IMPACT model, 闡述為何 CHD變少，是risk facotr 變少，加上treatment imrpovement

http://docs.google.com/present/edit?id=0AW78nGJMQBk7ZGc1d3FjYmpfMTIyZmY0c3E5aGM&hl=en

Staying Ahead of the Curve

Researchers relate trends in cardiovascular prevention and treatment to recent improvements in mortality from coronary heart disease.

Debate surrounds the relative contributions of preventive and treatment strategies to recent reductions in deaths from coronary heart disease (CHD). These investigators used epidemiologic data from Ontario, Canada, and the IMPACT CHD mortality model (slide presentation available on the Liverpool University website) to address this issue.

Between 1994 and 2005, the age-adjusted CHD mortality rate in Ontario residents aged 25–84 fell 35%, from 191 to 125 deaths per 100,000 residents. Changes in population risk factors accounted for 48% of the decrease, whereas medical and surgical treatments accounted for 43% (9% of the decrease was unaccounted for by variables included in the model). The 75-to-84-year-old age group had the greatest absolute reduction in CHD deaths. Among patients receiving treatment for various conditions, the greatest mortality reduction occurred in those with stable coronary artery disease. Improvements in the treatment of patients with acute myocardial infarction were responsible for 8% of the decrease. Increases in diabetes prevalence and body-mass index offset the mortality reductions (by 6% and 2%, respectively).

Comment: These findings indicate that reductions in CHD mortality are attributable to improvements in both prevention and treatment. However, as obesity and diabetes rates continue to grow, we could see some retrenchment in these gains during the coming decades.

— Harlan M. Krumholz, MD, SM

Published in Journal Watch Cardiology June 2, 2010

Citation(s):

Wijeysundera HC et al. Association of temporal trends in risk factors and treatment uptake with coronary heart disease mortality, 1994-2005. JAMA 2010 May 12; 303:1841.

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