Contrasting cardiovascular mortality trends in Eastern Mediterranean populations: Contributions from risk factor changes and treatments.

BACKGROUND: Middle income countries are facing an epidemic of non-communicable diseases, especially coronary heart disease (CHD). We used a validated CHD mortality model (IMPACT) to explain recent trends in Tunisia, Syria, the occupied Palestinian territory (oPt) and Turkey. METHODS: Data on populations, mortality, patient numbers, treatments and risk factor trends from national and local surveys in each country were collated over two time points (1995-97; 2006-09); integrated and analysed using the IMPACT model. RESULTS: Risk factor trends: Smoking prevalence was high in men, persisting in Syria but decreasing in Tunisia, oPt and Turkey. BMI rose by 1-2 kg/m(2) and diabetes prevalence increased by 40%-50%. Mean systolic blood pressure and cholesterol levels increased in Tunisia and Syria. Mortality trends: Age-standardised CHD mortality rates rose by 20% in Tunisia and 62% in Syria. Much of this increase (79% and 72% respectively) was attributed to adverse trends in major risk factors, occurring despite some improvements in treatment uptake. CHD mortality rates fell by 17% in oPt and by 25% in Turkey, with risk factor changes accounting for around 46% and 30% of this reduction respectively. Increased uptake of community treatments (drug treatments for chronic angina, heart failure, hypertension and secondary prevention after a cardiac event) accounted for most of the remainder. DISCUSSION: CHD death rates are rising in Tunisia and Syria, whilst oPt and Turkey demonstrate clear falls, reflecting improvements in major risk factors with contributions from medical treatments. However, smoking prevalence remains very high in men; obesity and diabetes levels are rising dramatically.

Explaining the decline in coronary heart disease mortality in Turkey between 1995 and 2008.

BACKGROUND: Coronary heart disease (CHD) mortality rates have been decreasing in Turkey since the early 1990s. Our study aimed to determine how much of the CHD mortality decrease in Turkey between 1995 and 2008 could be attributed to temporal trends in major risk factors and how much to advances in medical and surgical treatments. METHODS: The validated IMPACT CHD mortality model was used to combine and analyse data on uptake and effectiveness of CHD treatments and risk factor trends in Turkey in adults aged 35-84 years between 1995 and 2008.Data sources were identified, searched and appraised on population, mortality and major CHD risk factors for adults those aged 35-84 years. Official statistics, electronic databases, national registers, surveys and published trials were screened from 1995 onwards. RESULTS: Between 1995 and 2008, coronary heart disease mortality rates in Turkey decreased by 34% in men and 28% in women 35 years and over. This resulted in 35,720 fewer deaths in 2008.Approximately 47% of this mortality decrease was attributed to treatments in individuals (including approximately 16% to secondary prevention, 3% angina treatments, 9% to heart failure treatments, 5% to initial treatments of acute myocardial infarction, and 5% to hypertension treatments) and approximately 42% was attributable to population risk factor reductions (notably blood pressure 29%; smoking 27%; and cholesterol 1%). Adverse trends were seen for obesity and diabetes (potentially increasing mortality by approximately 11% and 14% respectively). The model explained almost 90% of the mortality fall. CONCLUSION: Reduction in major cardiovascular risk factors explained approximately 42% and improvements in medical and surgical treatments explained some 47% of the CHD mortality fall. These findings emphasize the complimentary value of primary prevention and evidence-based medical treatments in controlling coronary heart disease.

Decreasing trends in cardiovascular mortality in Turkey between 1988 and 2008.

BACKGROUND: Cardiovascular disease (CVD) mortality increased in developed countries until the 1970s then started to decline. Turkey is about to complete its demographic transition, which may also influence mortality trends. This study evaluated trends in coronary heart disease (CHD) and stroke mortality between 1988 and 2008. METHODS: The number of deaths by cause (ICD-8), age and sex were obtained from the Turkish Statistical Institute (TurkStat) annually between 1988 and 2008. Population statistics were based on census data (1990 and 2000) and Turkstat projections. European population standardised mortality rates for CHD and stroke were calculated for men and women over 35 years old. Joinpoint Regression was used to identify the points at which a statistically significant (p < 0.05) change of the trend occurred. RESULTS: The CHD mortality rate increased by 2.9% in men and 2.0% in women annually from 1988 to 1994, then started to decline. The annual rate of decline for men was 1.7% between 1994-2008, whilst in women it was 2.8% between 1994-2000 and 6.7% between 2005-2008 (p < 0.05 for all periods).Stroke mortality declined between 1990-1994 (annual fall of 3.8% in both sexes), followed by a slight increase between 1994-2004 (0.6% in men, 1.1% in women), then a further decline until 2008 (annual reduction of 4.4% in men, 7.9% in women) (p < 0.05 for all periods). CONCLUSIONS: A decrease in CVD mortality was observed from 1995 onwards in Turkey. The causes need to be explored in detail to inform future policy priorities in noncommunicable disease control.

The association between employment status and metabolic syndrome in women: modifying effect of education.

The aim of the researchers in this study was to examine the relations of paid work versus housework and educational level to metabolic syndrome in women. The study sample consisted of women who participated in a baseline survey of the Heart of Balcova Project, which is an ongoing cohort study in Izmir, Turkey. A randomly selected subsample of women who were aged 30-64 years and who were not retired or unemployed was derived from the individuals who participated in the Heart of Balcova Project. All data were collected through face-to-face interviews with 191 workers and 342 housewives. The association between employment status and metabolic syndrome was explored using multiple logistic regression models. The prevalence of metabolic syndrome was significantly higher among housewives than among workers. Among the women with a high educational level, odds of metabolic syndrome were significantly higher for housewives than for those who were employed. An association between employment status and metabolic syndrome was not observed in the group with a low level of education. The findings revealed that educational level had a modifying effect on the relationship between employment status and metabolic syndrome among women and thus has implications for improving the understanding of the importance of health and educational opportunities for housewives.

Balcova heart study: rationale and methodology of the Turkish cohort.

OBJECTIVES: Turkey is facing increasing rates of cardiovascular disease (CVD). The study is designed to meet the growing need to obtain information about the recent status and trends of CVD risk factors and their impact on mortality. METHODS: Balcova heart study (BHS) is a prospective cohort study, focusing on reducing the CVD risk factors of people over 30 years old living in Balcova District, Izmir, Turkey. Information about risk factors, anthropometric and biochemical measurements was collected in community centers. Interventions were planned, based on the 10-year coronary heart disease (CHD) risk and lifestyle characteristics with the collaboration of university and municipality. RESULTS: Mean age of the 16,080 participants was 52 years. The percentage of current smoking was 41.6 in men and 31.1 in women. One-third of the men were physically inactive. Hypertension was reported as 25% in men and 33% in women. CONCLUSIONS: The project is unique for being the first community-based cohort on CVD risk factors in a Turkish setting. This project will have a valuable contribution on not only determining CVD risks, but also incorporating interventions for prevention.