Key result
Higher use of vascular risk drug therapy was associated with reduced incident coronary disease hospitalizations (IRR 0.57; 95% CI 0.51-0.63; p<0.001), while smoking and obesity increased risk.
Why the study?
Do primary prevention strategies reduce incident coronary disease hospitalisation rates in the general population?
Observational
Yes
Do primary prevention strategies reduce incident coronary disease hospitalisation rates in the general population?
Relative Risk: 0.57 (95% CI 0.51–0.63)
p-value: p=<0.001
Primary prevention strategies, particularly smoking reduction and increased use of vascular risk drug therapy, are associated with a significant decline in incident ischemic heart disease hospitalizations at the population level.
Supports population-level vascular risk management; extends ecological data but leaves causal effects open.
OBJECTIVE: To assess the overall population impact of primary prevention strategies (promotion of healthy lifestyles, prevention of smoking and use of vascular risk drug therapy) of coronary disease in Spain. DESIGN: Ecological time series analysis, 1982-2009. SETTING: All public and private hospitals in Spain. PARTICIPANTS: General population. OUTCOME: Incident coronary disease hospitalisation as derived from official hospital discharge data. METHODS: Annual hospitalisation rates were modelled according to nationwide use of statins, antihypertensive, antidiabetic and antiplatelet drugs, and prevalences of smoking, obesity and overweight. Additive generalised models and mixed Poisson regression models were used for the purpose, taking year as the random-effect variable and adjusting for age, sex, prevalence of vascular risk factors and the number of hospital beds in intensive and coronary care units. RESULTS: Across 28 years and 671.5 million person-years of observation, there were 2 986 834 hospitalisations due to coronary disease; of these, 1 441 980 (48.28%) were classified as incident. Hospitalisation rates increased from 1982 to 1996, with an inflection point in 1997 and a subsequent 52% decrease until 2009. Prevalences of smoking, obesity, overweight and use of vascular risk drug therapy were significantly associated with hospitalisation rates (p<0.001): incidence rates ratios (95% CI) for the fourth versus the first quartile were 1.46 (1.42 to 1.50), 1.80 (1.78 to 1.83), 1.58 (1.55 to 1.60) and 0.57 (0.51 to 0.63), respectively. These variables accounted for 92% of interannual variability. CONCLUSIONS: After decades of continuous rises, hospitalisation due to incident ischaemic heart disease has been cut by half, an achievement associated with the decline in smoking and the increase in vascular risk drug therapy. These results indicate that these two primary prevention strategies have been effective at a population level, thanks to an appropriate balance between financial and health goals, something that should be left intact despite the current economic crisis. Future strategies ought to lay special stress on excessive body weight prevention.
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Medrano et al. (2014) conducted an observational in Coronary disease. Vascular risk drug therapy vs. Lowest quartile of use was evaluated on Incident coronary disease hospitalisation (IRR 0.57, 95% CI 0.51 to 0.63, p=<0.001). Higher use of vascular risk drug therapy was associated with reduced incident coronary disease hospitalizations (IRR 0.57; 95% CI 0.51-0.63; p<0.001), while smoking and obesity increased risk.
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