Key result
Coronary heart disease mortality rates in Tunisia increased by 11.8% for men and 23.8% for women between 1997 and 2009, with almost all of the 680 additional deaths explained by increases in major modifiable risk factors.
Observational (n=5,700,000)
Recent increases in CHD mortality in Tunisia are primarily driven by worsening modifiable risk factors (cholesterol, blood pressure, BMI, and diabetes), highlighting the urgent need for comprehensive population-level prevention strategies.
Rising CHD mortality in Tunisia tied to worsening risk factors; hypothesis-generating for prevention in similar settings, pending prospective confirmation.
BACKGROUND: In Tunisia, Cardiovascular Diseases are the leading causes of death (30%), 70% of those are coronary heart disease (CHD) deaths and population studies have demonstrated that major risk factor levels are increasing. OBJECTIVE: To explain recent CHD trends in Tunisia between 1997 and 2009. DATA SOURCES: Published and unpublished data were identified by extensive searches, complemented with specifically designed surveys. ANALYSIS: Data were integrated and analyzed using the previously validated IMPACT CHD policy model. Data items included: (i)number of CHD patients in specific groups (including acute coronary syndromes, congestive heart failure and chronic angina)(ii) uptake of specific medical and surgical treatments, and(iii) population trends in major cardiovascular risk factors (smoking, total cholesterol, systolic blood pressure (SBP), body mass index (BMI), diabetes and physical inactivity). RESULTS: CHD mortality rates increased by 11.8% for men and 23.8% for women, resulting in 680 additional CHD deaths in 2009 compared with the 1997 baseline, after adjusting for population change. Almost all (98%) of this rise was explained by risk factor increases, though men and women differed. A large rise in total cholesterol level in men (0.73 mmol/L) generated 440 additional deaths. In women, a fall (-0.43 mmol/L), apparently avoided about 95 deaths. For SBP a rise in men (4 mmHg) generated 270 additional deaths. In women, a 2 mmHg fall avoided 65 deaths. BMI and diabetes increased substantially resulting respectively in 105 and 75 additional deaths. Increased treatment uptake prevented about 450 deaths in 2009. The most important contributions came from secondary prevention following Acute Myocardial Infarction (AMI) (95 fewer deaths), initial AMI treatments (90), antihypertensive medications (80) and unstable angina (75). CONCLUSIONS: Recent trends in CHD mortality mainly reflected increases in major modifiable risk factors, notably SBP and cholesterol, BMI and diabetes. Current prevention strategies are mainly focused on treatments but should become more comprehensive.
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Saidi et al. (2013) conducted an observational in Coronary Heart Disease (n=5,700,000). Changes in cardiovascular risk factors and treatments vs. 1997 baseline rates was evaluated on Change in coronary heart disease mortality rates. Coronary heart disease mortality rates in Tunisia increased by 11.8% for men and 23.8% for women between 1997 and 2009, with almost all of the 680 additional deaths explained by increases in major modifiable risk factors.
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