Exploring potential mortality reductions in 9 European countries by improving diet and lifestyle: A modelling approach.

BACKGROUND: Coronary heart disease (CHD) death rates have fallen across most of Europe in recent decades. However, substantial risk factor reductions have not been achieved across all Europe. Our aim was to quantify the potential impact of future policy scenarios on diet and lifestyle on CHD mortality in 9 European countries. METHODS: We updated the previously validated IMPACT CHD models in 9 European countries and extended them to 2010-11 (the baseline year) to predict reductions in CHD mortality to 2020(ages 25-74years). We compared three scenarios: conservative, intermediate and optimistic on smoking prevalence (absolute decreases of 5%, 10% and 15%); saturated fat intake (1%, 2% and 3% absolute decreases in % energy intake, replaced by unsaturated fats); salt (relative decreases of 10%, 20% and 30%), and physical inactivity (absolute decreases of 5%, 10% and 15%). Probabilistic sensitivity analyses were conducted. RESULTS: Under the conservative, intermediate and optimistic scenarios, we estimated 10.8% (95% CI: 7.3-14.0), 20.7% (95% CI: 15.6-25.2) and 29.1% (95% CI: 22.6-35.0) fewer CHD deaths in 2020. For the optimistic scenario, 15% absolute reductions in smoking could decrease CHD deaths by 8.9%-11.6%, Salt intake relative reductions of 30% by approximately 5.9-8.9%; 3% reductions in saturated fat intake by 6.3-7.5%, and 15% absolute increases in physical activity by 3.7-5.3%. CONCLUSIONS: Modest and feasible policy-based reductions in cardiovascular risk factors (already been achieved in some other countries) could translate into substantial reductions in future CHD deaths across Europe. However, this would require the European Union to more effectively implement powerful evidence-based prevention policies

Current and future uses of breath analysis as a diagnostic tool

The analysis of exhaled breath is a potentially useful method for application in veterinary diagnostics. Breath samples can be easily collected from animals by means of a face mask on chamber with minimal disturbance to the animal. After the administration of a C-labelled compound the recovery of C-13 in breath can be used to investigate gastrointestinal and digestive functions. Exhaled hydrogen can be used to assess orocaecal transit time and malabsorption, and exhaled nitric oxide, carbon monoxide and pentane can be used to assess oxidative exhaled breath condensate) can be used to assess airway inflammation. This review summarises the current status of breath analysis in veterinary medicine, and analyses its potential for assessing animal health and disease

OP53 explaining Scottish coronary heart disease mortality trends between 2000 and 2010: socioeconomic analyses using the impact sec model

Background: Coronary heart disease (CHD) mortality rates have halved in recent decades. However, CHD remains the largest cause of death in Scotland generating persistent socioeconomic inequalities. A socioeconomic quantification of the prevention and treatment contributions to these mortality reductions might help inform future health policies.<p></p> Methods: IMPACTsec, a previously validated policy model, was used to apportion the Scottish CHD mortality decline between 2000 and 2010 to changes in six major CHD risk factors and to 40 treatments in nine patient groups. Analyses were stratified by gender, age and Scottish Index of Multiple Deprivation quintiles. Uncertainties around estimates were explored using probabilistic sensitivity analysis.<p></p> Results: There were 5770 fewer CHD deaths in 2010 than would have been expected if 2000 mortality rates had persisted unchanged. This reflected an overall 43% fall in CHD mortality rates (from 262 to 148 deaths per 100,000), but with a slower 37% decline amongst the two most deprived quintiles. The IMPACTsec model explained approximately 83% of the CHD mortality fall. Treatments accounted for approximately 44% of the fall. This benefit was fairly evenly distributed across deprivation quintiles. Three treatments contributed over half of these benefits: statins for primary prevention (13%) and medical therapies for stable angina (9%) and secondary prevention following revascularisation or myocardial infarction (11%). Risk factors accounted for approximately 39% of the mortality fall overall, with the largest contribution in the most deprived quintile (44%) and the least in the most affluent quintile (36%). The decline in systolic blood pressure made the biggest contribution (37%), exceeding that of smoking (4%), total cholesterol (9%) and inactivity (2%); the latter three demonstrating socioeconomic gradients. However, increases in diabetes and obesity negated some of these benefits potentially exacerbating mortality by -8% and -4% respectively. The diabetes contribution to the exacerbation of mortality showed strong socioeconomic patterning (-12% for the most deprived quintile compared to -5% for the most affluent).<p></p> Conclusion: This IMPACTsec analysis suggests that NHS medical treatments have made a large and equitable contribution to the recent decline in Scottish CHD mortality. The substantial contribution that improvements in risk factor profiles made on CHD mortality rates was diminished by adverse trends in obesity and diabetes; the latter having an adverse socioeconomic gradient. Population-wide interventions can be powerful, rapid and equitable. However, more radical policies will be required if the CHD mortality decline is to continue in future decades while reducing inequalities.<p></p&gt

Effects of changes to the stable environment on the exhalation of ethane, carbon monoxide and hydrogen peroxide by horses with respiratory inflammation

The aim of this study was to assess the effects of changes to the stable environment on exhaled markers of respiratory inflammation in six horses with clinical histories of recurrent airway obstruction. The horses were maintained for two weeks under conventional stable management (straw bedding and hay) and for two weeks on a reduced-dust regimen (paper bedding and ensiled grass), in a crossover study design. Exhaled ethane and carbon monoxide (CO) and exhaled breath condensate hydrogen peroxide (H<sub>2</sub>O<sub>2</sub>) were measured every three days under each regimen. The presence of clinical signs of airway inflammation (nasal discharge and cough) was monitored daily. The reduced-dust regimen was associated with fewer clinical signs of airway inflammation than the conventional regimen. Exhaled ethane and CO were significantly lower on the reduced-dust regimen and these markers were correlated with clinical signs of respiratory inflammation, but exhaled H<sub>2</sub>O<sub>2</sub> was not affected by the management regimen