Future declines of Coronary Heart Disease mortality in England and Wales could counter the burden of population ageing

BACKGROUND:Coronary Heart Disease (CHD) remains a major cause of mortality in the United Kingdom. Yet predictions of future CHD mortality are potentially problematic due to population ageing and increase in obesity and diabetes. Here we explore future projections of CHD mortality in England & Wales under two contrasting future trend assumptions. METHODS:In scenario A, we used the conventional counterfactual scenario that the last-observed CHD mortality rates from 2011 would persist unchanged to 2030. The future number of deaths was calculated by applying those rates to the 2012-2030 population estimates. In scenario B, we assumed that the recent falling trend in CHD mortality rates would continue. Using Lee-Carter and Bayesian Age Period Cohort (BAPC) models, we projected the linear trends up to 2030. We validate our methods using past data to predict mortality from 2002-2011. Then, we computed the error between observed and projected values. RESULTS:In scenario A, assuming that 2011 mortality rates stayed constant by 2030, the number of CHD deaths would increase 62% or approximately 39,600 additional deaths. In scenario B, assuming recent declines continued, the BAPC model (the model with lowest error) suggests the number of deaths will decrease by 56%, representing approximately 36,200 fewer deaths by 2030. CONCLUSIONS:The decline in CHD mortality has been reasonably continuous since 1979, and there is little reason to believe it will soon halt. The commonly used assumption that mortality will remain constant from 2011 therefore appears slightly dubious. By contrast, using the BAPC model and assuming continuing mortality falls offers a more plausible prediction of future trends. Thus, despite population ageing, the number of CHD deaths might halve again between 2011 and 2030. This has implications for how the potential benefits of future cardiovascular strategies might best be calculated and presented

Świadomość nadciśnienia tętniczego a palenie papierosów wśród dorosłych Polaków

Background Arterial hypertension (HT) is one the most frequent cardiovascular disease (CVD) risk factor. When the doctor recognizes hypertension he should search for and treat not only HT but also the other risk factors, especially cigarette smoking. Material and methods In 2002 year, we conducted national, cross sectional epidemiological survey NATPOL PLUS aimed to assess prevalence and control of main risk factors in Poland. In the representative sample of 3051 adults (age 18-94, 1664 F, 1387 M) we performed questionnaires, blood pressure and antropometric measurements, as well as laboratory tests. Results Analyses were done in a group of 809 patients with HT. HT diagnosis was based on three separate series of measurements. Correlation between HT awareness and cigarette smoking was found. In smokers (n = 218) only 53.5% of subjects were aware of HT. In nonsmokers (n = 422) this proportion was equal to 65.0%. Among patients aware of HT (n = 495, 61.2% of all subjects with HT) there were 23.6% of smokers, 55.4% of nonsmokers, and 21.0% of ex-smokers. Among patients unaware of HT (n = 314) corresponding figures were: 32.3%, 47.1%, 20.6% (p < 0.05). We also asked all patients with HT the question about their knowledge on methods to prevent CVD. Smoking cessation was mentioned by 45.8% of smokers and 32.2% of ex-smokers (p < 0.001). Only 12.1% of smokers and 18.8% of ex-smokers with HT declared giving up smoking as a method they used to prevent heart disease (p = 0.086). Seventy seven percent of patients (n = 515) with diagnosed HT admitted that they obtained antitobacco counseling from their doctors. Conclusion Prevalence of cigarette smoking in patients with HT that are aware of the disease was only slightly smaller in comparison with subjects unaware of HT. In process of medical treatment of HT the doctors should pay much more attention to diagnose and treat other CVD risk factors, especially cigarette smoking. Arterial Hypertension 2010, vol. 14, no 3, pages 196-200Wstęp Nadciśnienie tętnicze jest jednym z najbardziej rozpowszechnionych czynników ryzyka chorób serca i naczyń. Równolegle z terapią NT powinno się rozpoznawać i leczyć inne czynniki ryzyka, w szczególności palenie papierosów. Materiał i metody W 2002 roku, w ramach programu NATPOL PLUS, reprezentatywna próba 3051 Polaków (zakres wieku 18-94 lata; 1664 K, 1387 M) wypełniła kwestionariusz, a następnie przeprowadzono pomiary ciśnienia i antropometryczne oraz badania laboratoryjne na czczo. Wyniki Wykonane analizy u 809 chorych z NT wykazały związek między świadomością posiadanego nadciśnienia tętniczego a częstością palenia papierosów. Wśród palących (n = 218) jedynie 53,5% było świadomych NT, a wśród niepalących (n = 422) ten odsetek stanowił 65%. Wśród osób świadomych NT (n = 495, 61,2% chorych) palący stanowili 23,6%, niepalący 55,4%, a ci, którzy rzucili 21,0%. Wśród nieświadomych NT (n = 314) odpowiednie odsetki wynosiły: 32,3%, 47,1%, 20,6% (p < 0,05). Na otwarte pytanie o znajomość metod zapobiegania chorobom serca innych niż przyjmowanie leków, wśród osób z NT ograniczenie palenia papierosów wskazywało 45,8% palących oraz 32,2% osób, które rzuciły palenie (p < 0,001). Wśród chorych na NT, których pytano o świadome stosowanie metod zapobiegania chorobom serca na ograniczenie palenia wskazywało 12,1% palących oraz 18,8% osób, które rzuciły palenie (p = 0,086). Wśród osób, u których lekarz zdiagnozował wcześniej NT (n = 515), lekarze zalecali ograniczenie palenia tytoniu u 77,3% palących (p < 0,001). Wnioski Odsetek osób palących papierosy jest wśród chorych świadomych i leczonych z powodu NT tylko w niewielkim stopniu niższy w porównaniu z osobami nieświadomymi NT. W postępowaniu lekarskim u chorych z NT należy intensywniej niż dotąd dążyć do redukcji innych czynników ryzyka, w szczególności palenia tytoniu. Nadciśnienie Tętnicze 2010, tom 14, nr 3, strony 196-20

Depressive symptoms and cardiovascular diseases in the adult Polish population. Results of the NATPOL2011 study

Background: Poland is a country of high cardiovascular risk. Because depression was found to be a predictor of coronary artery disease and the prevalence of depressive symptoms (DSs) has risen worldwide, their monitoring in the population is desirable. Aims: We sought to evaluate the prevalence of DSs in relation to the socio-demographic status and selected types of cardio­vascular diseases in the adult Polish population. Methods: A country-representative random sample of 2413 subjects, aged 18 to 79 years, was examined in 2011. Rates of self-reported cardiovascular conditions including hypertension (HT), coronary artery disease (CAD), previous myocardial infarction (MI), heart failure, atrial fibrillation (AF), and stroke were assessed by a questionnaire, and the prevalence of DSs was assessed by Beck Depression Inventory (BDI), separately in men and women. DSs were defined as BDI score ≥ 10 points. Results: Depressive symptoms were found in 23.4% of men and 33.4% of women (p &lt; 0.0001). The prevalence of DSs increased with age, from 16.5% in the youngest group of men to 48.3% in the oldest group of women. We found that DSs were significantly more prevalent in subjects suffering from HT, CAD, stroke, AF, and diabetes, and also in women after MI. The rates of DSs in women with a history of MI or stroke were extremely high (76.3% and 83.3%, respectively). Age and primary education level were associated with DSs, as was history of stroke in women. DSs were more often found in older persons and in those with primary level of education. Conclusions: Depressive symptoms were more prevalent in women compared to men, and they were significantly and inde­pendently associated with age and primary education level in both sexes, and with a history of stroke in women

Decline in mortality from coronary heart disease in Poland after socioeconomic transformation: modelling study

Objectives To examine how much of the observed rapid decrease in mortality from coronary heart disease in Poland after the political, social, and economic transformation in the early 1990s could be explained by the use of medical and surgical treatments and how much by changes in cardiovascular risk factors

Dementia incidence trend in England and Wales, 2002–19, and projection for dementia burden to 2040: analysis of data from the English Longitudinal Study of Ageing

Background: Dementia incidence declined in many high-income countries in the 2000s, but evidence on the post-2010 trend is scarce. We aimed to analyse the temporal trend in England and Wales between 2002 and 2019, considering bias and non-linearity. // Methods: Population-based panel data representing adults aged 50 years and older from the English Longitudinal Study of Ageing were linked to the mortality register across wave 1 (2002–03) to wave 9 (2018–19) (90 073 person observations). Standard criteria based on cognitive and functional impairment were used to ascertain incident dementia. Crude incidence rates were determined in seven overlapping initially dementia-free subcohorts each followed up for 4 years (ie, 2002–06, 2004–08, 2006–10, 2008–12, 2010–14, 2012–16, and 2014–18). We examined the temporal trend of dementia incidence according to age, sex, and educational attainment. We estimated the trend of dementia incidence adjusted by age and sex with Cox proportional hazards and multistate models. Restricted cubic splines allowed for potential non-linearity in the time trend. A Markov model was used to project future dementia burden considering the estimated incidence trend. // Findings: Incidence rate standardised by age and sex declined from 2002 to 2010 (from 10·7 to 8·6 per 1000 person-years), then increased from 2010 to 2019 (from 8·6 to 11·3 per 1000 person-years). Adjusting for age and sex, and accounting for missing dementia cases due to death, estimated dementia incidence declined by 28·8% from 2002 to 2008 (incidence rate ratio 0·71, 95% CI 0·58–0·88), and increased by 25·2% from 2008 to 2016 (1·25, 1·03–1·54). The group with lower educational attainment had a smaller decline in dementia incidence from 2002 to 2008 and a greater increase after 2008. If the upward incidence trend continued, there would be 1·7 million (1·62–1·75) dementia cases in England and Wales by 2040, 70% more than previously forecast. // Interpretation: Dementia incidence might no longer be declining in England and Wales. If the upward trend since 2008 continues, along with population ageing, the burden on health and social care will be large. // Funding: UK Economic and Social Research Council

Impact of hypertension prevalence trend on mortality and burdens of dementia and disability in England and Wales to 2060: a simulation modelling study

BACKGROUND: Previous estimates of the impact of public health interventions targeting hypertension usually focus on one health outcome. This study aims to consider the effects of change in future hypertension prevalence on mortality, dementia, and disability simultaneously. METHODS: We modelled three plausible scenarios based on observed trends of hypertension prevalence from 2003 to 2017 in England: observed trends continue (baseline scenario); 2017 prevalence remains unchanged; and 2017 prevalence decreases by 50% by 2060. We used a probabilistic Markov model to integrate calendar trends in incidence of cardiovascular disease, dementia, disability, and mortality to forecast their future occurrence in the population of England and Wales. Assuming the hypertension prevalence trend modifies health transition probabilities, we compared mortality outcomes and the burden of dementia and disability to 2060 for the scenarios. FINDINGS: If the decline in hypertension prevalence stops, there would be a slight increase in the number of additional deaths to 2060 (22·9 [95% uncertainty interval 19·0-26·6] more deaths per 100 000 population), although the burdens of disability and dementia in absolute terms would change little. Alternatively, if the downward hypertension prevalence trend accelerates (with prevalence falling by 50% between 2017 and 2060), there would be a modest additional reduction in deaths (57·0 [50·4-63·5] fewer deaths per 100 000 population), a small increase in dementia burden (9·0 [5·1-13·2] more cases per 100 000 population), no significant effect on disability burden, and an 8% gain in healthy life expectancy at age 65 years from 2020 to 2060 (5·3 years vs 4·9 years) compared with the baseline scenario. INTERPRETATION: The major future impact of alternative hypertension prevention strategies appears to be on future life expectancy. The salutary effect of lower population blood pressure distribution on incidence of dementia and disability might not offset expansion of the susceptible population due to reduced mortality. FUNDING: British Heart Foundation and UK Economic and Social Research Council

Potential impact of diabetes prevention on mortality and future burden of dementia and disability : a modelling study

Aims/hypothesis Diabetes is associated with an increased risk of dementia. We estimated the potential impact of trends in diabetes prevalence upon mortality and the future burden of dementia and disability in England and Wales. Methods We used a probabilistic multi-state, open cohort Markov model to integrate observed trends in diabetes, cardiovascular disease and dementia to forecast the occurrence of disability and dementia up to the year 2060. Model input data were taken from the English Longitudinal Study of Ageing, Office for National Statistics vital data and published effect estimates for health-state transition probabilities. The baseline scenario corresponded to recent trends in obesity: a 26% increase in the number of people with diabetes by 2060. This scenario was evaluated against three alternative projected trends in diabetes: increases of 49%, 20% and 7%. Results Our results suggest that changes in the trend in diabetes prevalence will lead to changes in mortality and incidence of dementia and disability, which will become visible after 10-15 years. If the relative prevalence of diabetes increases 49% by 2060, expected additional deaths would be approximately 255,000 (95% uncertainty interval [UI] 236,000-272,200), with 85,900 (71,500-101,600) cumulative additional cases of dementia and 104,900 (85,900-125,400) additional cases of disability. With a smaller relative increase in diabetes prevalence (7% increase by 2060), we estimated 222,200 (205,700-237,300) fewer deaths, and 77,000 (64,300-90,800) and 93,300 (76,700-111,400) fewer additional cases of dementia and disability, respectively, than the baseline case of a 26% increase in diabetes. Conclusions/interpretation Reducing the burden of diabetes could result in substantial reductions in the incidence of dementia and disability over the medium to long term.Peer reviewe

Ocena przydatności komputerowego programu oceny ryzyka PRECARD w praktyce lekarza rodzinnego i specjalisty kardiologa

Podejmowanie decyzji w zakresie prewencji i terapii chorób układu krążenia jest złożonym procesem, którego podstawą zawsze powinna być integralna ocena czynników ryzyka sercowo-naczyniowego. Celem badania było określenie przydatności programu komputerowego PRECARD w ocenie ryzyka wystąpienia incydentów sercowo-naczyniowych oraz podejmowaniu decyzji terapeutycznych przez lekarza rodzinnego i kardiologa. Program komputerowy PRECARD to system oceny ryzyka sercowo-naczyniowego, w którym podstawą modelu obliczeniowego są skandynawskie badania populacyjne 11 765 osób w wieku 30&#8211;70 lat. Za pomocą programu, na podstawie analizy 5 modyfikowalnych i 5 niemodyfikowalnych czynników ryzyka, można określić ryzyko bezwzględne wystąpienia zawału serca, udaru mózgu lub zgonu. Metody. Uczestnictwo w badaniu zaproponowano 20 losowo wybranym lekarzom rodzinnym i 30 lekarzom z ośrodków kardiologicznych województwa pomorskiego. Na udział w badaniu wyraziło zgodę 13 lekarzy rodzinnych i 22 lekarzy specjalistów. Po przeszkoleniu dokonywali oni oceny ryzyka za pomocą podprogramu komputerowego u co najmniej 10 kolejnych pacjentów w trybie bieżących konsultacji lekarskich. Opinie lekarzy o zastosowaniu programu w praktyce lekarskiej zebrano przy użyciu kwestionariusza zawierającego 16 pytań z odpowiedziami wielokrotnego wyboru. Wyniki. Średni wiek lekarzy uczestniczących w ankiecie wynosił 41 &plusmn; 9 lat; 35% stanowili mężczyźni. Przed rozpoczęciem konsultacji z użyciem programu PRECARD 96% lekarzy uznawało konieczność wieloczynnikowej oceny ryzyka sercowo-naczyniowego przy podejmowaniu decyzji terapeutycznych. Po zakończeniu pracy z programem 92% lekarzy stwierdziło, że był on pomocny w ocenie ryzyka, zaś 86%, że ułatwił podejmowanie decyzji terapeutycznych. Sposób funkcjonowania programu spełnił większość lub wszystkie oczekiwania (96%) lekarzy. Według 92% uczestników badania graficzne sposoby prezentacji wielkości ryzyka (wykresy słupkowe i wykres kołowy struktury ryzyka) mogły istotnie wzmocnić motywację pacjentów i poprawić przestrzeganie zaleceń lekarskich. Sześćdziesiąt dwa procent lekarzy stwierdziło, że stosowanie programu może wydłużyć czas wizyty. Wnioski. W badaniu wykazano, że wspomaganie podejmowania decyzji w praktyce lekarskiej poprzez komputerowo opracowane algorytmy oceny ryzyka może poprawić trafność wyborów strategii leczenia i profilaktyki u pacjentów obciążonych podwyższonym ryzykiem sercowo-naczyniowym