Modelling Future Coronary Heart Disease Mortality to 2030 in the British Isles.

John Hughes,Maria Guzman-Castillo,Frank Kee,Simon Capewell,Kathleen Bennett,Martin O’Flaherty,Carolyn Davies,Alastair H Leyland,Julia Critchley,Piotr Bandosz,Zubair Kabir,Joel W Hotchkiss,Yiru Guo

doi:10.1371/journal.pone.0138044

Abstract

ObjectiveDespite rapid declines over the last two decades, coronary heart disease (CHD) mortality rates in the British Isles are still amongst the highest in Europe. This study uses a modelling approach to compare the potential impact of future risk factor scenarios relating to smoking and physical activity levels, dietary salt and saturated fat intakes on future CHD mortality in three countries: Northern Ireland (NI), Republic of Ireland (RoI) and Scotland.MethodsCHD mortality models previously developed and validated in each country were extended to predict potential reductions in CHD mortality from 2010 (baseline year) to 2030. Risk factor trends data from recent surveys at baseline were used to model alternative future risk factor scenarios: Absolute decreases in (i) smoking prevalence and (ii) physical inactivity rates of up to 15% by 2030; relative decreases in (iii) dietary salt intake of up to 30% by 2030 and (iv) dietary saturated fat of up to 6% by 2030. Probabilistic sensitivity analyses were then conducted.ResultsProjected populations in 2030 were 1.3, 3.4 and 3.9 million in NI, RoI and Scotland respectively (adults aged 25–84). In 2030: assuming recent declining mortality trends continue: 15% absolute reductions in smoking could decrease CHD deaths by 5.8–7.2%. 15% absolute reductions in physical inactivity levels could decrease CHD deaths by 3.1–3.6%. Relative reductions in salt intake of 30% could decrease CHD deaths by 5.2–5.6% and a 6% reduction in saturated fat intake might decrease CHD deaths by some 7.8–9.0%. These projections remained stable under a wide range of sensitivity analyses.ConclusionsFeasible reductions in four cardiovascular risk factors (already achieved elsewhere) could substantially reduce future coronary deaths. More aggressive polices are therefore needed in the British Isles to control tobacco, promote healthy food and increase physical activity.

Highlights

Coronary Heart Disease (CHD) mortality rates have more than halved in Northern Ireland, [1] Republic of Ireland [2] and Scotland [3] as in other European countries over the last four decades
More aggressive polices are needed in the British Isles to control tobacco, promote healthy food and increase physical activity
Other countries have been more successful at reducing smoking prevalence to less than 15%, (Australia) [5] decreasing dietary salt intake (Japan) [6] and saturated fats (Finland), [7] and increasing physical activity (Poland). [8]

Summary

Introduction

Coronary Heart Disease (CHD) mortality rates have more than halved in Northern Ireland, [1] Republic of Ireland [2] and Scotland [3] as in other European countries over the last four decades. The objective of this study was to evaluate the impact of a number of cardiovascular risk factor changes on future levels of CHD mortality to 2030 in three countries in the British Isles which have separate policy making frameworks. The IMPACT model quantifies observed decreases in CHD mortality which can be attributed to (i) risk factor changes in the population and (ii) advances in evidence based medical and surgical treatments. In this paper we extended established IMPACT models developed in Northern Ireland, Republic of Ireland and Scotland to examine the effect of a number of improved population level risk factor scenarios on projected CHD Mortality in 2030.

Methods

Results

Conclusion