title: Quantifying options for reducing coronary heart disease mortality by 2020.
abstract: BACKGROUND
  The American Heart Association (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.
  
  
  RESULTS
  We used data on 40 373 adults free of cardiovascular disease from the National Health and Nutrition Examination Survey (NHANES; 1988-2010). We quantified recent trends for 6 metrics (total cholesterol, systolic blood pressure, physical inactivity, smoking, diabetes mellitus, and 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 ≈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 2 different scenarios: (1) Assuming a 20% improvement in each cardiovascular health metric, we project 365 000 CHD deaths in 2020 (range 327 000-403 000) a 24% decrease reflecting modest reductions in total cholesterol (-41 000), systolic blood pressure (-36 000), physical inactivity (-12 000), smoking (-10 000), diabetes mellitus (-10 000), and obesity (-5000); (2) 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 total cholesterol, systolic blood pressure, smoking, and physical activity (≈167 000 fewer deaths), offset by increases in diabetes mellitus and body mass index (≈24 000 more deaths).
  
  
  CONCLUSIONS
  Two contrasting scenarios of change in cardiovascular health metrics could prevent 24% to 30% of the CHD deaths expected in 2020, though with differing effects by age. Unfavorable continuing trends in obesity and diabetes mellitus would have substantial adverse effects. This analysis demonstrates the utility of modelling to inform health policy.
authors: Northwestern University Feinberg School of Medicine, Department of Preventive Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA. m-huffman@northwestern.edu
authors: Mark D
authors: MD
authors: Huffman
authors: Donald M
authors: DM
authors: Lloyd-Jones
authors: Hongyan
authors: H
authors: Ning
authors: Darwin R
authors: DR
authors: Labarthe
authors: Maria
authors: M
authors: Guzman Castillo
authors: Martin
authors: M
authors: O'Flaherty
authors: Earl S
authors: ES
authors: Ford
authors: Simon
authors: S
authors: Capewell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000572:American Heart Association; D003327:Coronary Disease / Q000453:epidemiology* / Q000401:mortality* / Q000517:prevention & control; D048909:Diabetes Complications / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009749:Nutrition Surveys / Q000706:statistics & numerical data / Q000639:trends*; D009765:Obesity / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
keywords: American Heart Association; epidemiology; heart diseases; risk factors
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