NZ heart patients more likely to die

By MARTIN JOHNSTON health reporter

New Zealanders with heart and circulatory disease are 40 per cent more likely to die of it than patients in Australia.

A nine-year study of 9014 heart-attack and angina patients found that 14 per cent in New Zealand died of heart attacks, strokes and other cardiovascular causes. In Australia the figure was 10 per cent.



The research shows that even richer New Zealanders are worse off than their cousins across the Ditch when it comes to heart disease, the leading cause of death here.

Heart and circulatory disease has long been known to be worse among the poor, but even the wealthiest New Zealand patients in the study were at greater risk of dying of it than the poorest Australians.

Researchers cannot explain with any certainty why the discrepancy exists but they have suggested a number of contributing factors including:

* New Zealanders have proportionately fewer heart operations than Australians and make less use of cholesterol-lowering drugs.

* New Zealanders consume much more saturated fats than Australians, especially butter.

One of the researchers, Green Lane cardiologist Dr Ralph Stewart, said yesterday that Pharmac had improved access to statins, drugs which lower cholesterol, but New Zealand still lagged behind other countries.

Asked if access to treatment was a factor, he said: "It's possibly a contributing factor but it's almost certainly not the only reason."

After hearing the results at the Cardiac Society conference in Auckland yesterday, Professor Rod Jackson, a University of Auckland heart researcher, suggested greater saturated-fat intakes by New Zealanders might account for up to one-third of the difference in heart deaths. New Zealanders ate three times more butter than Australians.

A Health Ministry spokeswoman said that at 83 bypass operations a year per 100,000 people, New Zealand was behind Australia's 86. But we were well ahead of the Organisation for Economic Cooperation and Development average, which was 54.

The ideal was to improve access, but that had to be weighed against competing demands for health cash.

There were concerns that not everybody who could benefit from cholesterol-reducing drugs was receiving them.

Pharmac chief executive Wayne McNee said Pharmac provided money for the drugs and it was up to doctors to prescribe them.

"There are about 160,000 people eligible but only about 70,000 of those people are currently being prescribed the drugs."

Conference speaker Professor George Davey Smith, a clinical epidemiologist from Britain's Bristol University, said poor people were more likely to die from heart attacks.

British men in the unskilled and manual worker class had three times the heart disease risk of professionals and managers in 1991.

Some of the reasons were behavioural: higher rates of smoking and binge drinking, and less exercise.

With the trend to locating large supermarkets in harder-to-reach areas, poor people without cars had less access to fruit and vegetables and often paid more for them.

The poor also received proportionately fewer heart tests.

But even when the "conventional" risk factors were removed, there was still a big difference between rich and poor.

This suggested that cardiovascular disease in later life might be influenced by events 60 years earlier such as low birthweight and poor childhood nutrition.