Análisis del descenso de muertes por enfermedad coronaria entre 1995 y 2010. Estudio IMPACT CHD Argentina

Objective: To quantify the contribution of risk factors and treatments in the reduction of mortality due to coronary heart disease in Argentina between 1995 and 2010. Methods: We used the validated IMPACTCHD model integrating data on effectiveness, use of treatments and changes in the risk factors between 1995 and 2010 in people older than 25 years in Argentina. The difference between the coronary deaths observed and expected in 2010 was distributed between treatments and risk factors. Results: Between 1995 and 2010, adjusted mortality rates for coronary heart disease decreased 29.8% (8,500 deaths prevented or postponed - MPP). Improvements in treatments accounted for 49.9%, mostly secondary prevention of acute myocardial infarction (8.2%); antihypertensive treatment (11.9%) and treatment of heart failure (13.2%). Improvements in risk factors accounted for 32.9% of MPPs: systolic blood pressure 34.6%; total cholesterol 12.8%; smoking 6.8%. An excess of deaths was found due to the increase in diabetes (9.4%), obesity (6.9%) and sedentary lifestyle (5%). The 17.2% of the MPPs were not explained by the model. Conclusion: One out of every two MPP due to coronary heart disease in Argentina between 1995 and 2010 was due to treatments and one third to the improvement of risk factors. The decrease in blood pressure, cholesterol and smoking was limited by increases in the prevalence of obesity, sedentary lifestyle and diabetes. This study was possible thanks to the collaborative work to the cardiovascular epidemiology.