Prevalence of Coronary Mortality and Morbidity in the Turkish Adult Risk Factor Study: 10-year Follow-up Suggests Coronary "Epidemic"

The Turkish Adult Risk Factor Study, initiated in 1990 on a random sample of 3687 adults (20 years of age or over) residing in 59 communities scattered to all regions of Turkey, was followed up lastly in the summer of 2000. This paper reports 10-year cumulative data on the prevalence of coronary and all-cause mortality as well as of new coronary events based on a follow-up of 28790 person-years. Cardiovascular history and physical examination were obtained, and a 12-lead ECG was recorded at rest. New coronary events were defined to include fatal and nonfatal myocardial infarction, newly developed stable angina with or without associated myocardial ischemia. 2563 participants (of whom 1294 women) were examined or were reported to have died. Of the 290 deaths cumulated over 10 years, 42% were attributed to coronary origin. Overall annual death rate was 12.3 per 1000 men and 8 per 1000 women in a relatively young cohort the mean age of which moved from 37 to 50 years over the follow-up period. Coronary heart disease (CHD) mortality was found 5.2 per 1000 men and 3.2 per 1000 women. This indicated the occurrence of a coronary mortality of approximately 153.000 in the year 2000. In the age bracket of 45-74 years, overall mortality per 1000 was high, namely 20.3 in men and 12.9 in women. CHD mortality in the same age bracket was 8.0 in men and 4.7 in women. Rates in men were among the five highest European countries while rates in women exceeded even those of Ukraine women. Prevalence of CHD was estimated to be as 90 men and 71 women per 1000 adults, an observation which permitted to infer that 2.0 million Turkish adults currently suffer from CHD. Annual incidence of new coronary events which included fatal coronary events was estimated as 260.000, a very high rate for a "young" nation and suggesting that the CHD prevalence is rising at an annual rate of 5%. In order to stem the tide of the recent coronary "epidemic", these findings necessitate far more effective implementation of cardiovascular preventive measures among Turkish adults.