Moderated Poster Session I Epidemiology

M12 Explaining the continuing decrease in CHD mortality in Ireland: comparing population health behaviour and health service contributions from 1985-2000 with 2000-2006 K Bennett, I Perry, H Mcgee, K Morgan, E Shelley, S Jennings, S Capewell St James Hospital, Dublin, Ireland, University College Cork, Cork, Ireland, Royal College Surgeons of Ireland, Dublin, Ireland, HSE, Dublin, Ireland, University of Liverpool, Liverpool, United Kingdom Topic: Cardiovascular epidemiology Mortality from cardiovascular disease has been falling in several countries with previously high rates. Irish CHD mortality rates fell dramatically from 1985 to 2000. Between 2000 and 2006 there was a further 45% decrease in CHD mortality rates amongst both men and women aged 2584 years (44% men; 46% women) in Ireland, i.e. 2315 fewer deaths than expected or ‘deaths prevented or postponed (DPPs)’ between 2000 and 2006. Objective: the aim of this study was to use the validated IMPACT CHD mortality model to examine the CHD mortality fall in Ireland between 2000 and 2006; to determine the contribution of risk factor changes and "evidence based" treatments to this decline; and to compare with similar analyses for 1985-2000. Methods: the cell-based IMPACT CHD mortality model in Microsoft Excel has been described in detail elsewhere. Data on risk factors was obtained from the SLû N 1998, 2002 and 2007 health and lifestyle surveys. Medical treatment data was available from the national prescribing databases, the Heartwatch programme for secondary prevention therapy in primary care, as well as the EUROASPIRE II and III (2001) and EUROHeart Failure I and II surveys. Results: approximately half of the decrease in CHD deaths between 2000 and 2006 were attributed to improvements in uptake of treatments (48%), particularly secondary prevention (15%), and treatments for chronic angina (11%) and for heart failure in the community and hospital (12%). For risk factors, the largest contribution came from reductions in population cholesterol (25%). Reduction in smoking contributed a disappointing 6% (compared with 26% in 1985-2000 comparisons); reflecting little progress in smoking cessation since 2000. There was little evidence of an improvement in population blood pressure reduction, or physical activity levels. There was further deterioration in the rates of diabetes and obesity since 2000, which is contributing to increased deaths from CHD. Conclusion: the substantial decrease in CHD mortality in Ireland continues in both men and women. Important contributors include reductions in total cholesterol levels in the population, a slight reduction in smoking prevalence, and increased medical and surgical interventions. Despite these positive changes, the continued increase in levels of obesity and diabetes could result in the adverse trends recently observed in other countries such as the UK, US and Australia, with a reversal of the mortality decline, particularly among the youngest groups.