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Explaining the fall in Coronary Heart Disease mortality in the Republic of Ireland between 2000 and 2015 - IMPACT modelling study

  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Vivien Marasigan
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    School of Public Health, University College Cork, Cork, Ireland

    Department of Dermatology, University Hospitals Leuven, Belgium

    Department of Dermatology, University Hospital Limerick, Limerick, Ireland
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    Ivan Perry
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    Affiliations
    School of Public Health, University College Cork, Cork, Ireland
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    Kathleen Bennett
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    Affiliations
    Population Health Sciences Division, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
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    Kevin Balanda
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    Affiliations
    School of Public Health, University College Cork, Cork, Ireland

    Institute of Public Health, Dublin, Ireland
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    Simon Capewell
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    Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
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    Martin O' Flaherty
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    Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
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    Zubair Kabir
    Correspondence
    Corresponding author.
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    School of Public Health, University College Cork, Cork, Ireland
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

      Highlights

      • Coronary Heart Disease (CHD) death rates halved between 2000 and 2015 in Ireland.
      • 4060 fewer CHD deaths were observed in 2015 than expected.
      • CHD risk factor improvements contributed to ~30% of the CHD mortality decline.
      • Improved uptakes in cardiology treatments explained ~60% of the CHD decline.
      • Population health gains were reversed due to increase in BMI, diabetes and physical inactivity levels.

      Abstract

      Background

      To investigate the contribution of individual and population factors to Coronary Heart Disease (CHD) mortality rates in Ireland between 2000 and 2015.

      Methods

      The Irish IMPACT CHD model was utilized with CHD Deaths Prevented or Postponed (DPPs) as outcome.

      Results

      CHD mortality rates in Ireland in those aged 25–84 years fell by 56% (63% in women vs. men 53%), with 4060 fewer deaths than expected in 2015.
      Improvements in CHD risk factors explained ~30% of the decline (785 DPPs in men; 425 in women): [population systolic blood pressure (+25% DPPs), mean cholesterol serum levels (+11%) and smoking prevalence (+5%)]. Additional deaths attributable to rises in diabetes prevalence (−6%), BMI (−4%) and physical inactivity (−2%) negatively impacted DPPs.
      Increased uptake of cardiology treatments explained ~60% of the decline (1620 DPPs in men; 825 in women), particularly secondary prevention and heart failure treatments. Some 10% was unexplained.

      Conclusion

      CHD mortality declined in Ireland between 2000 and 2015, with two-thirds attributable to increased uptake in cardiology treatments and only one-third to improvements in population risk factors, partly reflecting adverse trends in obesity, diabetes and physical inactivity. Additional investments in prevention policies and treatments will be necessary to reduce future CHD deaths.

      Keywords

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