My name is Harindra Wijeysundera. I'm an internal cardiologist
at the Schulich Heart Centre here at Sunnybrook Health Sciences Centre.
We studied of the entire population of Ontario between two time points, beginning in
1994 and 2005.
And through our partners at ICES, the Institute of Clinical Evaluative Sciences,
we were able to identify
all patients who suffered
from coronary heart disease, specifically those patients who had been admitted to hospital
for different reasons, such as heart attacks or heart failure,
and patients in the community who were living with stable coronary disease or stable heart
failure, hypertension, or high cholesterol.
We were able to follow those patients over that decade.
So we had two objectives. The
first was to confirm that in Ontario
over the last decade from 1994 to about 2005
whether there was a reduction in deaths from
coronary heart disease.
Our second objective, which was the main part of our study was
if such a trend did exist we wanted to try to understand what was the underlying factor
that was driving it.
Was it changes in
in traditional risk factors, such as high blood pressure and high cholesterol?
Or, was it
improvements in treatments--new medications and news surgeries--and what proportion
each of those contributed
to this decline in cardiovascular deaths.
The biggest news is that things in general are going well.
Despite the fact that the population is getting older
deaths from coronary heart disease are going down.
And they've reduced by about a third, so that's the good news.
The second good news is that we have become
better at using the therapies that are available. The uptake of medications and therapies
that were in existence in 1994 have certainly all improved to 2005,
that there are new medical therapies, those are all important.
The final piece of good news is that blood pressure and cholesterol
are moving in the right direction,
as is smoking.
The caution, however, is that diabetes is increasing, and obesity is increasing, and
those are worrisome trends and things that we need to be looking out for,
and that there's still room for improvement, although the uptake of medications has got better,
it is not perfect yet.
The primary aims in our study was that by looking
in the past to see what has happened over
the last 10 to 15 years, it can give us a sense of what future trends
may be and where we should place our priorities.
So,
in order to
continue this encouraging
reduction cardiovascular deaths, we need to ensure that the trends and risk factors
for instance, the decrease in cholesterol and blood pressure continue, but
very importantly, that those worrisome increases in diabetes and obesity are halted.
Because otherwise, the gains that we've had over the last decade may be lost.
Trends in risk factors from behaviours or policies
continues to really play a very important role in the reduction of
cardiovascular mortality, you know,
just under 50%, which is really
quite an impressive amount, and so it really
highlights to patients--patients should take home--that doing exercise,
watching what they eat,
those important behavioural changes are just as important
as using the evidence-based medications that they're prescribed.