Open Access Research article

Explaining the decline in coronary heart disease mortality in Turkey between 1995 and 2008

Belgin Unal1*, Kaan Sözmen1, Hale Arık2, Gül Gerçeklioğlu1, Deniz Utku Altun1, Hatice Şimşek1, Sinem Doganay1, Yücel Demiral1, Özgür Aslan3, Kathleen Bennett4, Martin O´Flaherty5, Simon Capewell5 and Julia Critchley6

Author Affiliations

1 Department of Public Health, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey

2 Ordu Community Health Centre, Ordu, Turkey

3 Department of Cardiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey

4 Department of Pharmacology & Therapeutics, Trinity College, Dublin, Ireland

5 Department of Public Health, University of Liverpool, Liverpool, UK

6 Division of Population Health Sciences and Education, St George’s, University of London, London, UK

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BMC Public Health 2013, 13:1135  doi:10.1186/1471-2458-13-1135

Published: 5 December 2013



Coronary heart disease (CHD) mortality rates have been decreasing in Turkey since the early 1990s. Our study aimed to determine how much of the CHD mortality decrease in Turkey between 1995 and 2008 could be attributed to temporal trends in major risk factors and how much to advances in medical and surgical treatments.


The validated IMPACT CHD mortality model was used to combine and analyse data on uptake and effectiveness of CHD treatments and risk factor trends in Turkey in adults aged 35–84 years between 1995 and 2008.

Data sources were identified, searched and appraised on population, mortality and major CHD risk factors for adults those aged 35–84 years. Official statistics, electronic databases, national registers, surveys and published trials were screened from 1995 onwards.


Between 1995 and 2008, coronary heart disease mortality rates in Turkey decreased by 34% in men and 28% in women 35 years and over. This resulted in 35,720 fewer deaths in 2008.

Approximately 47% of this mortality decrease was attributed to treatments in individuals (including approximately 16% to secondary prevention, 3% angina treatments, 9% to heart failure treatments, 5% to initial treatments of acute myocardial infarction, and 5% to hypertension treatments) and approximately 42% was attributable to population risk factor reductions (notably blood pressure 29%; smoking 27%; and cholesterol 1%). Adverse trends were seen for obesity and diabetes (potentially increasing mortality by approximately 11% and 14% respectively). The model explained almost 90% of the mortality fall.


Reduction in major cardiovascular risk factors explained approximately 42% and improvements in medical and surgical treatments explained some 47% of the CHD mortality fall. These findings emphasize the complimentary value of primary prevention and evidence-based medical treatments in controlling coronary heart disease.

Coronary heart disease; Coronary heart disease mortality; Coronary heart disease risk factors; Coronary heart disease management; Turkey; Modelling