Quantifying Options for Reducing Coronary Heart Disease Mortality By 2020
Background—The AHA 2020 Strategic Impact Goal proposes a 20% improvement in cardiovascular health of all Americans. We aimed to estimate the potential reduction in coronary heart disease (CHD) deaths.
Methods and Results—We used data on 40,373 CVD-free adults from NHANES (1988-2010). We quantified recent trends for six metrics (total cholesterol [TC]; systolic blood pressure [SBP]; physical inactivity; smoking; diabetes; obesity) and generated linear projections to 2020. We projected the expected number of CHD deaths in 2020 if 2006 age- and sex-specific CHD death rates remained constant, which would result in approximately 480,000 CHD deaths in 2020 (12% increase). We used the previously validated IMPACT CHD model to project numbers of CHD deaths in 2020 under two different scenarios. A) Assuming a 20% improvement in each CVH metric, we project 365,000 CHD deaths in 2020, (range 327,000-403,000) a 24% decrease reflecting modest reductions in TC (-41,000), SBP (-36,000), physical inactivity (-12,000), smoking (-10,000), diabetes (-10,000), and obesity (-5,000). B) Assuming that recent risk factor trends continue to 2020, we project 335,000 CHD deaths (range 274,000-386,000), a 30% decrease reflecting improvements in TC, SBP, smoking and physical activity (~167,000 fewer deaths), offset by increases in diabetes and BMI (~24,000 more deaths).
Conclusions—Two contrasting scenarios of change in CVH metrics could prevent 24-30% of the CHD deaths expected in 2020, though with differing impacts by age. Unfavorable continuing trends in obesity and diabetes would have substantial adverse effects. This analysis demonstrates the utility of modelling to inform health policy.
- Received December 20, 2012.
- Revision received April 9, 2013.
- Accepted April 26, 2013.