Background
Methods
Data sources and assessment
Information on the population demographic changes
Data on population risk factors’ trends
Data on CHD hospital admissions and (in-hospital) treatment
Data on treatment use for CHD in the community
Data on efficacy of therapeutic interventions
Assessment of trends in CHD deaths (1996–2006) and the relative contribution of treatment and risk factors
Sensitivity analysis
Results
Men | |||||||
---|---|---|---|---|---|---|---|
Age groups |
25-34
|
35-44
|
45-54
|
55-64
|
65-74
|
+75
|
+25
|
Population in 1996 | 1063649 | 652453 | 381580 | 269255 | 171321 | 62074 | 2600332 |
Population in 2006 | 1478983 | 1053893 | 636889 | 351702 | 213778 | 107432 | 3842677 |
Deaths in 1996 (number) | 379 | 542 | 522 | 743 | 1423 | 583 | 4191 |
Deaths in 2006 (number) | 955 | 1573 | 1263 | 1327 | 3000 | 1674 | 9793 |
Death rates per 100,000 in 1996
| 36 | 83 | 137 | 276 | 831 | 939 | 161 |
Death rates per 100,000 in 2006
| 65 | 149 | 198 | 377 | 1403 | 1558 | 255 |
% Change (crude) | 81% | 80% | 45% | 37% | 69% | 66% | 58% |
Women
| |||||||
Age groups |
25-34
|
35-44
|
45-54
|
55-64
|
65-74
|
+75
|
+25
|
Population in 1996 | 1019177 | 634984 | 381124 | 271637 | 168367 | 66709 | 2541998 |
Population in 2006 | 1432147 | 1016763 | 627629 | 363840 | 234341 | 127094 | 3801814 |
Deaths in 1996 (number) | 145 | 195 | 256 | 314 | 911 | 642 | 2463 |
Deaths in 2006 (number) | 315 | 517 | 680 | 604 | 2268 | 2061 | 6445 |
Death rates per 100,000 in 1996
| 14 | 31 | 67 | 116 | 541 | 963 | 97 |
Death rates per 100,000 in 2006
| 22 | 51 | 108 | 166 | 968 | 1622 | 170 |
% Change (crude) | 55% | 66% | 61% | 44% | 79% | 68% | 75% |
Major CHD risk factors
RISK FACTORS*
| Risk factor levels 1996 2006 | Relative Change (%) in risk factor 1996-2006 | Relative Risk (RR1) (or βeta Coefficient)2
| Increase in Deaths | ||||
---|---|---|---|---|---|---|---|---|
Best Estimate | Minimum estimate | Maximum estimate | Proportion of overall deaths | |||||
Cholesterol
mmol/l
|
1000
|
635
|
1460
|
15.7%
| ||||
Cholesterol (men)
|
5.01
|
5.23
|
4.5
| β 0.65 | ||||
Cholesterol (women)
|
5.07
|
5.46
|
7.6
| β 0.65 | ||||
Smoking (
% )
| 1,60 (1–9 cig/d); |
225
|
145
|
320
|
3.5%
| |||
1.80 (10–19 cig/d); | ||||||||
2.10 (>20 cig/d) | ||||||||
(% men smoking)
|
55.3
|
58.6
|
6.0
| |||||
(% women smoking)
|
10.0
|
15.0
|
49.4
| |||||
BMI
Kg/m
2
|
470
|
270
|
710
|
7.3%
| ||||
BMI (men)
|
26.75
|
28.26
|
5.6
| β 0.02 | ||||
BMI (women)
|
29.08
|
31.24
|
7.4
| β 0.02 | ||||
Diabetes (%) |
770
|
490
|
1105
|
12.0%
| ||||
Diabetes (men)
|
7.4
|
11.5
|
55.6
| 2 | ||||
Diabetes (women)
|
10.1
|
15.5
|
52.6
| 2 | ||||
Population systolic BP mm/Hg |
2680
|
1620
|
4110
|
42.1%
| ||||
Population BP (men)
|
125.6
|
131.8
|
4.9
| β 0.053 | ||||
Population BP (women)
|
118.7
|
129.9
|
9.5
| β 0.053 | ||||
Physical inactivity
|
-
|
-
|
-
| - |
-
| - | - |
-
|
Estimated total risk factor effects
|
5140
|
3155
|
7705
|
80.7%
|
Medical and surgical treatments
TREATMENTS | Patients eligible | Treatment uptake (%) | CHD deaths prevented or postponed | Proportion of overall deaths | ||
---|---|---|---|---|---|---|
Best Estimate |
Minimum estimate
|
Maximum estimate
| Prevented or postponed (%) | |||
Acute myocardial infarction
|
18002
|
285
|
120
|
540
|
4.5%
| |
Hospital resuscitation
|
0.05
|
13
|
8
|
23
|
0.2%
| |
Aspirin alone
|
0.96
|
151
|
62
|
266
|
2.4%
| |
Thrombolytic alone
|
0.59
|
128
|
53
|
266
|
2.0%
| |
Beta blockers
|
0.82
|
29
|
12
|
59
|
0.5%
| |
ACE inhibitors
|
0.74
|
56
|
23
|
115
|
0.9%
| |
Treatments in 1996 subtracted
|
−92
|
−37
|
−191
| |||
Secondary Prevention post infarction
|
78976
|
372
|
125
|
949
|
5.8%
| |
Aspirin
|
0.46
|
112
|
37
|
278
|
1.8%
| |
Beta blockers
|
0.47
|
125
|
41
|
310
|
2.0%
| |
ACE inhibitors
|
0.33
|
92
|
30
|
230
|
1.4%
| |
Statins
|
0.28
|
90
|
29
|
223
|
1.4%
| |
Warfarin
|
0.04
|
16
|
5
|
39
|
0.2%
| |
Rehabilitation
|
0.10
|
36
|
12
|
89
|
0.6%
| |
Treatments in 1996 subtracted
|
−97
|
−29
|
−219
| |||
Secondary Prevention post revascularisation (5 years)
|
106517
|
65
|
22
|
164
|
1.0%
| |
Angina
|
803
|
664
|
2124
|
12.6%
| ||
CABG surgery (1997–2006)
|
106517
|
0.10
|
97
|
-
|
-
|
1.5%
|
Aspirin
|
319974
|
0.44
|
511
|
168
|
1273
|
8.0%
|
Statins
|
319974
|
0.34
|
443
|
116
|
1322
|
6.9%
|
Treatments in 1996 subtracted
|
−248
|
−75
|
−671
| |||
Treatments for unstable angina
|
22877
|
150
|
92
|
403
|
2.3%
| |
Heart Failure with Hospital admission
|
6927
|
84
|
25
|
223
|
1.3%
| |
ACE inhibitors
|
0.57
|
41
|
11
|
122
|
0.6%
| |
Beta blockers
|
0.22
|
22
|
6
|
67
|
0.4%
| |
Spironolactone
|
0.49
|
64
|
21
|
160
|
1.0%
| |
Aspirin
|
0.80
|
55
|
18
|
135
|
0.9%
| |
Treatments in 1996 subtracted
|
−99
|
−30
|
−262
| |||
Heart failure in the community
|
52251
|
332
|
104
|
854
|
5.2%
| |
ACE inhibitors
|
112
|
29
|
327
|
1.8%
| ||
Beta blockers
|
108
|
35
|
269
|
1.7%
| ||
Spironolactone
|
226
|
74
|
563
|
3.6%
| ||
Aspirin
|
97
|
32
|
240
|
1.5%
| ||
Treatments in 1996 subtracted
|
−211
|
−66
|
−546
| |||
Hypertension Treatments
|
863425
|
45
|
8
|
311
|
0.7%
| |
Statins for Primary Prevention
|
307295
|
6
|
2
|
65
|
0.5%
| |
Total treatment effects*
|
2145
|
1165
|
5630
|
33.7%
|