In July last year, the Taoiseach, Deputy Bertie Ahern, launched the cardiovascular health strategy group report, Building Healthier Hearts. This report showed that the premature death rate from coronary heart disease in Ireland is twice the EU average. The report is very comprehen sive and its recommendations are far reaching. In the implementation of these recommendations my Department has set a medium-term objective to bring our levels of premature deaths from cardiovascular disease into line with the EU average at a minimum and a long-term objective of reducing our rates to those of the best performers in the European Union. This strategy document, which contains 211 recommendations, is designed to achieve these goals in a systematic and sustained manner.
Additional funding of £12 million has been made available in 2000 to commence the implementation process, and this funding will be the foundation for the implementation of some of the more immediate recommendations across the health services. It is expected that progress will be achieved this year in health promotion, primary care, pre-hospital care, hospital care, and in the area of audit and evaluation.
With regard to the implementation of the HOPE – heart outcomes prevention evaluation – study, it has received mention in the strategy report. The research began in 1993 and it is a multicentre, 200 site, international trial to which Ireland contributed. It explored whether angiotensin converting enzyme, ACE, inhibition with ramipril at 10 mg/day or antioxidation therapy with vitamin E could prevent cardiovascular event or stroke in at-risk patients without known left ventricular dysfunction. Vitamin E therapy was studied because it has been associated with a reduced risk for cardiovascular events and stroke in preliminary clinical studies, and oxidation of lipids has been experimentally found to contribute to atherosclerosis. The results of the study were published in theNew England Journal of Medicine in January this year in two separate papers.
The first paper concluded that ramipril significantly reduces the rates of death, myocardial infarction and stroke in a broad range of high-risk patients who are not known to have a low ejection fraction or heart failure. The authors estimated that treating 1,000 such patients would prevent 150 cardiovascular events in about 70 patients. The second paper concluded that in patients at high risk for cardiovascular events, treatment with vitamin E for a mean of 4.5 years has no apparent effect on cardiovascular outcomes.
This study shows the importance of secondary and tertiary prevention of cardiovascular disease in patients who are at high risk for cardiovascular event such as heart attacks, stroke, heart failure and other events. The cardiovascular strategy sets out the importance of the identification of high risk patients in a general practice setting who can benefit from this kind of therapy. It also recommends the development and implementation of treatment guidelines which can help to ensure the potential benefits identified in the HOPE study can be realised by those at risk in this country.