Explaining the recent decrease in coronary heart disease mortality rates in Ireland, 1985–2000
- Kathleen Bennett1,
- Zubair Kabir1,
- Belgin Unal2,
- Emer Shelley3,
- Julia Critchley4,
- Ivan Perry5,
- John Feely1,
- Simon Capewell6
- 1Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James’s Hospital, Dublin, Ireland
- 2Dokuz Eylul University, Faculty of Medicine, Department of Public Health, Izmir, Turkey
- 3Department of Health and Children, Hawkins House, Dublin, Ireland
- 4International Health Research Group, Liverpool School of Tropical Medicine and Hygiene, Liverpool, UK
- 5Department of Epidemiology and Public Health, University College, Cork, Ireland
- 6Department of Public Health, University of Liverpool, Liverpool, UK
- Correspondence to: Dr K Bennett Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James’s Hospital, Dublin 8, Ireland;
- Accepted 14 October 2005
Study objectives: To examine the proportion of the recent decline in coronary heart disease (CHD) deaths in Ireland attributable to (a) “evidence based” medical and surgical treatments, and (b) changes in major cardiovascular risk factors.
Design setting: IMPACT, a previously validated model, was used to combine and analyse data on the use and effectiveness of specific cardiology treatments and risk factor trends, stratified by age and sex. The main data sources were published trials and meta-analyses, official statistics, clinical audits, and observational studies.
Results: Between 1985 and 2000, CHD mortality rates in Ireland fell by 47% in those aged 25–84. Some 43.6% of the observed decrease in mortality was attributed to treatment effects and 48.1% to favourable population risk factor trends; specifically declining smoking prevalence (25.6%), mean cholesterol concentrations (30.2%), and blood pressure levels (6.0%), but offset by increases in adverse population trends related to obesity, diabetes, and inactivity (−13.8%).
Conclusions: The results emphasise the importance of a comprehensive strategy that maximises population coverage of effective treatments, and that actively promotes primary prevention, particularly tobacco control and a cardioprotective diet.
Funding: the Irish Heart Foundation funded this project.
Competing interests: none declared.