(Circulation. 2000;102:1511.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Explanation for the Decline in Coronary Heart Disease Mortality Rates in Auckland, New Zealand, Between 1982 and 1993
From the Department of Public Health (S.C.), University of Liverpool, Liverpool, L69 3GB UK; Department of Community Health (R.B.), Faculty of Medicine and Health Science, University of Auckland, Auckland, New Zealand; and Department of Cardiology (M.S., J.M.), Glasgow Western Infirmary, Glasgow, G12 8RZ UK.
Correspondence to Prof Simon Capewell, Department of Public Health, University of Liverpool, Liverpool, L69 3GB UK. E-mail capewell{at}liverpool.ac.uk
Background—We sought to determine how much of the recent, substantial fall in coronary heart disease (CHD) mortality rates in New Zealand can be attributed to "evidence-based" medical and surgical treatments and how much can be attributed to cardiovascular risk factor reductions.
Methods and Results—A cell-based mortality model was developed and refined. This model combined (1) the published effectiveness of cardiological treatments and risk factor reductions with (2) data on all medical and surgical treatments administered to all CHD patients and (3) trends in population cardiovascular risk factors (principally smoking, cholesterol, and hypertension) from 1982 to 1993 in Auckland, New Zealand (population 996 000). Between 1982 and 1993, CHD mortality rates fell by 23.6%, with 671 fewer CHD deaths than expected from baseline mortality rates in 1982. Forty-six percent of this fall was attributed to treatments (acute myocardial infarction 12%, secondary prevention 12%, hypertension 7%, heart failure 6%, and angina 9%), and 54% was attributed to risk factor reductions (smoking 30%, cholesterol 12%, population blood pressure 8%, and other, unidentified factors 4%). These proportions remained relatively consistent after a robust sensitivity analysis.
Conclusions—Approximately half the CHD mortality rate fall in Auckland, New Zealand, was attributed to medical therapies, and approximately half was attributed to reductions in major risk factors. These findings emphasize the importance of a comprehensive strategy that maximizes the population coverage of effective treatments and actively promotes a prevention program, particularly for smoking, diet, and blood pressure reduction.
Key Words: coronary disease • mortality • drugs • risk factors • population
This article has been cited by other articles:
 |
|
 |
|
  D. Weisz, M. K. Gusmano, V. G. Rodwin, and L. G. Neuberg Population health and the health system: a comparative analysis of avoidable mortality in three nations and their world cities Eur J Public Health, April 1, 2008; 18(2): 166 - 172. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Blakely, M. Tobias, and J. Atkinson Inequalities in mortality during and after restructuring of the New Zealand economy: repeated cohort studies BMJ, February 16, 2008; 336(7640): 371 - 375. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Nolte and C. M. McKee Measuring The Health Of Nations: Updating An Earlier Analysis Health Aff., January 1, 2008; 27(1): 58 - 71. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. S. Ford, U. A. Ajani, J. B. Croft, J. A. Critchley, D. R. Labarthe, T. E. Kottke, W. H. Giles, and S. Capewell Explaining the Decrease in U.S. Deaths from Coronary Disease, 1980-2000 N. Engl. J. Med., June 7, 2007; 356(23): 2388 - 2398. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Fidan, B. Unal, J. Critchley, and S. Capewell Economic analysis of treatments reducing coronary heart disease mortality in England and Wales, 2000-2010 QJM, May 1, 2007; 100(5): 277 - 289. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. K. Smith, R. M. Califf, R. H. Tuttle, L. K. Shaw, K. L. Lee, E. R. Delong, R. E. Lilly, M. H. Sketch Jr, E. D. Peterson, and R. H. Jones Selection of surgical or percutaneous coronary intervention provides differential longevity benefit. Ann. Thorac. Surg., October 1, 2006; 82(4): 1420 - 1429. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Z. Kabir, K. Bennett, E. Shelley, B. Unal, J. Critchley, J. Feely, and S. Capewell The population mortality benefits of maximizing the number of eligible patients receiving appropriate cardiology treatments in Ireland QJM, August 1, 2006; 99(8): 523 - 530. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. W. Tang, C.-K. Wong, N. J. Restieaux, P. Herbison, M. J. A. Williams, P. Kay, and G. T. Wilkins Clinical outcome of older patients with acute coronary syndrome over the last three decades. Age Ageing, May 1, 2006; 35(3): 280 - 285. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Bennett, Z. Kabir, B. Unal, E. Shelley, J. Critchley, I. Perry, J. Feely, and S. Capewell Explaining the recent decrease in coronary heart disease mortality rates in Ireland, 1985-2000. J. Epidemiol. Community Health, April 1, 2006; 60(4): 322 - 327. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Laatikainen, J. Critchley, E. Vartiainen, V. Salomaa, M. Ketonen, and S. Capewell Explaining the Decline in Coronary Heart Disease Mortality in Finland between 1982 and 1997 Am. J. Epidemiol., October 15, 2005; 162(8): 764 - 773. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Unal, J. A. Critchley, and S. Capewell Modelling the decline in coronary heart disease deaths in England and Wales, 1981-2000: comparing contributions from primary prevention and secondary prevention BMJ, September 17, 2005; 331(7517): 614. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. J Nestel, K. Baghurst, D. M Colquhoun, R J. Simes, K. Mehalski, H. D White, A. M Tonkin, A. Kirby, C. Pollicino, and for the Long-Term Intervention with Pravastatin in Relation of diet to cardiovascular disease risk factors in subjects with cardiovascular disease in Australia and New Zealand: analysis of the Long-Term Intervention with Pravastatin in Ischaemic Disease trial Am. J. Clinical Nutrition, June 1, 2005; 81(6): 1322 - 1329. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Unal, J. A. Critchley, D. Fidan, and S. Capewell Life-Years Gained From Modern Cardiological Treatments and Population Risk Factor Changes in England and Wales, 1981-2000 Am J Public Health, January 1, 2005; 95(1): 103 - 108. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. M. Califf, T. Ryan, P. Douglas, and P. J. Goldschmidt-Clermont A time of accelerated change in academic cardiovascular medicine: Implications for academic divisions of cardiology and their training programs J. Am. Coll. Cardiol., November 16, 2004; 44(10): 1957 - 1965. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Unal, J. A. Critchley, and S. Capewell Explaining the Decline in Coronary Heart Disease Mortality in England and Wales Between 1981 and 2000 Circulation, March 9, 2004; 109(9): 1101 - 1107. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Vartiainen A lot more can be done to prevent cardiovascular diseases Eur. Heart J., March 2, 2004; 25(6): 457 - 458. [Full Text] [PDF]
|
|
|
|
|
|
E. Nolte and M. McKee Measuring the health of nations: analysis of mortality amenable to health care BMJ, November 15, 2003; 327(7424): 1129. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Salomaa, M. Ketonen, H. Koukkunen, P. Immonen-Raiha, T. Jerkkola, P. Karja-Koskenkari, M. Mahonen, M. Niemela, K. Kuulasmaa, P. Palomaki, et al. Trends in coronary events in Finland during 1983-1997; The FINAMI study Eur. Heart J., February 2, 2003; 24(4): 311 - 319. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.A. Critchley and S. Capewell Why model coronary heart disease? Eur. Heart J., January 2, 2002; 23(2): 110 - 116. [Full Text] [PDF]
|
|