...Professor Pascal McKeown: I thank the Cathaoirleach, Deputies and Senator. We are grateful to the committee for providing us with this opportunity to discuss issues related to cardiovascular disease in Ireland and, where relevant, the European Union and European Society of Cardiology. I am the immediate past president of the Irish Cardiac Society in that we held our annual general meeting last weekend in Belfast and I handed over the president's role to Professor Brendan McAdam, who is currently the president....

What is the burden of cardiovascular disease? It remains the most common cause of death across Europe, accounting for about 1.7 million deaths annually across the EU and is the second most common contribution to mortality in Ireland. Each year, nearly 9,000 people in Ireland lose their lives to cardiovascular disease. The common forms of cardiovascular disease include coronary heart disease, valvular disease, heart failure, cardiac arrhythmias, congenital heart disease, hypertension, stroke and inherited cardiac conditions. In 2021 in Ireland the estimated costs attributed to cardiovascular diseases, including health and social care, as well as losses due to morbidity and mortality, were estimated to about €3.4 billion. There are many modifiable risk factors, including hypertension, elevated cholesterol levels, diabetes mellitus, smoking, alcohol, being overweight or obese and environmental pollution. The European Society of Cardiology recently published the 2023 Atlas of Cardiovascular Disease Statistics. It is helpful to highlight some important data.

Despite Ireland having one of the highest GDP per capita, it has the lowest number of cardiologists per million population across the EU. Age-standardised mortality rates for cardiovascular diseases in Ireland remain higher than in many other countries in western Europe. There is also a significant gender equality issue in Europe; there are more cardiovascular disease deaths in women than for all cancers combined; mortality following a heart attack is higher in women; and women are significantly under-represented in research studies. In 2004, the Tánaiste, Deputy Micheál Martin, then the Minister of Health, introduced ground-breaking legislation to ban smoking in the workplace. Many countries followed Ireland’s lead. Nevertheless, Ireland still has relatively high rates of tobacco consumption. We are cognisant of recent additional investments related to cardiovascular health announced as part of the budget. We also wish to acknowledge that there are several examples of successful cross-Border initiatives such as the All-Island Congenital Heart Disease Network and treatment for emergency heart attacks in Altnagelvin Hospital for people in Donegal....

...Professor Brendan McAdam: Social determinants of the disease, healthy living, exercise, obesity-----

Deputy Róisín Shortall: Yes, but what is the split?

Professor Brendan McAdam: They are the majority. I think genetic determinants of disease account for probably 5% or 10%, whereas lifestyle is really important, that is, obesity, exercise, pollution, smoking, alcohol and so on....

Deputy Gino Kenny: What factor does drug use play? Regarding the prevalence of cocaine, for example, regular use will obviously have a detrimental effect on someone’s health, including the heart. Does Professor McAdam see that in his work? 

Professor Brendan McAdam: Yes. At Beaumont Hospital, my colleagues and I will once or twice per week see people coming in with cocaine-related chest pains, heart attacks and significant----- 

Deputy Gino Kenny: How prevalent is that? 

Professor Brendan McAdam: It is difficult to give a number. I would say that approximately 10% of our chest pain admissions may be directly or indirectly related to drug use. 

Deputy Gino Kenny: That figure is quite high. 

Professor Brendan McAdam: There is always a risk of sudden cardiac death. In fact, I have a few patients who have significant heart damage and are on life-saving treatments. One has a defibrillator and is only 29 years of age. That patient may end up getting a transplant. It is a serious health problem and growing. 

Deputy Gino Kenny: What about alcohol? 

Professor Brendan McAdam: Alcohol has a large impact on adverse cardiovascular outcomes and cancer outcomes. Obesity and poor diet lead to hypertension and significant health problems, including heart and liver problems. 

Deputy Gino Kenny: Most of us would not view air pollution as a factor in heart health, but it is. If people are breathing in these fumes----- 

Professor Brendan McAdam: It is well described as being an adverse risk factor for cardiovascular disease. Obviously, smoking and e-cigarettes are also harmful.

[Click here for the full debate on the Oireachtas website]