Abstract 13229: Quantifying Options for Reducing Coronary Heart Disease Mortality by 2020

Abstract

Introduction The AHA 2020 Strategic Impact Goals target a 20% decrease in CVD death rates and a 20% relative improvement in cardiovascular health (CVH) from 2006 to 2020. Our objective was to estimate changes in CHD mortality by 2020 if a 20% overall improvement in CVH metrics were realized compared with projections of CVH metrics to 2020 based on recent trends.

Methods We used data on 35,060 CVD-free adults from NHANES (1988-2010). We quantified recent risk factor trends and generated linear, forward projections to 2020 as previously published. Using the widely validated IMPACT CHD policy model, we compared the projected number of CHD deaths in 2020, along with rigorous sensitivity analyses, under two scenarios: A) 20% improvement in each of six CVH metrics (excluding diet); and B) forward projections of recent trends in CVH metrics to 2020.

Results If 2006 age- and sex-specific CHD mortality rates persisted unchanged to 2020, then population growth and aging would increase CHD deaths by approximately 13% to 480,000 deaths per year in 2020. Scenario A. A 20% improvement in each metric would result in 366,000 (range 330,000-405,000) CHD deaths in 2020 representing a 24% reduction in expected deaths due to modest reductions in TC (-41,000), SBP (-36,000), physical inactivity (-12,000) smoking (-10,000), diabetes (-10,000) and BMI (-5,000). Scenario B. If trends in CVH metrics observed from 1988-2010 continue until 2020, there would be 337,000 CHD deaths (range 275,000-398,000), 30% less than expected. This would represent approximately 167,000 fewer deaths attributable to improvements in TC, SBP, smoking and physical activity, offset by approximately 24,000 additional deaths due to increases in diabetes and BMI. These near-term reductions in CHD mortality would be driven primarily by changes in CVH metrics in older Americans, who are projected to experience larger absolute improvements in CVH metrics than younger Americans.

Conclusions Similar reductions in CHD deaths would be expected under both scenarios by 2020. Improving CVH in younger Americans would be expected to have greater impact on longer-term outcomes, including other CVD outcomes.