Preventing heart disease: is treating the high risk sufficient?
Monte Carlo simulation was used to assess the effects of several intervention strategies on coronary heart disease mortality rates in a Finnish and a North American cohort. Lowering total serum cholesterol by 4%, smoking by 15%, and diastolic blood pressure by 3% for the whole cohort would be expected to reduce the incidence of non-fatal myocardial infarction by at least 13% and coronary heart disease deaths by at least 18%. Lowering serum cholesterol by 34%, diastolic blood pressure to 90 mmHg, and reducing smoking by 20% in the subset of the population with all three risk factors in the highest quartile would result in a 6-8% reduction in non-fatal myocardial infarction and a 2-9% reduction in deaths from coronary heart disease in these cohorts. These data demonstrate that in populations with a relatively high incidence of heart disease, treating the entire population will produce larger effects than focusing only on high-risk populations.
Kottke
T E
TE
Department of Medicine, Mayo Clinic, Rochester, MN 55905.
Gatewood
L C
LC
Wu
S C
SC
Park
H A
HA
D000293:Adolescent; D000328:Adult; D002648:Child; D003327:Coronary Disease / Q000517:prevention & control*; D005387:Finland; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000517:prevention & control; D006973:Hypertension / Q000150:complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D009874:Operations Research; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D000074606:Smoking Prevention; D014481:United States