic and reference populations during 21 years of follow-up

BackgroundPatients with diabetes mellitus (DM) have a markedly higher overall mortality from coronary heart disease (CHD), as well as many other causes of death like cancer. Since diabetes is a...

Coronary heart disease mortality in treated familial hypercholesterolaemia: Update of the UK Simon Broome FH register

Background and aimsPatients with familial hypercholesterolaemia (FH) have an elevated risk of coronary heart disease (CHD). Here we compare changes in CHD mortality in patients with heterozygous (FH) pre 1992, before lipid-lowering therapy with statins was used routinely, and in the periods 1992–2008 and 2008–2016. Methods1903 Definite (DFH) and 1650 Possible (PFH) patients (51% women) aged 20–79 years, recruited from 21 lipid clinics in the United Kingdom and followed prospectively between 1980 and 2016 for 67,060 person-years. The CHD standardised mortality ratio (SMR) compared to the population in England and Wales was calculated (with 95% Confidence intervals). ResultsThere were 585 deaths, including 252 from CHD. Overall, the observed 2.4-fold excess coronary mortality for treated DFH post-1991 was significantly higher than the 1.78 excess for PFH (35% 95% CI 3%–76%). In patients with DFH and established coronary disease, there was a significant excess coronary mortality in all time periods, but in men it was reduced from a 4.83-fold excess (2.32–8.89) pre-1992 to 4.66 (3.46–6.14) in 1992–2008 and 2.51 (1.01–5.17) post-2008, while in women the corresponding values were 7.23 (2.65–15.73), 4.42 (2.70–6.82) and 6.34 (2.06–14.81). Primary prevention in men with DFH resulted in a progressive reduction in coronary mortality over the three time-periods, with no excess mortality evident post-2008 (0.89 (0.29–2.08)), although in women the excess persisted (post-2008 3.65 (1.75–6.72)). ConclusionsThe results confirm the benefit of statin treatment in reducing CHD mortality, but suggest that FH patients with pre-existing CHD and women with FH may not be treated adequately.

Alcohol Consumption and Mortality From Coronary Heart Disease: An Updated Meta-Analysis of Cohort Studies

Previous meta-analyses estimate that low-volume alcohol consumption protects against coronary heart disease (CHD). Potential errors in studies include systematic misclassification of drinkers as abstainers, inadequate measurement, and selection bias across the life course. Prospective studies of alcohol consumption and CHD mortality were identified in scholarly databases and reference lists. Studies were coded for potential abstainer biases and other study characteristics. The alcohol-CHD risk relationship was estimated in mixed models with controls for potential biases. Stratified analyses were performed based on variables identified as potential effect modifiers. Fully adjusted meta-analysis of all 45 studies found significantly reduced CHD mortality for current low-volume drinkers (relative risk [RR] = 0.80, 95% CI [0.69, 0.93]) and all current drinkers (RR = 0.88, 95% CI [0.78, 0.99]). There was evidence of effect modification by cohort age, gender, ethnicity, and heart health at baseline. In stratified analyses, low-volume consumption was not significantly protective for cohorts ages 55 years or younger at baseline (RR = 0.95, 95% CI [0.75, 1.21]), for studies controlling for heart health (RR = 0.87, 95% CI [0.71, 1.06]), or for higher quality studies (RR = 0.86, 95% CI [0.68, 1.09]). In studies in which the mean age was 55 years or younger at baseline, there were significantly increased RRs for both former (RR = 1.45, 95% CI [1.08, 1.95]) and occasional drinkers (RR = 1.44, 95% CI [1.09, 1.89]) compared with abstainers. Pooled analysis of all identified studies suggested an association between alcohol use and reduced CHD risk. However, this association was not observed in studies of those age 55 years or younger at baseline, in higher quality studies, or in studies that controlled for heart health. The appearance of cardio-protection among older people may reflect systematic selection biases that accumulate over the life course.

Role of Omega-3 Fatty Acids in Dyslipidemia and Cardiovascular Diseases

Globally, coronary heart disease (CHD) is a leading cause of mortality and morbidity, especially in developing countries. Both marine and plants sources of omega-3 fatty acids has been shown to be beneficial in reducing CHD mortality. Beside of anti-arrhythmic effects, omega-3 has been shown anti-thrombotic and anti-atherosclerotic effect. In 2011, US population spent about 25 billion US dollar for omega-3 supplement; it is projected to be 35 billion US dollar in the year 2016. Several reviews on randomized controlled trial conclude that omega-3 fatty acids reduced plasma triglyceride level consistently in a dose-dependent fashion. Other beneficial effects on blood pressure, endothelial function and high density lipoprotein (HDL) level participate in lowering CHD mortality. American Heart Association (AHA) recommended routine fish consumption as secondary prevention in patient at risk. Omega-3 fatty acids role in primary prevention is inconclusive and need further investigation regarding cost-benefit and bleeding risk.

Hyperuricemia and coronary heart disease mortality: a meta-analysis of prospective cohort studies.

BackgroundHyperuricemia may be associated with an increased risk of coronary heart disease (CHD) mortality; however, the results from prospective studies are conflicting. The objective of this study was to assess the association between hyperuricemia and risk of CHD mortality by performing a meta-analysis.MethodsPubmed and Embase were searched for relevant prospective cohort studies published until July 2015. Studies were included only if they reported data on CHD mortality related to hyperuricemia in a general population. The pooled adjusted relative risk (RR) was calculated using a random-effects model.ResultsA total of 14 studies involving 341 389 adults were identified. Hyperuricemia was associated with an increased risk of CHD mortality (RR: 1.14; 95 % CI: 1.06–1.23) and all-cause mortality (RR: 1.20; 95 % CI: 1.13–1.28). For each increase of 1 mg/dl of serum uric acid (SUA), the overall risks of CHD and all-cause mortality increased by 20 and 9 %, respectively. According to the gender subgroup analyses, hyperuricemia increased the risk of CHD mortality in women (RR: 1.47; 95 % CI: 1.21–1.73) compared to men (RR: 1.10; 95 % CI: 1.00–1.19). The risk of all-cause mortality was greater in women.ConclusionsHyperuricemia may modestly increase the risk of CHD and all-cause mortality. Future research is needed to determine whether urate–lowering therapy has beneficial effects for reducing CHD mortality.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0379-z) contains supplementary material, which is available to authorized users.

Cost-effectiveness analysis of eliminating industrial and all trans fats in England and Wales: modelling study

Coronary heart disease (CHD) remains a leading cause of UK mortality. Dietary trans fats (TFA) represent a powerful CHD risk factor. However, UK efforts to reduce intake have been less successful than other nations. We modelled the potential health and economic effects of eliminating industrial and all TFA up to 2020. We extended the previously validated IMPACTsec model, to estimate the potential effects on health and economic outcomes of mandatory reformulation or a complete ban on dietary TFA in England and Wales from 2011 to 2020. We modelled two policy scenarios: 1) Elimination of industrial TFA consumption, from 0.8% to 0.4% daily energy 2) Elimination of all TFA consumption, from 0.8% to 0. Elimination of industrial TFA across the England and Wales population could result in approximately 1600 fewer deaths per year, with some 4000 fewer hospital admissions; gaining approximately 14 000 additional life years. Health inequalities would be substantially reduced in both scenarios. Elimination of industrial TFA would be cost saving. This would include approximately £100 m saved in direct healthcare costs. Elimination of all TFA would double the health and economic gains. Eliminating industrial or all UK dietary intake of TFA could substantially reduce CHD mortality and inequalities, while resulting in substantial annual savings.

Lipid lowering drug therapy in patients with coronary heart disease from 24 European countries – Findings from the EUROASPIRE IV survey

ObjectiveSince dyslipidaemia is one of the most important risk factors for coronary heart disease (CHD), lowering of LDL-cholesterol (LDL-C) causes significant reduction in morbidity and mortality, particularly in patients with established CHD. The aim of this survey was to assess how statins were prescribed in CHD patients at discharge after a coronary event from hospitals throughout Europe and how the intake of these drugs was reported by the patients when they were seen more than one year later in relationship with their achieved LDL-C levels. Methods6648 CHD patients' data from centres in 24 European countries were gathered using standardized methods. Lipid measurements were performed in one central laboratory. Patients were divided in three groups: high-intensity statin therapy, moderate or low intensity statin therapy and no statin therapy at all. Results90.4% CHD patients were on statin therapy at the time of discharge from the hospital which decreased to 86% one year later. Only 37.6% of these patients were prescribed a high-intensity statin at discharge which even decreased to 32.7% later. In only 6 countries (all of them high-income countries) the number of patients on a high-intensity statin therapy increased substantially after the hospital discharge. It is worrying that statin therapy was discontinued in 11.6% and that only 19.3% of all CHD patients achieved target values of LDL-C < 1.8 mmol/L at the time of interview. ConclusionsToo many CHD patients with dyslipidaemia are still inadequately treated and most of these patients on statin therapy are not achieving the treatment targets. Therapeutic control of LDL-C is clearly related to the intensity of lipid lowering drug regimen after the CHD event indicating that a considerable potential still exists throughout Europe to reduce CHD mortality and morbidity rates through more efficient LDL-C lowering.

Optimism and Mortality in Older Men and Women: The Rancho Bernardo Study.

Purpose. To examine the associations of optimism and pessimism with all-cause, cardiovascular disease (CVD), coronary heart disease (CHD), and cancer mortality in a population-based sample of older men and women followed ≤12 years. Methods. 367 men and 509 women aged ≥50 from the Rancho Bernardo Study attended a 1999–2002 research clinic visit when demographic, behavioral, and medical history were obtained and completed a 1999 mailed survey including the Life Orientation Test-Revised (LOT-R). Mortality outcomes were followed through 2012. Results. Average age at baseline was 74.1 years; during follow-up (mean = 8.1 years), 198 participants died, 62 from CVD, 22 from CHD, and 49 from cancer. Total LOT-R, optimism and pessimism scores were calculated. Participants with the highest optimism were younger and reported less alcohol use and smoking and more exercise. Cox proportional hazard models showed that higher total LOT-R and optimism, but not pessimism scores, were associated with reduced odds of CHD mortality after adjusting for age, sex, alcohol, smoking, obesity, physical exercise, and medication (HR = 0.86, 95% CI = 0.75, 0.99; HR = 0.77, 95% CI = 0.61, 0.99, resp.). No associations were found for all-cause, CVD, or cancer mortality. Conclusions. Optimism was associated with reduced CHD mortality in older men and women. The association of positive attitudes with mortality merits further study.

Modelling Future Coronary Heart Disease Mortality to 2030 in the British Isles.

ObjectiveDespite rapid declines over the last two decades, coronary heart disease (CHD) mortality rates in the British Isles are still amongst the highest in Europe. This study uses a modelling approach to compare the potential impact of future risk factor scenarios relating to smoking and physical activity levels, dietary salt and saturated fat intakes on future CHD mortality in three countries: Northern Ireland (NI), Republic of Ireland (RoI) and Scotland.MethodsCHD mortality models previously developed and validated in each country were extended to predict potential reductions in CHD mortality from 2010 (baseline year) to 2030. Risk factor trends data from recent surveys at baseline were used to model alternative future risk factor scenarios: Absolute decreases in (i) smoking prevalence and (ii) physical inactivity rates of up to 15% by 2030; relative decreases in (iii) dietary salt intake of up to 30% by 2030 and (iv) dietary saturated fat of up to 6% by 2030. Probabilistic sensitivity analyses were then conducted.ResultsProjected populations in 2030 were 1.3, 3.4 and 3.9 million in NI, RoI and Scotland respectively (adults aged 25–84). In 2030: assuming recent declining mortality trends continue: 15% absolute reductions in smoking could decrease CHD deaths by 5.8–7.2%. 15% absolute reductions in physical inactivity levels could decrease CHD deaths by 3.1–3.6%. Relative reductions in salt intake of 30% could decrease CHD deaths by 5.2–5.6% and a 6% reduction in saturated fat intake might decrease CHD deaths by some 7.8–9.0%. These projections remained stable under a wide range of sensitivity analyses.ConclusionsFeasible reductions in four cardiovascular risk factors (already achieved elsewhere) could substantially reduce future coronary deaths. More aggressive polices are therefore needed in the British Isles to control tobacco, promote healthy food and increase physical activity.

Trends in coronary heart disease mortality and statin utilization in two European areas with different population risk levels: Stockholm and Sicily

Background and Aim: The reduction in coronary heart disease (CHD) mortality in Europe has been associated with a&lt;br /&gt;reduction in coronary risk factors, including dyslipidaemia. Statins reduce blood cholesterol levels and the risk of coronary&lt;br /&gt;events. Their utilization has substantially increased over the years. Although statins should be prescribed according to clinical&lt;br /&gt;guidelines, doctors’ decisions about treatment are usually made subjectively and are influenced by the population risk level.&lt;br /&gt;The aim of this study was to investigate the relation between the time trend of population risk level and statin utilization in two&lt;br /&gt;areas with different levels of coronary risk in the population.&lt;br /&gt;Methods: CHD mortality, as a proxy of population coronary risk level, and statin utilization trends in the period 2001-2011,&lt;br /&gt;were compared between a relatively high-risk CHD area, Stockholm county, and a low-risk area, Sicily.&lt;br /&gt;Results: There was a reduction in CHD mortality and an increase in statin utilization in both areas. The mean annual reduction&lt;br /&gt;in CHD mortality rate/100,000 was greater in Stockholm than in Sicily (-4.6, 95% CI -5.3 -4.0, and -1.9 95% CI -2.6 – 1.2,&lt;br /&gt;respectively). The mean annual increase in statin DDD/TID utilization was larger in Sicily than in Stockholm (5.1, 95% CI 4.8 –&lt;br /&gt;5.3, and 3.7, 95% CI 3.2 – 4.1, respectively). In Stockholm the increase in statin use was mainly due to increased utilization of&lt;br /&gt;simvastatin, whereas it included a greater variety of statins in Sicily.&lt;br /&gt;Conclusion: The relations between time trends of CHD mortality and statin utilization in Stockholm and in Sicily were&lt;br /&gt;different. A larger increase in statins was observed in the low-risk area, associated with a slower reduction in CHD mortality,&lt;br /&gt;whereas a smaller increase in statins was observed in the high-risk area, associated with a greater reduction in CHD mortality.&lt;br /&gt;Other factors apart from the actual risk of the patients may explain these observations, such as differences in socioeconomic&lt;br /&gt;factors, adherence to treatment, policies of drug cost-containment, and population CHD risk profiles.

Abstract P325: Quantifying the UK Social and Economic Benefits of Potential Policies to Reduce dietary Trans Fats: Modelling Study.

Background: Industrial trans fatty acids (TFAs) are commonly added to processed foods as a cheap way to increase shelf-life and enhance palatability. Natural TFA are found in small quantities in meat and dairy products. TFA substantially increase the risk of Coronary Heart Disease (CHD). The UK burden of CHD remains large, and unequal across socio-economic groups. TFA intake is also unequal, with largest intake in the most deprived groups. Methods: We modelled three policy options for reducing TFA in the English diet; a) increased labelling requirements resulting in partial voluntary reformulation; b) a ban on TFA in all restaurant &amp; take-away food, and c) a total TFA ban in all processed foods. We quantified health benefits for the period 2015-2020 for each policy (deaths prevented and life-years-gained -LYG). Analyses were stratified by age, gender, and socioeconomic quintiles (IMDQ). Mortality gains were linked to economic cost and benefits: direct healthcare costs, productivity loss averted, and informal care; government costs comprising legislative and monitoring; and costs to industry. Results were tested in a probabilistic sensitivity analysis. Results: The most effective UK policy in reducing CHD mortality from 2015-2020, would be a total TFA ban resulting in approximately 8,600 fewer CHD deaths [95% confidence interval 3,400 - 14,700] with a substantial inequality reduction of some 3,300 deaths [1,300 - 6,000]. Labelling with partial voluntary reformulation might result in approximately 2,500 fewer CHD deaths [1,100 - 4,600]; and an inequality reduction of some 800 deaths [300 - 1,400]. Whilst a TFA ban in restaurant and take-away food could yield approximately 2,200 fewer CHD deaths [900 - 3,800]; and an inequality reduction of some 700 [300 - 1,200]). All policies would be cost-saving for the government due to big reductions in health care costs. A total ban could achieve annual societal savings of approximately £96 million The labelling and restaurant and take-away bans might gain £12 - £14 million savings for, representing £8,600 to £3,700-£4,800 per QALY. Industry costs might reach some £210 million if extensive reformulations were required, but could be negligible if reformulations were absorbed into natural product reformulation cycles. Conclusions: Policies to reduce TFA consumption in the English population are a priority public health measure. As both TFA consumption and CHD burden are higher deprived groups, any TFA reduction will reduce inequalities in CHD mortality. A total ban on TFA in ALL processed foods would have the greatest coverage across social groups. It would also represent a good investment from a societal perspective. Policies with less comprehensive coverage would be correspondingly less effective at reducing mortality, inequalities and cost effective, but would still yield substantial health, and economic gains.

The contribution of primary prevention medication and dietary change in coronary mortality reduction in England between 2000 and 2007: a modelling study

ObjectiveTo analyse the falls in coronary heart disease (CHD) mortality in England between 2000 and 2007 and quantify the relative contributions from preventive medications and population-wide changes in blood pressure...

Abstract MP18: Estimating Coronary Mortality Reductions By Shifting The Population Blood Pressure Distribution Or By Improving The Management Of Hypertensive Patients

Introduction: Hypertension is an important risk factor for coronary heart disease (CHD) in the UK and US. Although CHD death rates are falling, a large proportion of hypertensive patients are poorly controlled and population salt intake, a major determinant of hypertension, remains well above the recommended daily maximum of 6g/day. G. Rose identified two strategies to reduce CHD mortality. The first proposes that small, but population-wide, reductions in systolic blood pressure (SBP), achieved by public health measures to reduce salt intake, will deliver large reductions in mortality. The second seeks to reduce mortality by treating hypertensive patients and keeping them below a given risk-threshold. Here we explore the potential to reduce CHD deaths through a combination of these strategies in England and Wales up to 2030. Methods: We used the Stock of Health (SoH) model assuming each individual is born with a SoH, and on an annual basis this stock depreciates due to demographic factors, and fixed and variable risk factors. When the individual’s SoH reaches a critical point, a death from CHD occurs. The model parameters were calibrated using data from the US Cardiovascular Lifetime Risk Pooling Project. Births, deaths and risk factors distributions were estimated using data from England and Wales (ONS). We modelled a baseline scenario, three population-level strategies and two high-risk strategies. The population level strategies to reduce SBP were: (1) a reduction of 0.1 mmHg achievable by health promotion or labelling strategies, (2) a reduction of 1.3 mmHg achievable by mandatory reformulation and (3) matching England and Wales SBP levels to the observed values in the US population (average reduction:7 mmHg). In the high-risk strategies, 30% and 50% of the currently uncontrolled hypertensive patients respectively are treated to keep their SBP under 140 mmHg. Results: In the baseline scenario, the total number of CHD deaths from 2013 to 2030 will be approximately 465,000 (95% CI 460,308 to 469,334). We predict 1,244 (95% CI -3,320 to 5,807) fewer deaths by health promotion; approximately 16,203 (11,691 to 20,718) fewer deaths by mandatory reformulation of foods and some 78,051 (74,016 to 82,087) fewer deaths by reducing SBP levels to the observed levels in US. Conversely, by controlling the SBP of 30% and 50% of uncontrolled hypertensive patients, we predict 4,594 (6 to 9,191) and 7,172 (6,473 to 11,767) fewer deaths respectively. Conclusion: Both risk-targeted treatment strategies and population shifts attributable to salt reduction appear to provide potential substantial contributions to reducing CHD mortality in England and Wales. There remains, however, considerable potential to achieve much greater reductions in mortality by reducing SBP levels to those seen in the US.

Population Assessment of Future Trajectories in Coronary Heart Disease Mortality

BackgroundCoronary heart disease (CHD) mortality rates have been decreasing in Iceland since the 1980s, largely reflecting improvements in cardiovascular risk factors. The purpose of this study was to predict future CHD mortality in Iceland based on potential risk factor trends.Methods and findingsThe previously validated IMPACT model was used to predict changes in CHD mortality between 2010 and 2040 among the projected population of Iceland aged 25–74. Calculations were based on combining: i) data on population numbers and projections (Statistics Iceland), ii) population risk factor levels and projections (Refine Reykjavik study), and iii) effectiveness of specific risk factor reductions (published meta-analyses). Projections for three contrasting scenarios were compared: 1) If the historical risk factor trends of past 30 years were to continue, the declining death rates of past decades would level off, reflecting population ageing. 2) If recent trends in risk factors (past 5 years) continue, this would result in a death rate increasing from 49 to 70 per 100,000. This would reflect a recent plateau in previously falling cholesterol levels and recent rapid increases in obesity and diabetes prevalence. 3) Assuming that in 2040 the entire population enjoys optimal risk factor levels observed in low risk cohorts, this would prevent almost all premature CHD deaths before 2040.ConclusionsThe potential increase in CHD deaths with recent trends in risk factor levels is alarming both for Iceland and probably for comparable Western populations. However, our results show considerable room for reducing CHD mortality. Achieving the best case scenario could eradicate premature CHD deaths by 2040. Public health policy interventions based on these predictions may provide a cost effective means of reducing CHD mortality in the future.

Treatment potential for dyslipidaemia management in patients with coronary heart disease across Europe: Findings from the EUROASPIRE III survey

ObjectiveDyslipidaemia is among the most important risk factors for coronary heart disease (CHD). The lowering of LDL-cholesterol (LDL-C) yields significant reduction in both morbidity and mortality rates, particularly in patients with established CHD. The aim of this survey was to assess how dyslipidaemia is managed following a coronary event in different places in Europe. MethodsCHD patients' data from centres in 22 European countries were gathered using standardised methods. In total, 8467 CHD patients with lipid measurements in one central laboratory were included. Trends from 8 countries participating in all three EUROASPIRE surveys (1994–1995, 1999–2000, 2006–2007) were also investigated. Results51.1% of CHD patients had elevated total cholesterol (≥4.5 mmol/L), 54.5% had raised LDL-C (≥2.5 mmol/L), 36.7% had low HDL-C (<1.0 mmol/L for men and <1.2 mmol/L for women), and 34.7% had increased triglycerides (≥1.7 mmol/L). The use of lipid lowering drugs was 79.8% but it varied considerably, ranging from only 41.6% (Lithuania) to 95.4% (Finland). Over the past decade, in 8 countries the prevalence of hypercholesterolaemia (≥4.5 mmol/L) in CHD patients has decreased from 94.5% in the first to 76.7% in the second and 46.2% in the third survey (p < 0.0001). The use of lipid-lowering drugs increased from 32.3% in the first, to 62.7% in the second and 88.8% in the third survey (p < 0.0001). ConclusionsAlthough management of dyslipidaemia in CHD patients is improving, a large majority of CHD patients with dyslipidaemia is still inadequately treated and many patients on lipid-lowering therapy are not reaching the treatment goals. Therefore, a considerable potential still exists throughout Europe to reduce CHD mortality and morbidity rates through better treatment of dyslipidaemia.

Modelling factors in primary care quality improvement: a cross-sectional study of premature CHD mortality

ObjectivesTo identify features of primary care quality improvement associated with improved health outcomes using premature coronary heart disease (CHD) mortality as an example, and to determine impacts of different modelling...

OP56 Modelling Future Coronary Heart Disease Mortality to 2030 in the British Isles

BackgroundDespite rapidly declining coronary heart disease (CHD) mortality rates over the last two decades, CHD mortality rates in the British Isles are still amongst the highest in Europe. Greater risk...

Trends in age-specific coronary heart disease mortality in the European Union over three decades: 1980–2009

AimsRecent decades have seen very large declines in coronary heart disease (CHD) mortality across most of Europe, partly due to declines in risk factors such as smoking. Cardiovascular diseases (predominantly CHD and stroke), remain, however, the main cause of death in most European countries, and many risk factors for CHD, particularly obesity, have been increasing substantially over the same period. It is hypothesized that observed reductions in CHD mortality have occurred largely within older age groups, and that rates in younger groups may be plateauing or increasing as the gains from reduced smoking rates are increasingly cancelled out by increasing rates of obesity and diabetes. The aim of this study was to examine sex-specific trends in CHD mortality between 1980 and 2009 in the European Union (EU) and compare trends between adult age groups.MethodsSex-specific data from the WHO global mortality database were analysed using the joinpoint software to examine trends and significant changes in trends in age-standardized mortality rates. Specific age groups analysed were: under 45, 45–54, 55–64, and 65 years and over. The number and location of significant joinpoints for each country by sex and age group was determined (maximum of 3) using a log-linear model, and the annual percentage change within each segment calculated. Average annual percentage change overall (1980–2009) and separately for each decade were calculated with respect to the underlying joinpoint model.ResultsRecent CHD rates are now less than half what they were in the early 1980s in many countries, in younger adult age groups as well as in the population overall. Trends in mortality rates vary markedly between EU countries, but less so between age groups and sexes within countries. Fifteen countries showed evidence of a recent plateauing of trends in at least one age group for men, as did 12 countries for women. This did not, however, appear to be any more common in younger age groups compared with older adults. There was little evidence to support the hypothesis that mortality rates have recently begun to plateau in younger age groups in the EU as a whole, although such plateaus and even a small number of increases in CHD mortality in younger subpopulations were observed in a minority of countries.ConclusionThere is limited evidence to support the hypothesis that CHD mortality rates in younger age groups in the member states of the EU have been more likely to plateau than in older age groups. There are, however, substantial and persistent inequalities between countries. It remains vitally important for the whole EU to monitor and work towards reducing preventable risk factors for CHD and other chronic conditions to promote wellbeing and equity across the region.