Article

Explaining the recent decrease in coronary heart disease mortality rates in Ireland, 1985-2000.

Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland.
Journal of Epidemiology &amp Community Health (impact factor: 3.19). 05/2006; 60(4):322-7. DOI:10.1136/jech.2005.038638 pp.322-7
Source: PubMed

ABSTRACT 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.
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.
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%).
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.

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  • Article: Body mass index and cardiovascular disease in the Asia-Pacific Region: an overview of 33 cohorts involving 310 000 participants.
    C Ni Mhurchu, A Rodgers, W H Pan, D F Gu, M Woodward
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    ABSTRACT: Few prospective data from the Asia-Pacific region are available relating body mass index (BMI) to the risks of stroke and ischaemic heart disease (IHD). Our objective was to assess the age-, sex-, and region-specific associations of BMI with cardiovascular disease using individual participant data from prospective studies in the Asia-Pacific region. Studies were identified from literature searches, proceedings of meetings, and personal communication. All studies had at least 5000 person-years of follow-up. Hazard ratios were calculated from Cox models, stratified by sex and cohort, and adjusted for age at risk and smoking. The first 3 years of follow-up were excluded in order to reduce confounding due to disease at baseline. A total of 33 cohort studies, including 310 283 participants, contributed 2 148 354 person-years of follow-up, during which 3332 stroke and 2073 IHD events were observed. There were continuous positive associations between baseline BMI and the risks of ischaemic stroke, haemorrhagic stroke, and IHD, with each 2 kg/m(2) lower BMI associated a 12% (95% CI: 9, 15%) lower risk of ischaemic stroke, 8% (95% CI: 4, 12%) lower risk in haemorrhagic stroke, and 11% (95% CI: 9, 13%) lower risk of IHD. The strengths of all associations were strongly age dependent, and there was no significant difference between Asian and Australasian cohorts. This overview provides the most reliable estimates to date of the associations between BMI and cardiovascular disease in the Asia-Pacific region, and the first direct comparisons within the region. Continuous relationships of approximately equal strength are evident in both Asian and Australasian populations. These results indicate considerable potential for cardiovascular disease reduction with population-wide lowering of BMI.
    International Journal of Epidemiology 09/2004; 33(4):751-8. · 6.41 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

CHD
 
CHD mortality rates
 
cholesterol concentrations
 
clinical audits
 
comprehensive strategy
 
coronary heart disease
 
effective treatments
 
favourable population risk factor trends
 
Ireland attributable
 
main data sources
 
major cardiovascular risk factors
 
maximises population coverage
 
observed decrease
 
risk factor trends
 
specific cardiology treatments
 
stratified
 
surgical treatments
 
tobacco control
 
treatment effects
 
validated model