Potential benefits of healthy food and lifestyle policies for reducing coronary heart disease mortality in Turkish adults by 2025: a modelling study

Objective This study uses a modelling approach to compare the potential impact of future risk factor scenarios relating to smoking, physical activity levels, dietary salt, saturated fat intake, mean body mass index (BMI) levels, diabetes prevalence and fruit and vegetable (F&V) consumption on future coronary heart disease (CHD) mortality in Turkey for year 2025. Design A CHD mortality model previously developed and validated in Turkey was extended to predict potential trends in CHD mortality from 2008 to 2025. Setting Using risk factor trends data from recent surveys as a baseline, we modelled alternative evidence-based future risk factor scenarios (modest/ideal scenarios). Probabilistic sensitivity analyses were conducted to account for uncertainties. Subject Projected populations in 2025 (aged 25–84) of 54 million in Turkey. Results Assuming lower mortality, modest policy changes in risk factors would result in ∼25 635 (range: 20 290–31 125) fewer CHD deaths in the year 2025; 35.6% attributed to reductions in salt consumption, 20.9% to falls in diabetes, 14.6% to declines in saturated fat intake and 13.6% to increase in F&V intake. In the ideal scenario, 45 950 (range: 36 780–55 450) CHD deaths could be prevented in 2025. Again, 33.2% of this would be attributed to reductions in salt reduction, 19.8% to increases in F&V intake, 16.7% to reductions in saturated fat intake and 14.0% to the fall in diabetes prevalence. Conclusions Only modest risk factor changes in salt, saturated/unsaturated fats and F&V intake could prevent around 16 000 CHD deaths in the year 2025 in Turkey, even assuming mortality continues to decline. Implementation of population-based, multisectoral interventions to reduce salt and saturated fat consumption and increase F&V consumption should be scaled up in Turkey

Détermination de l’expression des gènes codant pour le TNF-α et la leptine par RT-PCR dans le sang de vaches présentant un déplacement de la caillette à gauche

The aims of this study are to evaluate the TNF-α and leptin gene expression in blood from Holstein cows with left abomasal displacement and to correlate it with induced liver injury. The TNF-α and leptin expression in blood samples was determined by RT-PCR after normalisation using the constant expression of the housekeeping GAPDH gene in cows with left abomasal displacement (LAD) (n = 20) before surgery and 7 days after as well as in healthy controls (n = 10). Plasma hepatic enzyme (AST: aspartate aminotransferase, ALT: alanine aminotransferase and ALP: alkaline phosphatase) activities were measured in parallel. Plasma AST and ALP activities dramatically increased in diseased cows during the preoperative period and then declined. Although not significantly, the leptin expression tended to decrease in LAD affected cows while the TNF-α expression tended to increase during the postoperative period. These results suggest that TNF-α may be associated with liver damage during abomasal displacement and that leptin was inversely correlated.Les objectifs de cette étude ont été d’évaluer l’expression des gènes codant pour le TNF-α et la leptine dans le sang de vaches Holstein présentant un déplacement à gauche de la caillette et de la corréler avec les lésions hépatiques induites. L’expression du TNF-α et de la leptine a été déterminée par RT-PCR après normalisation en considérant l’expression du gène de ménage GAPDH comme constante dans les échantillons sanguins provenant de vaches atteintes d’un déplacement à gauche de la caillette (n = 20) avant et 7 jours après traitement chirurgical ou provenant de vaches saines (témoins, n = 10). Les activités plasmatiques des enzymes hépatiques (AST : aspartate aminotransférase, ALT ; alanine aminotransférase et PAL : phosphatase alcaline) ont été mesurées en parallèle. Les activités plasmatiques de l’AST et de la PAL étaient considérablement augmentées chez les vaches malades avant la chirurgie puis elles ont diminué durant la période postopératoire. Bien que les variations n’aient pas été significatives, l’expression de la leptine chez les animaux malades a tendu à diminuer alors que celle du TNF-α a augmenté durant la période postopératoire. Ces résultats suggèrent que le TNF-α pourrait être associé aux lésions hépatiques associées à un déplacement de la caillette alors que la leptine serait inversement corrélée.Scientific Research Projects Commission of Mehmet Akif Ersoy Universit

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

Predicting the health impact of lowering salt consumption in Turkey using the DYNAMO health impact assessment tool

Objective To estimate the impact of three daily salt consumption scenarios on the prevalence and incidence of ischaemic heart disease (IHD) and cerebrovascular disease in 2025 in the Turkish population aged ≥30 years using the DYNAMO Health Impact Assessment tool. Study design Statistical disease modelling study. Methods DYNAMO health impact assessment was populated using data from Turkey to estimate the prevalence and incidence of IHD and cerebrovascular disease in 2025. TurkSTAT data were used for demographic data, and national surveys were used for salt consumption and disease-specific burden. Three salt consumption scenarios were modelled: (1) reference scenario: mean salt consumption stays the same from 2012–2013 until 2025; (2) gradual decline: daily salt intake reduces steadily by 0.47 g per year by lowering salt intake from bread by 50% and from table salt by 40% by 2025; and (3) World Health Organization (WHO) advice: daily salt intake of 5 g per day from 2013 until 2025. Results The gradual decline scenario would lead to a decrease in the prevalence of IHD and cerebrovascular disease by 0.3% and 0.2%, respectively, and a decrease in the incidence by 0.6 and 0.4 per 1000, respectively. Following WHO's advice would lead to a decrease in the prevalence of IHD and cerebrovascular disease by 0.8% and 0.5%, respectively, and a decrease in the incidence by 1.0 and 0.7 per 1000, respectively. Conclusion This model indicates that Turkey can lower its future cardiovascular disease burden by following the gradual decline scenario. Following WHO's advice would achieve an even greater benefit.</p