Decline of Coronary Heart Disease Mortality in the Netherlands from 1978 to 1985: Contribution of Medical Care and Changes Over Time in Presence of Major Cardiovascular Risk Factors
Restricted accessResearch articleFirst published online June, 1996
Decline of Coronary Heart Disease Mortality in the Netherlands from 1978 to 1985: Contribution of Medical Care and Changes Over Time in Presence of Major Cardiovascular Risk Factors
Objective To study the relative contributions of medical care and changes in cardiovascular risk factors to the decline in coronary heart disease (CHD) mortality in The Netherlands from 1978 to 1985.
Methods The number of potential CHD deaths prevented in this period was estimated by subtracting the number of observed CHD deaths from the number of deaths that would have occurred without any change in age-specific CHD mortality. In addition, the number of myocardial infarctions over this period was determined, Using estimates of risk associated with smoking, based on national and international data, of effects of changes in total cholesterol level, of benefits of antihypertensive drug treatment and of effects of different intervention strategies in subjects with a previous myocardial infarction, we calculated the relative contribution of the separate factors to the decline in CHD mortality,
Results The estimated contribution of treatment in coronary care units, postinfarction treatment and coronary bypass grafting to the fall in CHD mortality was 46%. Approximately 44% of the decline in CHD mortality could be attributed to primary prevention efforts (cessation of smoking, change in cholesterol level and treatment of hypertension).
Conclusion On the basis of available estimates of the potential effects of primary and seondary prevention it seems likely that a sizeable proportion of the age-specific reduction in mortality in The Netherlands during the period 1978–85 could have resulted from these measures. However, our findings should be considered to be estimates illustrating the relative benefits of different strategies rather than absolute figures.
ThornTJ: International mortality from heart disease: Rates and trendsInt J Epidemiol1989, 18 (suppl 1):S20–S28.
2.
HoogendoornD: Is, besides the mortality rate, the incidence of acute myocardial infarction declining? [in Dutch]Ned Tijdschr Geneeskd1990, 134:1896–1900.
3.
BotsMLGrobbeeDE: Cardiovascular diseases in The Netherlands over the past 25 years: Prevalence, incidence, trends of morbidity and mortalityNeth J Cardiol1991, 4:141–145.
4.
HigginsMWLuepekerRV (eds): Trends in Coronary Heart Disease Mortality. The Influence of Medical Care. Oxford: Oxford University Press; 1989.
5.
GoldmanLCookF: The decline in ischemic heart disease mortality rates. An analysis of the comparative effects of medical interventions and changes in lifestyleAnn Intern Med1984, 101:825–836.
6.
KillipT: Twenty years of coronary bypass surgeryN Engl J Med1988, 319:366–368.
7.
BalETMastEGvan den BergCJMTjon Joe GinRMErnstJMPGPlokkerHWM: PTCA, the years after. … 7.5 years clinical follow-up after PTCANeth J Cardiol1990, 3:32–36.
8.
YusufSPetoRLewisJCollinsRSleightP.Beta blockade during and after myocardial infarction: An overview of the randomized trialsProg Cardiovasc Dis1985, 27:335–371.
9.
Sixty Plus Reinfarction Study Research Group: A double-blind trial to assess long-term oral anticoagulant therapy in elderly patients after myocardial infarctionLancet1980, ii:989–993.
10.
SmithPArensenHHolmeI: The effect of warfarin on mortality and reinfarction after myocardial infarctionN Engl J Med1990, 323:147–153.
11.
Anticoagulants in the Secondary Prevention of Events in Coronary Thrombosis (ASPECT) Research Group: Effect of long-term oral anticoagulant treatment on mortality and cardiovascular morbidity after myocardial infarctionLancet1994, 343:499–503.
12.
Antiplatelet Trialists' Collaboration: Collaborative overview of randomised trial of antiplatelet therapy. I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patientsBMJ1994, 308:81–106.
13.
TIMI Study Group: Comparison of invasive and conservative strategies after treatment with intravenous tissue plasminogen activator in acute myocardial infarction. Results of the Thrombolysis In Myocardial Infarction (TIMI) phase II trialN Engl J Med1989, 320:618–627.
14.
SimoonsMLVosJTijssenJGPVermeerFVerheugtFWKraussVH: Longterm benefit of early thrombolytic therapy in patients with acute myocardial infarction: 5 year follow-up of a trial conducted by the Interuniversity Cardiology Institute of The NetherlandsJ Am Coll Cardiol1989, 14:1609–1615.
15.
Dutch Central Bureau of Statistics: Mortality by Cause, Age and Gender, 1969–1990 [in Dutch]. Series A1, 1990.
The Netherlands Foundation on Smoking and Health: Annual Report, 1988. The Hague: The Netherlands Foundation on Smoking and Health; 1989.
18.
DollRPetoR: Mortality in relation to smoking: 20 years observation on male British doctorsBMJ1976, 274:1525–1536.
19.
KannelWBGordonT: The Framingham Study. An epidemiological investigation of cardiovascular disease. Section 26. Some characteristics related to the incidence of cardiovascular disease and death: 16 year follow-up, 1970. Washington: USA Government Printing Office; 1971.
20.
BotsMLGrobbeeDEHofmanA: High blood pressure in the elderlyEpidemiol Rev1991, 13:294–314.
21.
CollinsRPetoRMacMahonSHerbertPFiebachNHEberleinKA: Blood pressure, stroke, and coronary heart disease. Part 2, short-term reductions in blood pressure: Overview of randomised drug trials in their epidemiological contextLancet1990, ii:827–838.
22.
HoesAWGrobbeeDEValkenburgHALubsenJHofmanA: Cardiovascular risk and all-cause mortality. A twelve-year follow-up study in The NetherlandsEur J Epidemiol1993, 9:285–292.
23.
WittemanJCMKokFJvan SaaseJLCMHofmanAValkenburgHA: Aortic calcification as a predictor of cardiovascular mortalityLancet1986, ii:1120–1122.
24.
Continue Moribiditeits Registratie Peilstations Nederland 1985 [in Dutch] Utrecht: Stichting Nederlands Instituut voor Onderzoek van de Eerstelijns-gezondheidszorg (NIVEL); 1985.
25.
FracheboudJ: Hartbewaking of thuisblijven?: Een descriptieve studie over thuisbehandeling van patiënten met een hartinfarct in Nederland [in Dutch]. Utrecht: Nederlands Instituut voor Onderzoek van de Eerstelijnsgezond-heidszorg (NIVEL); 1987.
26.
RossouwJELewisBRifkindBM: The value of lowering cholesterol after myocardial infarctionN Engl J Med1990, 323:1112–1119.
27.
Coronary Drug Project Research Group: Natural history of myocardial infarction in the Coronary Drug Project: Long term prognostic importance of lipid levelsAm J Cardiol1978, 42:489–498.
28.
VerschurenWMMAlMBoermaGJMKromhoutD: Trend in serum total cholesterol level in 111 000 young adults in The Netherlands, 1974 to 1986Am J Epidemiol1991, 134:1290–1302.
29.
KromhoutDde Lezenne CoulanderCOberman-de BoerGLvan Kampen-DonkerMGoddijnEBloembergBP: Changes in food and nutrient intake in middle-aged men from 1960 to 1985. The Zutphen StudyAm J Clin Nutr1990, 51:123–129.
30.
HofmanAValkenburgHA: An epidemiological study of cardiovascular risk indicators (EPOZ).II. Prevalence, tracing and treatment of hypertension in an open population [in Dutch]Ned Tijdschr Geneeskd1980, 124:189–195.
31.
ChiribogaDYarzebskiJGoldbergRJGoreJMAlpertJS: Temporal trends (1975 through 1990) in the incidence and case-fatality rates of primary ventricular fibrillation complicating acute myocardial infarction. A communitywide perspectiveCirculation1994, 89:998–1003.
32.
EcclesMBradshawC: Use of secondary prophylaxis against myocardial infarction in the north of EnglandBMJ1991, 302:91–92.
33.
The Netherlands Federation of Thrombosis Centres. Annual Report. The Hague, The Netherlands, 1985.
34.
ProudfitWLKramerJRGoormasticMLoopFD: Survival of non-surgical patients with mild angina or myocardial infarction without angina: A comparison of medical and surgical treatmentBr Heart J1988, 59:641–647.
35.
ProudfitWLKramerJRGoormasticMLoopFD: Ten-year survival of patients with mild angina or myocardial infarction without angina: A comparison of medical and surgical treatmentAm Heart J1990, 119:942–947.
36.
CaliffRMHarrellFELeeKLLeavertonPE: The evolution of medical and surgical therapy for coronary artery diseaseJAMA1989, 261:2077–2086.
37.
VerschurenWMMBoermaGJMKromhoutD: Total and HDL cholesterol in The Netherlands: 1987–1992. Levels and changes over time in relation to age, gender and educational levelInt J Epidemiol1994, 23:948–956.
BeagleholeR: Medical management and the decline in mortality from coronary heart diseaseBMJ1986, 292:33–35.
40.
NeutzeJMWhiteHD: What contribution has cardiac surgery made to the decline in mortality from coronary heart disease?BMJ1987, 294:405–409.
41.
SigfussonNSigvaldasonHSteingridottirLGudmundsottirIIStefansdottirIThorsteinssonT: Decline in ischaemic heart disease in Iceland and change in risk factor levelsBMJ1991, 302:1371–1375.
42.
VartiainenEPuskaPPekkanenJToumilehtoJJousilahtiP: Changes in risk factors explain changes in mortality from ischaemic heart disease in FinlandBMJ1994, 309:23–27.
43.
DobsonAJ: Trends in cardiovascular risk factors in Australia, 1966–1986: Evidence from prevalence surveysCommunity Health Stud1987, 11:2–14.
44.
SytkowskiPAKannelWBd'AgostinoRB: Changes in risk factors and the decline in mortality from cardiovascular disease. The Framingham Heart StudyN Engl J Med1990, 322:1635–1641.
