Explaining the increment in coronary heart disease mortality in Mexico between 2000 and 2012

Abstract

Background: Mexico is still in the growing phase of the epidemic of coronary heart disease (CHD), with mortality increasing by 48% since 1980. However, no studies have analyzed the drivers of these trends. We aimed to model CHD deaths between 2000 and 2012 in Mexico and to quantify the proportion of the mortality change attributable to advances in medical treatments and to changes in population-wide cardiovascular risk factors.

Methods: We performed a retrospective analysis using the previously validated IMPACT model to explain observed changes in CHD mortality in Mexican adults. The model integrates nationwide data at two-time points (2000 and 2012) to quantify the effects on CHD mortality attributable to changes in risk factors and therapeutic trends.

Results: From 2000 to 2012, CHD mortality rates increased by 33.8% in men and by 22.8% in women. The IMPACT model explained 71% of the CHD mortality increase. Most of the mortality increases could be attributed to increases in population risk factors, such as diabetes (43%), physical inactivity (28%) and total cholesterol (24%). Improvements in medical and surgical treatments together prevented or postponed 40.3% of deaths; 10% was attributable to improvements in secondary prevention treatments following MI, while 5.3% to community heart failure treatments.

Conclusions: CHD mortality in Mexico is increasing due to adverse trends in major risk factors and suboptimal use of CHD treatments. Population-level interventions to reduce CHD risk factors are urgently needed, along with increased access and equitable distribution of therapies.

Fig 1. Proportion of all coronary heart disease deaths explained by the model, which were attributed to the contribution of treatments and risk factors in Mexico, 2000 to 2012.

The bars are the best model estimate and the vertical lines the extreme minimum and maximum estimates in sensitivity analysis. CABG indicates coronary artery bypass graft; PTCA Percutaneous transluminal coronary angioplasty; HF heart failure, AH antihypertensive and PCI percutaneous coronary intervention.