Abstract
BackgroundTo investigate whether primary prevention might be more favourable than secondary prevention (risk factor reduction in patients with coronary heart disease(CHD)).MethodsThe cell-based IMPACT CHD mortality model was used to integrate data for Ireland describing CHD patient numbers, uptake of specific treatments, trends in major cardiovascular risk factors, and the mortality benefits of these specific risk factor changes in CHD patients and in healthy people without recognised CHD.ResultsBetween 1985 and 2000, approximately 2,530 fewer deaths were attributable to reductions in the three major risk factors in Ireland. Overall smoking prevalence declined by 14% between 1985 and 2000, resulting in about 685 fewer deaths (minimum estimate 330, maximum estimate 1,285) attributable to smoking cessation: about 275 in healthy people and 410 in known CHD patients. Population total cholesterol concentrations fell by 4.6%, resultingin approximately 1,300 (minimum estimate 1,115, maximum estimate 1,660) fewer deaths attributable to dietary changes(1,185 in healthy people and 115 in CHD patients) plus 305 fewer deaths attributable to statin treatment (45 in people without CHD and 260 in CHD patients). Mean population diastolic blood pressure fell by 7.2%, resulting in approximately 170 (minimum estimate 105, maximum estimate 300) fewer deaths attributable to secular falls in blood pressure (140 in healthy people and 30 in CHD patients), plus approximately 70 fewer deaths attributable to antihypertensive treatments in people without CHD.Of all the deaths attributable to risk factor falls, some 1,715 (68%) occurred in people without recognized CHD and 815(32%) in CHD patients.ConclusionCompared with secondary prevention, primary prevention achieved a two-fold larger reduction in CHD deaths. Future national CHD policies should therefore prioritize nationwide interventions to promote healthy diets and reduce smoking.
Highlights
To investigate whether primary prevention might be more favourable than secondary prevention (risk factor reduction in patients with coronary heart disease(CHD))
We explicitly considered demographic change by using age and sex specific population Coronary heart disease (CHD) mortality and CHD patient numbers for 1985 and for 2000 [11]
Overall smoking prevalencedeclined by 14% between 1985 and 2000, resulting in about 685 fewer deaths attributable to smoking cessation: about 275 in healthy people and 410 in known CHD patients
Summary
To investigate whether primary prevention might be more favourable than secondary prevention (risk factor reduction in patients with coronary heart disease(CHD)). Coronary heart disease (CHD) remains the largest single cause of death in Ireland, as elsewhere in Europe, the USA and Australasia [1]. Consultants and department of health officials in particular prioritise risk factor reduction in CHD patients (secondary prevention), citing the low numbers needed to treat. Epidemiological principles suggest that primary prevention (risk factor reduction in healthy subjects) may have a bigger potential than secondary prevention to reduce CHD deaths [6]. Researchers have used models to quantify the potential contribution of risk factor reductions before and after CHD manifests in an individual [2,8,9]
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