Medrano María José, Alcalde-Cabero Enrique, Ortíz Cristina, Galán Iñaki
National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
BMJ Open. 2014 Feb 17;4(2):e004257. doi: 10.1136/bmjopen-2013-004257.
To assess the overall population impact of primary prevention strategies (promotion of healthy lifestyles, prevention of smoking and use of vascular risk drug therapy) of coronary disease in Spain.
Ecological time series analysis, 1982-2009.
All public and private hospitals in Spain.
General population.
Incident coronary disease hospitalisation as derived from official hospital discharge data.
Annual hospitalisation rates were modelled according to nationwide use of statins, antihypertensive, antidiabetic and antiplatelet drugs, and prevalences of smoking, obesity and overweight. Additive generalised models and mixed Poisson regression models were used for the purpose, taking year as the random-effect variable and adjusting for age, sex, prevalence of vascular risk factors and the number of hospital beds in intensive and coronary care units.
Across 28 years and 671.5 million person-years of observation, there were 2 986 834 hospitalisations due to coronary disease; of these, 1 441 980 (48.28%) were classified as incident. Hospitalisation rates increased from 1982 to 1996, with an inflection point in 1997 and a subsequent 52% decrease until 2009. Prevalences of smoking, obesity, overweight and use of vascular risk drug therapy were significantly associated with hospitalisation rates (p<0.001): incidence rates ratios (95% CI) for the fourth versus the first quartile were 1.46 (1.42 to 1.50), 1.80 (1.78 to 1.83), 1.58 (1.55 to 1.60) and 0.57 (0.51 to 0.63), respectively. These variables accounted for 92% of interannual variability.
After decades of continuous rises, hospitalisation due to incident ischaemic heart disease has been cut by half, an achievement associated with the decline in smoking and the increase in vascular risk drug therapy. These results indicate that these two primary prevention strategies have been effective at a population level, thanks to an appropriate balance between financial and health goals, something that should be left intact despite the current economic crisis. Future strategies ought to lay special stress on excessive body weight prevention.
评估西班牙冠心病一级预防策略（促进健康生活方式、预防吸烟和使用血管风险药物治疗）对总体人群的影响。
1982 - 2009年生态时间序列分析。
西班牙所有公立和私立医院。
普通人群。
根据官方医院出院数据得出的冠心病住院病例。
根据全国他汀类药物、抗高血压药、抗糖尿病药和抗血小板药物的使用情况，以及吸烟、肥胖和超重的患病率，对年度住院率进行建模。为此使用了加法广义模型和混合泊松回归模型，以年份作为随机效应变量，并对年龄、性别、血管危险因素患病率以及重症监护病房和冠心病监护病房的病床数量进行了调整。
在28年和6.715亿人年的观察期内，因冠心病住院2986834例；其中，1441980例（48.28%）被归类为新发病例。住院率从1982年到1996年上升，1997年出现拐点，随后到2009年下降了52%。吸烟、肥胖、超重和血管风险药物治疗的患病率与住院率显著相关（p<0.001）：第四四分位数与第一四分位数的发病率比（95%可信区间）分别为1.46（1.42至1.50）、1.80（1.78至1.83）、1.58（1.55至1.60）和0.57（0.51至0.63）。这些变量占年际变异性的92%。
在经历了数十年的持续上升之后，新发缺血性心脏病的住院率已减半，这一成果与吸烟率下降和血管风险药物治疗的增加有关。这些结果表明，这两种一级预防策略在人群层面是有效的，这得益于财务目标和健康目标之间的适当平衡，尽管当前存在经济危机，但这一点应保持不变。未来的策略应特别强调预防超重。
