Life-years-gained from population risk factor changes and modern cardiology treatments in Ireland.
BACKGROUND
Coronary heart disease (CHD) mortality rates in Ireland have halved since the mid-1980s, and adult life expectancy has also steadily improved. This study estimated the life-years-gained by CHD treatments and by changes in cardiovascular risk factor levels.


METHODS
A previously validated Irish IMPACT CHD mortality model was used to integrate large amounts of data on (i) patient numbers, (ii) treatment uptake, (iii) risk factor trends, (iv) effectiveness of cardiology treatments and risk factor reductions, and (v) median survival in patients with and without CHD, all stratified by age and sex. Results were tested in rigorous sensitivity analyses.


RESULTS
There were 3763 fewer CHD deaths than expected in 2000 compared with the base year, 1985. This resulted in approximately 44,060 life-years-gained among people aged 25-84. Specific medical and surgical treatments given in 2000 for CHD patients together gained approximately 14,505 life-years. Population changes in cholesterol and smoking levels accounted for some 32,705 life-years-gained, 66% from reductions in cholesterol alone. Adverse changes in obesity and diabetes resulted in a loss of approximately 3670 life-years.


CONCLUSIONS
Use of modern cardiology treatments in Ireland from 1985 to 2000 gained many thousands of life-years. However, twice as many life-years were generated by relatively modest reductions in major risk factors. Effective policies, such as the promotion of healthy diets, and weight reduction, together with the recent nationwide workplace smoking ban, will be essential to maintain and further enhance health gain.
Kabir
Zubair
Z
Department of Pharmacology & Therapeutics, Trinity College & St. James's Hospital Dublin, Ireland. kabirzin@yahoo.com
Bennett
Kathleen
K
Shelley
Emer
E
Unal
Belgin
B
Critchley
Julia
J
Feely
John
J
Capewell
Simon
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D005260:Female; D015438:Health Behavior; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D006973:Hypertension / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D009765:Obesity / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D000074606:Smoking Prevention; D016019:Survival Analysis