CHD China and Ireland by Pranshul Chauhan

8/6/2019 CHD China and Ireland by Pranshul Chauhan

1/5

Coronary Heart Disease in Ireland and Beijing - Reducing

CHD mortality

Introduction

In Ireland, approximately 25% of the the country's total public expenditure is devoted to

the public health sector. To achieve the best quality of care towards the patients Irish

healthcare workers need to target resources towards the most effective interventions in

the population with the greatest need.

CHD is projected to be the leading global cause of death an diability by 2020. This review

article discusses Coronary Heart Disease (CHD) and compares and contrasts trends in

CHD in Ireland and China to realise what factors attribute to improved case fatality.

CHD mortality rates are in decline in Ireland but remains increasing in developing

countries such as China. This article will review work work of Bennett, Kabir, Unal et al.

who used the IMPACT CHD model to examine the CHD mortality fall in Ireland between

1985 and 2000. We will also review a publication by Critchley et al. that uses data from

WHO MONICA and Sino-MONICA studies, the Chinese Multi-provincial Cohort Study,

routine hospital statistics, and published meta-analyses to explain the increase in CHD

mortality in Beijing between 1984 and 1999.

In Ireland, between 1985 and 2000 CHD mortality rates fell by 47% (3763 fewer deaths)

in those aged 25-84. On the other hand in Beijing the CHD mortality rates increased by~50% in men and 27% in women between 1984 and 1999. By studying these to articles

we can help determine which specific medical and surgical treaments and which

population trends in major cardiovascular risk factors would attribute to imoved case

fatality of CHD. This will allow Irish healthcare workers to better target their resources.

1.The importance of favourable population trends in primary prevention in relation to

CHD mortality:

In Ireland: Favourable population trends in cardiovascular risk factors attribute to 61%(2327 people) of deaths prevented or posted. Bennett, Kabir, Unal et al discuss

population trends in smoking, cholestrol and blood pressure. In Ireland these have been

favourable trends.


2/5

a. Total mean cholestrol levels decreased from 6.2mmol/L in 1985 to 5.73mmol/L in 2000 -this was a decrease of 4.6% relative change in cholestrol level as a risk factor. This

decrease accounted for 30.2% (1135 people) of the deaths prevented or postponed.

b. Smoking prevlance decrased form 33.6% in 1985 to 28.8% in 2000 - a decrease14.2%. This decrease accounted for 25.6% (or 964 people) deaths prevented or

postponed.

c. Mean diastolic blood pressure levels decreased from 81 mm Hg in 1985 to 75mm Hg in2000. This was a relative decrease in population BP by 7.2%; accounting for a decrease

of a much less 6.1% (228 people) of deaths prevented or postponed.

These figures indicate the importance of favourable population trends in primary

prevention in relation to CHD mortality. The favourable population trend in cholestrol

being most important in primary prevention followed by smoking prevelance, with

population BP decrease being least effective in comparision. Mortality increases occured

relatively quickly after cholestrol increases.

In Beijing: Favourable populations trends have not been seen. According to Critchley et

al. Cholestrol levels have increased along smoking prevlance decreased and mean

diastoloic pressure increased.

a. Cholestrol levels increased in Beijing by 24%. This was associated with 76.7% increase indeaths between 1984 and 1999.

b. Smoking prevalance increased in men by 17% but decreased in women by 44%.There was an overall decrease of smoking prevalence by 17% and accociated

with a small increase of 0.9% in deaths.

c. Population BP decreased by a small 0.44%. Not substancial enough to have animpact on decreasing deaths. Population BP decrease and Hypertention

treatment was still associated with 0.3% increase in death.

These figures in Beijing reflect the importance of reducing cholestrol levels on reducing

risk factor associated CHD mortality.

This comparison between Ireland and Beijing reflects the importance of favourable

population trends in cholestrol level in primary prevention in relation to CHD mortality.

2.The importance of adverse population trends in primary prevention in relation to

CHD mortality:

In Ireland: Adverse population trends in risk factors attribute to 13.8% (517 people) of

deaths caused.Bennett, Kabir, Unal et al discuss population trends in physical incativity,

obesity and diabetes.


3/5

d. Physical inactivity prevlance increased by 4.8%. Since Irish data was not availablethe UK prevalence data was used. This caused an increase in 4.1% (152 people)

of deaths caused due to CHD related to risk factors.

e. Obesity prevalence increased from 8% in 1985 to 24% in 2000 - an increase of195.1%. This accounted for 3.5% (131 people) of deaths caused by CHD relatedto risk factors.

f. Diabetes prevalence increased from 1.7% in 1985 to 2.5% in 2000 - an increaseof 48% in relative change in risk factor. This accounted for an increase in 6.2%

(232 people) of deaths caused by CHD related to risk factors.

Thes figures reflect the importance of adverse population trends in having a negetive effect on

CHD mortality. This gives an insight on the importance of reducing adverse population trends -

physical inactivity poses the most important as it's associated greatly with CHD mortality. This is

followed by diabetes. Obesity seems to be less of a problem.

In Beijing: Adverse population trends do exist in Beijing, along with significant increasein cholestrol there was also an increase in BMI (obesity) and diabetes prevalance. These

contribute to CHD mortality.

g. BMI increased by 4% between 1984 and 1999. This accounted for a 3.7%increase in deaths.

h. Diabetes prevalence increased by 201% and associated with a 19% increase indeath rates.

Diabetes is the biggest risk factor after cholestrol levels in Beijing. This shows the impact of

diabetes on CHD mortality.

This comparison between Ireland and Beijing reflects the importance of adverse

population trends, reflected by physica inactivity increase and diabetes prevalance in

primary prevention in relation to CHD mortality. These to need to be targets in order to

reduce mortality.

3.The importance of treatment and its effect on CHD mortality:

In Ireland treatment in all has help prevent around 1639 deaths from CHD giving a

43.6% risk reduction best estimate.

i. Treatment for acute MI in 2000 has prevented 166 death,j. Secondary treatment prevented 678 deathsk. Unstable angina prevented 33 deaths,l. Chronic angina prevented 317 deaths,m. Heart failure 340 deaths,


4/5

n. Hypertension prevented 59 deathso. Statins for primary prevention prevented 46 deaths.p. The biggest contribution came from CPR aspirin and thrombolysis.q. CABG although useful only accounted for 5% of total mortality decrease.

Disappointing considering large amount of money that is invested into it.

The most important contributions came from secondary prevention and heart failure

treatment. However the reduction in deaths from heart failure would gain only a few

extra life years due to the shorter life expectancy of these patients. Thromolysis only

account for about 1.6% of deaths prevented or postponed. Aspirin therapy for patients

with angina in the community prevented more than twice as did treatment for unstable

angina it the hospital.

Treatment uptake level were variable and sometimes poor.

In Beijing the study data shows that treatment has prevented 642 deaths compared to

only 72 in 1984. This tells us that investment in this area is successful in Beijing.

r. Treatments for acute MI had the biggest impact contributing to 41% of all thedeaths prevented

s. Hypertension (24%)t. Treatment of angina (15%)u. Heart failure (10%)v. Secondary prevention (11%)

Despite intelligent investment there have been many people on the community eligible

for aspirin and other secondary prevention treatments that have not been prescribed

them. 11% and 10% respectively. Revascularization interventions only played a minor

role accounting for only 2% of the total mortality fall due to CHD.

This comparison between Ireland and Beijing reflects the importance of treatment and

its CHD mortality. Maninly what is observed is that invesment in treatment in Beijing is

relatively more successful. In Ireland there should be greater concentration of resources

in secondary treatment chronic angina and heart failure compared to revascularisation.

Conclusion

Based on your discussions above what are your recommendations to further reduce

mortality from CHD in Ireland or China. The conclusion of the article should highlight

your main points


5/5

It is evident from the discussion that there is a necessity to promote the importance of

primary prevention such as cholestrol level and smoking prevalance.

In Ireland levels of cholestrol are still much higher compared to Beijing and healthcare

workers her should promote better and more cardioprotective diets. Chinese studies

have shown that a 1mmol/L increase in cholestrol level leads to a 37% increase in CHD

mortality.

In Beijing there needs to be a reversion to traditional diet in urban areas that shows to

be more cardioprotective.

Smoking cesation and reduced smoking prevalance has shown it's benefits in Ireland

and a smoking ban should be introduced in Beijing similar to the Irish one introduced in

2004.

Resources invested in the promotion of cholestrol lowering and smoking cesation arekey in reducing mortality due to CHD. Diabetes also needs to be tackled in both

countries as it shows a problem. With the increase of diabetes prevalence the CHD

mortality is increased. Awareness towards diabetes testing needs to be increased and

control of diabetes needs to be better regulated in patients. Obesity needs to be

controlled for a general healthy popuation aswell as to reduce CHD mortality.

Irish healthcare workers need to concenrate resoouces wisely as regards treatment for

CHD. Revascularisation tends to be most expensive and relatively not as effective. On

the other hand secondary treatment of heart failure and chronic angina shows better

results and should be promoted by the Irish healthcare team. Compliance is an issue

that should be tackled by GPs consulting with all patients. Secondary prevention should

be better promoted to GPs and health care workers in Beijing.

In conclusion, resources are limited here in Ireland and should be targeted towards

promoting more effective methods of reducing CHD mortality weather it be in the area

of primary prevention or treatment - resources should be better focused.

Documents

CHD China and Ireland by Pranshul Chauhan