Email updates

Keep up to date with the latest news and content from BMC Public Health and BioMed Central.

Open Access Highly Accessed Research article

Explaining the increase in coronary heart disease mortality in Syria between 1996 and 2006

Samer Rastam15*, Radwan AL Ali1, Wasim Maziak12, Fawaz Mzayek13, Fouad M Fouad1, Martin O'Flaherty4 and Simon Capewell4

Author affiliations

1 Syrian Centre for Tobacco Studies, Aleppo, Syria

2 Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA

3 University of Memphis, School of Public Health, Division of Epidemiology and Biostatistics, Memphis, TN, USA

4 Department of Public Health and Policy, University of Liverpool, Liverpool, UK

5 Syrian Center for Tobacco Studies Syrian Society against Cancer building, St.Aleppo, Shihan, Syria

For all author emails, please log on.

Citation and License

BMC Public Health 2012, 12:754  doi:10.1186/1471-2458-12-754

Published: 9 September 2012



Despite advances made in treating coronary heart disease (CHD), mortality due to CHD in Syria has been increasing for the past two decades. This study aims to assess CHD mortality trends in Syria between 1996 and 2006 and to investigate the main factors associated with them.


The IMPACT model was used to analyze CHD mortality trends in Syria based on numbers of CHD patients, utilization of specific treatments, trends in major cardiovascular risk factors in apparently healthy persons and CHD patients. Data sources for the IMPACT model included official statistics, published and unpublished surveys, data from neighboring countries, expert opinions, and randomized trials and meta-analyses.


Between 1996 and 2006, CHD mortality rate in Syria increased by 64%, which translates into 6370 excess CHD deaths in 2006 as compared to the number expected had the 1996 baseline rate held constant. Using the IMPACT model, it was estimated that increases in cardiovascular risk factors could explain approximately 5140 (81%) of the CHD deaths, while some 2145 deaths were prevented or postponed by medical and surgical treatments for CHD.


Most of the recent increase in CHD mortality in Syria is attributable to increases in major cardiovascular risk factors. Treatments for CHD were able to prevent about a quarter of excess CHD deaths, despite suboptimal implementation. These findings stress the importance of population-based primary prevention strategies targeting major risk factors for CHD, as well as policies aimed at improving access and adherence to modern treatments of CHD.

Coronary heart disease; Mortality; Modelling