Tt HRB Centre for Health and Diet Research Overview of Irish risk factors Ivan J Perry, Dept. of Epidemiology and Public Health, University College Cork

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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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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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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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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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Sick individuals and sick populations:Total cholesterol in three populations

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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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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)

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SLÁN 2007 - National Health &lifestyle Study

10,364 adults from 400 clusters nationally

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Protective Health Behaviours

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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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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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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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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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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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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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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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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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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%

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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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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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CVD prevention moving intopublic policy arena

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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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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

Documents

Tt HRB Centre for Health and Diet Research Overview of Irish risk factors Ivan J Perry, Dept. of Epidemiology and Public Health, University College Cork