The leading cause of death in Irish men and women is coronary heart disease. Among our EU partners we have the highest rate of death, by far, before the age of 65. Each year in Ireland more than 14,000 people die from heart attack, stroke and other diseases of the circulation.
The statistics are grim. While there was some improvement in the 1980s, according to the Irish Heart Foundation, it does not compare well with the strides taken by other countries such as the US and Canada.
It was no surprise that the Minister for Health saw the need to establish a group to develop a strategy to reduce deaths and illness caused by cardio-vascular disease. The previous minister, Mr Michael Noonan, introduced a national cancer strategy while in office, and the present Minister, Mr Cowen, wishes to leave his mark on the fight against heart disease.
A result of this has been the creation of the Cardiovascular Health Strategy Review Group. Its chairman, Mr Michael Jacob, said the group was due to report at the end of August, and had been asked to identify steps to develop cardiac care and rehabilitation services at all levels. It will look at access to treatment and quality and efficiency of care.
The extensive waiting lists for cardiac surgery, with some people waiting for over six years, was a spur for Mr Cowen to establish the group. At the time he announced it the Minister said he realised there would be costs involved.
Given the extent of the disease these are bound to be considerable. At present, only 10 per cent of Irish patients who suffer heart attacks undergo surgery or angioplasty are offered rehabilitation at four hospitals around the country. One submission to the group suggested rehabilitation units should be set up in at least 40 other sites.
All involved agree that one of the main tasks is an effective public health campaign to advise people on the changes in lifestyle they can make to prevent heart disease. Health promotion is a very young discipline in Ireland and traditionally the Department of Health has been poor at implementing good policies in this area.
According to Prof John Horgan, consultant cardiologist at Beaumont Hospital, countries which have had success are those where "risk factor intervention" is vigorously espoused and people adopt healthier life styles. "They changed diet, exercised regularly, did not smoke."
Dr Emer Shelley, an Eastern Health Board specialist in public health medicine, said a multi-disciplined approach was needed "properly resourced and systematically applied so that people do not fall through the net. The challenge for the group is to come up with a solution appropriate for the Irish situation," she said.
Dr Shelley, who provides research support to the group, said the bad news was that cardio-vascular disease was such a common cause of illness among Irish people. But the good news was that the number of deaths is going down for men and women. "However, there is much work to be done to raise awareness. The timing is very good because the tide has turned in terms of health awareness."
BUT Dr Horgan emphasised the strategy devised by the group could only go so far. "People will have to take the message on board and assist the Government. It will not be sufficient for people to say they were not told."
The underlying cause of heart disease is a gradual build-up of fatty substances in the blood vessels which reduces blood flow and causes long-term changes in blood pressure. Known as hardening of the arteries, it develops slowly over the years and is difficult to reverse once symptoms occur. Medical and scientific research shows that coronary heart disease is closely related to lifestyle characteristics and associated risk factors.
The Irish Heart Foundation, the only national organisation working to reduce the highest incidence of heart-disease deaths through education and research, stresses the importance of preventing heart disease but says treatment of diseases of the circulation will be necessary well into the future.