Modelling Coronary Heart Disease Mortality declines in the Republic of Ireland, 1985–2006

Abstract

Background: Consistent declines in coronary heart disease (CHD) death rates have been previously observed in Ireland since1985. Aims & Methods: To use the previously validated Irish IMPACT CHD mortality model to further examine the subsequent CHD mortality falls from 1985 through to 2006, and to determine the contribution of risk factor changes and "evidence based" treatments to this decline by age and gender. Results: CHD mortality rates fell by 68% in men (63% in 65-84 years) and by 69% in women (66% in 65-84 years). This resulted in approximately 6450 fewer CHD deaths than if mortality rates had not changed. Overall, approximately 40% (38% in men; 45% in women) of the CHD mortality decline could be attributed to improvements in treatment uptake, particularly secondary prevention (12%), angina (9%), and heart failure therapies (8%). Approximately 48% of the CHD mortality decline was attributable to risk factor improvements (54% in men; 37% in women); the biggest contributions came from falls in population systolic pressure (28%), cholesterol (24%), and physical inactivity levels (10%). Negative trends in diabetes and obesity levels generated an estimated 17% additional CHD deaths. The largest benefits from improvements in risk factors were seen in men aged 25-64 years, while the greatest treatment benefits occurred in women aged 65-84 years. The model explained approximately 88% of the observed mortality declines. Conclusion: Falls in CHD mortality have continued in both sexes in Ireland, but with notable gender and age differences. The continued increase in diabetes and obesity levels is particularly worrying.

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“…Improvement in prescribing rate is similarly observed in other countries [7, 25, 26] and is believed to contribute to improvement in NSTEMI outcomes [27, 28]. Similar trend has been described for STEMI patients [18].…”

Hypertension prevalence, awareness, treatment and control in the over 50s in Ireland: evidence from The Irish Longitudinal Study on Ageing

“…3 This decline in cardiovascular mortality is attributed to a combination of improved treatment uptake (40%) and an improvement in risk factors (48%). 4 Hypertension is a leading modifiable risk factor for CVD and estimated to be responsible for at least 45% of ischaemic heart disease mortality and 51% of total stroke mortality globally. 5 The burden of hypertension is increasing worldwide.…”

Modelling the impact of specific food policy options on coronary heart disease and stroke deaths in Ireland

“…In a recent updated modelling study of CHD mortality decline in Ireland between 1985 and 2006, similar trends were observed. However, in the latter study, deteriorating trends in obesity and diabetes prevalence were observed 4. For many population-level interventions, the first step is to quantify the effectiveness of such interventions to make judgements on the allocation of finite health resources.…”

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