Achieving Healthy People 2010 targets ‘could halve US CHD deaths’
MedWire News: Achieving the Healthy People 2010 (HP2010) cardiovascular risk factor targets could have almost halved the predicted number of coronary heart disease (CHD) deaths in 2010 in the USA, report researchers.
Simon Capewell (University of Liverpool, UK) and colleagues say that if these specific targets were achieved, approximately 190,000 CHD deaths would be prevented or postponed.
But if recent risk factor trends continue, their report shows, a much more modest reduction of around 20,000 fewer CHD deaths than in the year 2000 is likely, with over half the gains from population-wide improvements in cholesterol, smoking, physical activity, and blood pressure levels in men cancelled out as a result of rising obesity and diabetes rates and worsening blood pressure in women.
The findings are reported in the Bulletin of the World Health Organization.
The researchers extended the 1998–2000 IMPACT CHD policy model using US Census Bureau population projections and mortality data for men and women aged 25 to 84 years, and then used the model to calculate the number of CHD deaths expected in 2010 under three contrasting scenarios.
If trends seen from the late 80s through 2002 continued, some 388,000 CHD deaths would occur in 2010, Capewell and co-authors report. This represents approximately 19,000 fewer CHD deaths than in 2000, the result of 51,000 fewer deaths due to improvements in mean total cholesterol and in mean blood pressure in men, less smoking, and increased physical activity, offset by around 32,000 additional deaths due to adverse trends in obesity and diabetes, and mean blood pressure in women.
But if the specific reductions in risk factors laid out in HP2010 were achieved, there would be approximately 188,000 fewer CHD deaths than in 2000.
This figure is based on: 40,000 fewer deaths if population mean blood cholesterol levels declined to 199 mg/dl (5.15 mmol/l) in both men and women; 26,000 fewer deaths if smoking prevalence fell to 12% among both men and women; 48,000 fewer deaths for reaching mean systolic BP targets of 119.4 mmHg in men and 118.9 mmHg in women (a 5-mmHg reduction in all age groups); 12,000 fewer deaths if physical activity rates rose to 80% among both men and women; 17,000 fewer deaths for substantial reductions to mean body mass index targets of 25.0 kg/m2 in men and 26.0 kg/m2 in women; and 44,000 fewer deaths if the total diabetes prevalence dropped to 6% in both men and women.
In an optimistic scenario in which mean population cardiovascular risk factors reached ideal levels reported in the healthiest stratum of study cohorts (involving zero smoking prevalence and all men and women becoming physically active), around 372,000 CHD deaths could be prevented or postponed.
“Implementing evidence-based policies to better control tobacco use and achieve a healthier diet across the population could potentially halve future CHD deaths in the USA,” the authors summarize. “Additional reductions in major risk factors could prevent or postpone substantially more deaths from CHD.”
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By Caroline Price