What is the clinical evidence from this study?

Study design: Observational. Population: Coronary heart disease. Intervention: Population-level changes in risk factors and treatments vs. 1996 baseline mortality rates. Primary outcome: Excess coronary heart disease deaths in 2006 compared to expected deaths based on 1996 rates.

September 9, 2012Open Access

Explaining the increase in coronary heart disease mortality in Syria between 1996 and 2006

SRSamer RastamSion College RARadwan Al AliUniversitätsklinikum des Saarlandes WMWasim MaziakFlorida International University

Key Result

Between 1996 and 2006, coronary heart disease mortality in Syria increased by 64%, with 81% of the 6370 excess deaths attributable to increases in major cardiovascular risk factors.

Study Design

Type

Observational

Structured PICO

What proportion of the increase in coronary heart disease mortality in Syria between 1996 and 2006 is explained by changes in cardiovascular risk factors versus medical and surgical treatments?

Population

Adults aged ≥25 years in Syria between 1996 and 2006 (population in 2006: 3,842,677 men and 3,801,814 women)

Intervention

Changes in major cardiovascular risk factors (blood pressure, cholesterol, diabetes, BMI, smoking) and utilization of medical and surgical treatments for coronary heart disease

Comparator

Expected mortality if 1996 baseline mortality rates and risk factor/treatment levels had held constant

Outcome

Coronary heart disease (CHD) mortality trends (number of deaths prevented or postponed, or excess deaths)hard clinical

The significant increase in coronary heart disease mortality in Syria between 1996 and 2006 was primarily driven by worsening population risk factors, highlighting the urgent need for primary prevention strategies.

Limitations

Data used were of variable completeness and quality
National death registry data for causes of death were incomplete and of questionable quality
Explicit assumptions were used when data were not available, including extrapolating from a neighboring Palestinian population
Lag times between risk factor changes and mortality were not formally considered in the model
Assumptions were needed to fill in gaps for missing information, such as risk factor levels for the 65-74 age group

Abstract

BACKGROUND: Despite advances made in treating coronary heart disease (CHD), mortality due to CHD in Syria has been increasing for the past two decades. This study aims to assess CHD mortality trends in Syria between 1996 and 2006 and to investigate the main factors associated with them. METHODS: The IMPACT model was used to analyze CHD mortality trends in Syria based on numbers of CHD patients, utilization of specific treatments, trends in major cardiovascular risk factors in apparently healthy persons and CHD patients. Data sources for the IMPACT model included official statistics, published and unpublished surveys, data from neighboring countries, expert opinions, and randomized trials and meta-analyses. RESULTS: Between 1996 and 2006, CHD mortality rate in Syria increased by 64%, which translates into 6370 excess CHD deaths in 2006 as compared to the number expected had the 1996 baseline rate held constant. Using the IMPACT model, it was estimated that increases in cardiovascular risk factors could explain approximately 5140 (81%) of the CHD deaths, while some 2145 deaths were prevented or postponed by medical and surgical treatments for CHD. CONCLUSION: Most of the recent increase in CHD mortality in Syria is attributable to increases in major cardiovascular risk factors. Treatments for CHD were able to prevent about a quarter of excess CHD deaths, despite suboptimal implementation. These findings stress the importance of population-based primary prevention strategies targeting major risk factors for CHD, as well as policies aimed at improving access and adherence to modern treatments of CHD.

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