Can small changes in cardiovascular risk factors predict large future reductions in coronary heart disease mortality in Ireland?

Abstract

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.