Comparing primary prevention with secondary prevention to explain decreasing Coronary Heart Disease death rates in Ireland, 1985-2000
Comparing primary prevention with secondary prevention to explain decreasing Coronary Heart Disease death rates in Ireland, 1985-2000
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DOI：
10.1186/1471-2458-7-117
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发表时间：
2007-06-21
影响因子：
4.5
通讯作者：
Capewell, Simon
中科院分区：
文献类型：
--
作者：
Kabir, Zubair;Bennett, Kathleen;Capewell, Simon
背景：调查一级预防是否比二级预防（减少冠心病 (CHD) 患者的危险因素）更有利。方法：使用基于细胞的 IMPACT CHD 死亡率模型整合爱尔兰的数据，描述 CHD 患者数量、特定治疗的采用情况、主要心血管危险因素的趋势，以及这些特定危险因素变化对 CHD 患者和未识别 CHD 的健康人的死亡率益处。结果：1985 年至 2000 年间，大约减少了 2,530 例爱尔兰的死亡归因于三大风险因素的减少。 1985 年至 2000 年间，总体吸烟率下降了 14%，导致因戒烟而死亡的人数减少了约 685 人（最低估计为 330 人，最高估计为 1,285 人）：健康人群中约有 275 人，已知的先心病患者中约有 410 人。人口总胆固醇浓度下降了 4.6%，导致因饮食改变导致的死亡人数减少了约 1,300 人（最低估计为 1,115 人，最大估计为 1,660 人）（健康人群为 1,185 人，CHD 患者为 115 人），加上他汀类药物治疗导致的死亡人数减少了 305 人（无 CHD 人群为 45 人，CHD 患者为 260 人）。人群平均舒张压下降 7.2%，导致因血压长期下降导致的死亡人数减少约 170 人（最低估计为 105 人，最多估计为 300 人）（健康人群为 140 人，CHD 患者为 30 人），加上非 CHD 人群因抗高血压治疗而导致的死亡人数减少约 70 人。在所有因危险因素下降而导致的死亡中，约有 1,715 人（68%）发生在未认识到CHD的人群中，其中815例（32%）发生在CHD患者中。结论：与二级预防相比，一级预防使CHD死亡人数减少了两倍。因此，未来的国家冠心病政策应优先考虑全国范围内的干预措施，以促进健康饮食和减少吸烟。
Background: To investigate whether primary prevention might be more favourable than secondary prevention (risk factor reduction in patients with coronary heart disease(CHD)).Methods: The cell-based IMPACT CHD mortality model was used to integrate data for Ireland describing CHD patient numbers, uptake of specific treatments, trends in major cardiovascular risk factors, and the mortality benefits of these specific risk factor changes in CHD patients and in healthy people without recognised CHD.Results: Between 1985 and 2000, approximately 2,530 fewer deaths were attributable to reductions in the three major risk factors in Ireland. Overall smoking prevalence declined by 14% between 1985 and 2000, resulting in about 685 fewer deaths (minimum estimate 330, maximum estimate 1,285) attributable to smoking cessation: about 275 in healthy people and 410 in known CHD patients. Population total cholesterol concentrations fell by 4.6%, resultingin approximately 1,300 (minimum estimate 1,115, maximum estimate 1,660) fewer deaths attributable to dietary changes(1,185 in healthy people and 115 in CHD patients) plus 305 fewer deaths attributable to statin treatment (45 in people without CHD and 260 in CHD patients). Mean population diastolic blood pressure fell by 7.2%, resulting in approximately 170 (minimum estimate 105, maximum estimate 300) fewer deaths attributable to secular falls in blood pressure (140 in healthy people and 30 in CHD patients), plus approximately 70 fewer deaths attributable to antihypertensive treatments in people without CHD.Of all the deaths attributable to risk factor falls, some 1,715 (68%) occurred in people without recognized CHD and 815(32%) in CHD patients.Conclusion: Compared with secondary prevention, primary prevention achieved a two-fold larger reduction in CHD deaths. Future national CHD policies should therefore prioritize nationwide interventions to promote healthy diets and reduce smoking.