BACKGROUND: Coronary heart disease (CHD) mortality has declined substantially in the Czech Republic over the last two decades. DESIGN: The purpose of this study was to determine what proportion of this CHD mortality decline could be associated with temporal trends in major CHD risk factors and what proportion with advances in medical and surgical treatments. METHODS: The validated IMPACT mortality model was used to combine and analyse data on uptake and effectiveness of CHD management and risk factor trends in the Czech Republic in adults aged 25-74 years between 1985 and 2007. The main sources were official statistics, national quality of care registries, published trials and meta-analyses, and the Czech MONICA and Czech post-MONICA studies. RESULTS: Between 1985 and 2007, age-adjusted CHD mortality rates in the Czech Republic decreased by 66.2% in men and 65.4% in women in the age group 25-74 years, representing 12,080 fewer CHD deaths in 2007. Changes in CHD risk factors explained approximately 52% of the total mortality decrease, and improvements in medical treatments approximately 43%. Increases in body mass index and in diabetes prevalence had a negative impact, increasing CHD mortality by approximately 1% and 5%, respectively. CONCLUSIONS: More than half of the very substantial fall in CHD mortality in the Czech Republic between 1985 and 2007 was attributable to reduction in major cardiovascular risk factors. Improvement in treatments accounted for approximately 43% of the total mortality decrease. These findings emphasize the value of primary prevention and evidence-based medical treatment.

Centre of Biomedical Informatics Institute of Computer Science Academy of Sciences of the Czech Republic Prague Czech Republic

Department of Cardiovascular Surgery Charles University Medical School 2 and Motol University Hospital Prague Czech Republic

Department of Preventive Cardiology Institute for Clinical and Experimental Medicine Prague Czech Republic Centre for Cardiovascular Prevention Thomayer Hospital and Charles University Medical School 1 Prague Czech Republic Department of Medicine 2 Charles University Medical School 1 Prague Czech Republic International Clinical Research Centre Brno Czech Republic

Department of Preventive Cardiology Institute for Clinical and Experimental Medicine Prague Czech Republic Department of Medicine 2 Charles University Medical School Pilsen Czech Republic

Division of Public Health University of Liverpool UK

Institute of Health and Society University of Newcastle UK

Institute of Health Information and Statistics of the Czech Republic Prague Czech Republic

Medical Statistics Unit Institute for Clinical and Experimental Medicine Prague Czech Republic

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