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    Comparing primary prevention with secondary prevention to explain decreasing coronary heart disease death rates in Ireland, 1985-2000.

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    Authors
    Kabir, Zubair
    Bennett, Kathleen
    Shelley, Emer
    Unal, Belgin
    Critchley, Julia A
    Capewell, Simon
    Affiliation
    Harvard School of Public Health, Division of Public Health Practice, Boston, USA. zkabir@hsph.harvard.edu <zkabir@hsph.harvard.edu>
    Issue Date
    2007
    MeSH
    Aged
    Aged, 80 and over
    Coronary Disease
    Female
    Health Behavior
    Humans
    Hydroxymethylglutaryl-CoA Reductase Inhibitors
    Hypercholesterolemia
    Hypertension
    Intervention Studies
    Ireland
    Male
    Middle Aged
    Mortality
    Risk Factors
    Smoking
    Smoking Cessation
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    Citation
    Comparing primary prevention with secondary prevention to explain decreasing coronary heart disease death rates in Ireland, 1985-2000. 2007, 7:117 BMC Public Health
    Journal
    BMC public health
    URI
    http://hdl.handle.net/10147/95630
    DOI
    10.1186/1471-2458-7-117
    PubMed ID
    17584932
    Abstract
    BACKGROUND: To investigate whether primary prevention might be more favourable than secondary prevention (risk factor reduction in patients with coronary heart disease(CHD)). METHODS: The 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. RESULTS: Between 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%, resulting in 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. CONCLUSION: Compared 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.
    Language
    en
    ISSN
    1471-2458
    ae974a485f413a2113503eed53cd6c53
    10.1186/1471-2458-7-117
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