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Can small changes in cardiovascular risk factors predict large future reductions in coronary heart disease mortality
Zubair Kabir1, Kathleen Bennett, Julia A Critchley
1Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St. James's Hospital, Trinity College Dublin, Dublin, 8, Ireland. bennettk@tcd.ie
Insights
Reducing cardiovascular risk factors in Ireland could significantly decrease coronary heart disease deaths. Implementing stricter policies on tobacco control and diet could halve deaths by 2010.
Area of Science:
- Cardiovascular epidemiology
- Public health policy
- Preventive cardiology
Background:
- Coronary heart disease (CHD) remains a significant public health concern in Ireland.
- Attaining national targets for CHD mortality reduction requires effective risk factor management.
- Previous studies have established models for predicting CHD mortality based on risk factor trends.
Purpose of the Study:
- To assess the potential impact of decreasing cardiovascular risk factors on coronary heart disease (CHD) mortality in Ireland by 2010.
- To model future CHD deaths under different risk factor trend scenarios.
Main Methods:
- Utilized a validated epidemiological model integrating cardiology treatments and major cardiovascular risk factor trends.
- Stratified analysis by age and sex to estimate CHD death reductions by 2010.
- Compared two scenarios: continuation of recent risk factor trends versus achievement of greater risk factor reductions.
Main Results:
- Continuing recent trends projected 635 fewer CHD deaths by 2010 compared to 2000 levels.
- Improvements in cholesterol, blood pressure, smoking, and physical activity offset by adverse obesity and diabetes trends.
- Achieving greater risk factor reductions could potentially avert 3,100 CHD deaths, with cholesterol reduction alone accounting for 2,065 fewer deaths.
Conclusions:
- Continuation of current risk factor trends is unlikely to meet national CHD mortality targets in Ireland.
- Substantial reductions in CHD deaths are achievable through enhanced tobacco control and healthier diet policies.
- Targeted interventions addressing major cardiovascular risk factors can significantly reduce CHD mortality.
Aim:
To examine the potential for decreasing cardiovascular risk factors in order to reduce coronary heart disease deaths by 2010 in Ireland.
Methods:
A previously validated model was used, which integrates information on all cardiology treatments, and trends in all the major cardiovascular risk factors, stratified by age and sex to estimate the reduction in coronary deaths by 2010. The model was extended from 2000 (the base year) to 2010 for two contrasting scenarios: If recent risk factor trends simply continued to 2010, or if greater reductions in risk factors were achieved.
Results:
If recent risk factor trends simply continued, approximately 635 fewer coronary deaths in 2010 compared with an observed 6,589 coronary deaths in 2000; approximately 1,055 fewer deaths attributable to improvements in total cholesterol, blood pressure, smoking and physical activity, offset by 420 additional deaths attributable to adverse trends in obesity and diabetes. Additional reductions in the six cardiovascular risk factors by 2010, already achieved elsewhere, could potentially achieve 3,100 fewer deaths (minimum 1,815, maximum 4,535). Approximately 2,065 fewer deaths were from reducing total mean cholesterol levels alone. These results remained stable in a rigorous analysis of extremes sensitivity analysis.
Conclusions:
If recent trends in the major cardiovascular risk factors simply continued to 2010, the national targets for CHD death rates are less likely to be achieved in Ireland. However, additional reductions in the major cardiovascular risk factors through tobacco control and healthier diet policies could halve the current coronary deaths by 2010.
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