Key Points
- To determine the proportion of the rapid decrease in coronary heart disease mortality following socioeconomic transformation attributable to medical and surgical interventions versus changes in cardiovascular risk factors.
- Applied a validated epidemiological model combining data from clinical trials, meta-analyses, national surveys, and official vital statistics.
- Partitioned the reduction in coronary heart disease deaths among adults aged 25–74 in Poland between 1991 and 2005 into treatment effects and risk factor modifications.
- Coronary heart disease death rates halved from 1991 to 2005, preventing or postponing 26,200 coronary deaths in 2005 among adults aged 25–74.
- Risk factor changes accounted for approximately 54% (range 41%–65%) of the mortality drop, driven by a 39% reduction from lower total cholesterol and 10% from increased physical activity, which were partially offset by rising body mass index (-4%) and diabetes prevalence (-2%).
- Medical and surgical treatments explained roughly 37% (range 13%–77%) of the decline, led by therapies for heart failure (12%) and acute coronary syndrome (9%).
Structured PICO
How much of the decrease in coronary heart disease mortality in Poland between 1991 and 2005 can be explained by medical/surgical treatments versus changes in cardiovascular risk factors?
PPopulationPopulation of adults aged 25-74 in Poland in 1991-2005.
IInterventionMedical and surgical treatments for coronary heart disease and changes in cardiovascular risk factors
CComparatorExpected mortality if 1991 mortality rates had persisted
OOutcomeNumber of deaths prevented or postponed in 2005 attributable to specific treatments for coronary heart disease and changes in risk factorshard clinical
Over half of the large decline in coronary heart disease mortality in Poland between 1991 and 2005 was attributable to reductions in major cardiovascular risk factors, highlighting the powerful effect of population-level risk factor changes.
Limitations
- Data for the initial analysis year (1991) were not complete and were less representative
- Assumed a minimal lag time between changes in risk factors and changes in mortality
- Model failed to explain 9% of the overall reduction in deaths (residual confounding, unmeasured risk factors)