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HRB Centre for Health and Diet Research
Overview of Irish risk factors
Ivan J Perry, Dept. of Epidemiology and Public
Health, University College Cork. Ireland Day Conference
EuroPrevent 2012
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HRB Centre for Health and Diet Research
Acknowledgements• SLAN 2007 Research Consortium: Hannah McGee,
Karen Morgan, Emer Shelley, Ruairi Brugha, Ronan Conroy, Nuala Tully, Mark Ward, Dorothy Watson, Richard Layte Ms Janas Harrington, Ms Jennifer Lutomski, Margaret Barry, Michal Molcho, Eric Van Lente
• IMPACT model collaboration: Kathleen Bennett, Simon Capewell, Julia Critchley, Martin O’ Flaherty, Janas Harrington & Zubair Kabir
• HRB Centre Cluster 3: Patricia Kearney,Janas Harrington Vera McCarthy, Tony Fitzgerald, Fiona Geaney, Mark Loughrey, Fiona O’Shea, Christina Dillon, Frances Shiely , Jan van den Broeck
• Funding: DoH, HRB and EUROHEART 2 PROJECT
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HRB Centre for Health and Diet Research
Overview• Brief reflection on risk factors
- Sick individuals & sick populations- Not all risk factors created equal
• Headline findings from SLAN 2007 most recent National Health & Lifestyle Survey- Protective factors and risk factors
• Trends in major risk factors 1985 to 2006 – IMPACT CHD Model 1985 to 2006
• Trends in major risk factors in men and women 50-69 years in primary care between 1998 to 2010
-Cork & Kerry Study & Mitchelstown Cohort Study
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HRB Centre for Health and Diet Research4
Sick individuals and sick populations
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HRB Centre for Health and Diet Research
CHD and Stroke mortality in Ireland
Trend in CHD mortality rates 1996-2009, selected countries
0
50
100
150
200
250
SDR
, all a
ges p
er 10
0,000
po
pulat
ion
016 France
022 Ireland
015 Finland
052 United Kingdom
Trend in Stroke mortality 1996 - 2009, selected countries
01020
30405060
708090
SDR
per 1
00,00
0 (all
ages
)
016 France
022 Ireland
015 Finland
052 United Kingdom
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HRB Centre for Health and Diet Research
Sick individuals and sick populations:Total cholesterol in three populations
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HRB Centre for Health and Diet Research
INTERHEART study
Standardised case-control study of acute myocardial infarction in 52 countries, with 15,152 cases and 14,820 controls. Lancet 2004
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HRB Centre for Health and Diet Research
Risk factors for CVD are not created equal
• Primary causal factors, e.g. smoking, dietary saturated fat & trans fat intake, calorie excess, physical inactivity, gene markers
• Markers of underlying causal factors, e.g. raised LDL cholesterol, low HDL cholesterol, raised ApoB/ ApoA1 ratio obesity, insulin resistance, C reactive protein etc..
• Early manifestations of the disease process e.g., hypertension, carotid intima-media thickness (CIMT)
t
HRB Centre for Health and Diet Research
Overview• Brief reflection on risk factors
- Sick individuals & sick populations- Not all risk factors created equal
• Headline findings from SLAN 2007 most recent National Health & Lifestyle Survey- Protective factors and risk factors
• Trends in major risk factors 1985 to 2006 – IMPACT CHD Model 1985 to 2006
• Trends in major risk factors in men and women 50-69 years in primary care between 1998 to 2010
-Cork & Kerry Study & Mitchelstown Cohort Study
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HRB Centre for Health and Diet Research
SLÁN 2007 - National Health &lifestyle Study
10,364 adults from 400 clusters nationally
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HRB Centre for Health and Diet Research
Protective Health Behaviours
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HRB Centre for Health and Diet Research
Prevalence of core protective health behaviours in Irish adults:
SLAN 2007
2 2
16
11
3027
3437
18
24
05
10
152025
303540
%
0 1 2 3 4
Number of PLBs
Male
Female
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HRB Centre for Health and Diet Research
Protective lifestyle behaviours in SLAN-07 by Social Class
0 1 2 3 40
5
10
15
20
25
30
35
40
45
3
16
31
34
16
3
19
36
32
11
3
19
34
31
12
SC 1-2SC 3-4SC 5-6
0 1 2 3 40
5
10
15
20
25
30
35
40
45
1
9
28
40
22
2
13
30
37
18
5
16
35
30
14
Males
WomenMen
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HRB Centre for Health and Diet Research
Data source Nutrient Mean (sd) Gender
Male Female
SLAN 2007 Total fat (g/d) 98 86
SFA (g/d) 36 30
SFA (% energy of energy intake)
14 12
Fruit (mean servings (SD))
2.6 (2.4) 3.1 (2.8)
Vegetables (mean servings (SD))
3.9 (2.6) 4.6 (3.2)
Salt (mean (SD) 10.3 (5.0) 7.4 (4.2)
NANS 2008-10 SFA (g/d) 38.7 (13.1) 28.9 (9.5)
SFA (% energy of energy intake)
13.1 (3.2) 13.5 (3.3)
Fruit and vegetables (mean g/d (SD))
181 (140) 197 (152)
Fats, Salt, Fruit and Vegetable intake Current estimates for Republic of Ireland
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HRB Centre for Health and Diet Research
Obesity, Hypertension, Hypercholesterolemia & Smoking in adults
aged 45 years and older SLAN 2007
8 2
6 0
3 2
2 0
9 4
5 9
18
0 1 0 2 0 3 0 4 0 5 0 6 0 7 0 8 0 9 0 1 0 0
1
2
3
4
5
6
7
( % )
Obese
Above normal BP
Above normal cholesterol
Current smoker
All 3 biological risk factors
Any 2 of 3 risk factors
Any 1 of 3 risk factors
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HRB Centre for Health and Diet Research
Overview• Brief reflection on risk factors
- Sick individuals & sick populations- Not all risk factors created equal
• Headline findings from SLAN 2007 most recent National Health & Lifestyle Survey- Protective factors and risk factors
• Trends in major risk factors 1985 to 2006 – IMPACT CHD Model 1985 to 2006
• Trends in major risk factors in men and women 50-69 years in primary care between 1998 to 2010
-Cork & Kerry Study & Mitchelstown Cohort Study
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HRB Centre for Health and Diet Research
0
200
400
600
800Per 100,000Per 100,000
Ireland
UK
USA
Netherlands
Finland
ItalyFrance
International mortality trends in CHD in men aged 35 to 74 years from 1968 to
2002
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HRB Centre for Health and Diet Research
IMPACT Model: Estimation of deaths prevented or postponed (DPPs)
For treatment:Patients Treatment Absolute risk eligible uptake reduction
a x b x c = DPPs
For risk factors:
CHD deaths x Risk Factor x Beta
in 1985 Reduction Coefficient
a x b x c = DPPs
SOURCES Routine Local & national Meta-
analyses & statistics audits & surveys RCTs
X cohorts
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HRB Centre for Health and Diet Research
Data sources on cardiovascular risk factors in Ireland: 1985-2006
1985 2006
Population SBP (mmHg) Kilkenny Health Project SLAN 2007 Study
Smoking Prevalence (%) Kilkenny Health Project SLAN 2007
Total Cholesterol Belfast MONICA mid-data SLAN 2007
(=25-34 year-olds)
Kilkenny Health Project
(>/= 35 year-olds)
Diabetes Kilkenny Health Project SLAN 2007
Obesity (BMI levels) Kilkenny Health Project SLAN 2007
Physical Inactivity Kilkenny Health Project SLAN 2007
Cork & Kerry 1998 Cork & Kerry 2008
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HRB Centre for Health and Diet Research
Population weighted average risk factor changes between 1985 & 2006
Risk factors 1985 2006 % Change
Smoking Prevalence (%)
32.3 28.2 -12.7
Mean Total Cholesterol (mmol/L) 5.88 5.39 -8.3
Mean SBP (mm Hg) 144 136 -4.9
Physical Inactivity (%) 63.5 62.3 -1.9
Mean BMI (Kg/m2) 25.4 28.5 +12.2
Diabetes Prevalence (%)
1.8 3.2 +78
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HRB Centre for Health and Diet Research
CHD mortality fall in Ireland between 1985 and 2006 estimated impact of risk factor trends and
treatments
-7000
-6000
-5000
-4000
-3000
-2000
-1000
0
1000
Baseline End
6439 fewer deaths
Risk Factors worse +17%
Risk Factors better - 84%
Treatments - 23%
20061985
Obesity (increase) + 4.5%Diabetes (increase) + 12.5%
Smoking - 3%Cholesterol - 30%Population BP fall - 42%PI (less) - 9%
AMI treatments - 3%Secondary prevention - 8%Heart failure - 5%Angina – 3%Hypertension drugs – 2%Statins 1’ prevention - 2%
t
HRB Centre for Health and Diet Research
Overview• Brief reflection on risk factors
- Sick individuals & sick populations- Not all risk factors created equal
• Headline findings from SLAN 2007 most recent National Health & Lifestyle Survey- Protective factors and risk factors
• Trends in major risk factors 1985 to 2006 – IMPACT CHD Model 1985 to 2006
• Trends in major risk factors in men and women 50-69 years in primary care between 1998 to 2010
-Cork & Kerry Study & Mitchelstown Cohort Study
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HRB Centre for Health and Diet Research
Males Females
1998 (N=491) 2010 (N=953)
1998 (N=524) 2010 (N=984)
Obese % (N)
Systolic BP Mean (std)
25.6 (120)
137.9 (19.3)
36.5 (346)
130.6 (15.5)
26.8 (134)
132.2 (21.5)
29.2 (287)
128.0 (17.7)
Diastolic BPMean (std)
82.0 (10.6) 79.9 (9.6) 78.9 (11.8) 80.4 (9.9)
Clinic Hypertension %(N)
44.4 (211) 48.4 (450) 34.9 (175) 44.2 (430)
Cholesterol mean (std)
5.6 (0.9) 5.1 (1.0) 6.0 (1.0) 5.4 (1.0)
HbA1c>6.5%% (N)
4.2 (20) 11.2 (105) 2.6 (13) 5.8 (56)
Current Smokers %(N)
20.8 (98) 23.4 (140) 17.6 (87) 29.4 (145)
Excessive Alcohol consumption % (N)
15.2 (64) 13.7 (90) 1.1 (5) 3.7 (19)
5 Daily servings of Fruit & Veg % (N) 39.8 (171) 50.9 (230) 62.9 (298) 73.7 (716)
High Physical Activity % (N)
16.6 (70) 28.9 (252) 15.0 (73) 14.8 (140)
CVD Risk Factors in men and women aged 50-69 years recruited from primary care registers in
Cork & Kerry in 1998 and 2010
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HRB Centre for Health and Diet Research
Summary• Significant positive trends in CVD risk factors
and mortality over 20 year period to the middle of the last decade
• Recent trends give cause for alarm especially in relation to obesity and diabetes
• Need for ongoing, regular and standardised risk factor surveillance
• Importance of evidence based public policy response addressing core environmental and behavioural factors in children and adults
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HRB Centre for Health and Diet Research
CVD prevention moving intopublic policy arena
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HRB Centre for Health and Diet Research
Mass prevention of CVD: a realistic challenge for our time!
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HRB Centre for Health and Diet Research27
Thank you
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HRB Centre for Health and Diet Research
Joinpoint regression analyses of trends by age
Trend in Irish IHD mortality per 100,000 (M) using joinpoint regression analysis
0
500
1000
1500
2000
2500
3000
3500
1990 1995 2000 2005 2010
Age
sp
eci
fic
mo
rtal
ity
pe
r 1
00
,00
0
55-64
65-74
75-84
Significant joinpoints at 1998 and 2005
Source: PHIS 2011, Dr Siobhan Jennings Irish Cardiac Society and Dr Kathleen Bennett, TCD