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The European Journal of Public Health Advance Access originally published online on June 23, 2006
The European Journal of Public Health 2007 17(2):193-198; doi:10.1093/eurpub/ckl090
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© The Author 2006. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Health services research

Life-years-gained from population risk factor changes and modern cardiology treatments in Ireland

Zubair Kabir1, Kathleen Bennett1, Emer Shelley2, Belgin Unal3, Julia Critchley4, John Feely1 and Simon Capewell5

1 Department of Pharmacology & Therapeutics, Trinity College & St. James's Hospital Dublin, Ireland
2 Department of Health and Children, Dublin Ireland
3 Department of Public Health, Dokuz Eylul University School of Medicine Izmir, Turkey
4 School of Population and Health Sciences, University of Newcastle upon Tyne UK
5 Department of Public Health, University of Liverpool UK

Correspondence: Dr Zubair Kabir, Department of Pharmacology & Therapeutics, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland, tel: +353 1 6083404; fax: +353 1 4539033; email: kabirzin{at}yahoo.com

Received January 23, 2006 , accepted May 19, 2006

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 ~44 060 life-years-gained among people aged 25–84. Specific medical and surgical treatments given in 2000 for CHD patients together gained ~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 ~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.

Keywords: coronary heart disease, Ireland, life-years-gained, risk factors, treatments


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