title: Exploring potential mortality reductions in 9 European countries by improving diet and lifestyle: A modelling approach.
abstract: BACKGROUND
  Coronary heart disease (CHD) death rates have fallen across most of Europe in recent decades. However, substantial risk factor reductions have not been achieved across all Europe. Our aim was to quantify the potential impact of future policy scenarios on diet and lifestyle on CHD mortality in 9 European countries.
  
  
  METHODS
  We updated the previously validated IMPACT CHD models in 9 European countries and extended them to 2010-11 (the baseline year) to predict reductions in CHD mortality to 2020(ages 25-74years). We compared three scenarios: conservative, intermediate and optimistic on smoking prevalence (absolute decreases of 5%, 10% and 15%); saturated fat intake (1%, 2% and 3% absolute decreases in % energy intake, replaced by unsaturated fats); salt (relative decreases of 10%, 20% and 30%), and physical inactivity (absolute decreases of 5%, 10% and 15%). Probabilistic sensitivity analyses were conducted.
  
  
  RESULTS
  Under the conservative, intermediate and optimistic scenarios, we estimated 10.8% (95% CI: 7.3-14.0), 20.7% (95% CI: 15.6-25.2) and 29.1% (95% CI: 22.6-35.0) fewer CHD deaths in 2020. For the optimistic scenario, 15% absolute reductions in smoking could decrease CHD deaths by 8.9%-11.6%, Salt intake relative reductions of 30% by approximately 5.9-8.9%; 3% reductions in saturated fat intake by 6.3-7.5%, and 15% absolute increases in physical activity by 3.7-5.3%.
  
  
  CONCLUSIONS
  Modest and feasible policy-based reductions in cardiovascular risk factors (already been achieved in some other countries) could translate into substantial reductions in future CHD deaths across Europe. However, this would require the European Union to more effectively implement powerful evidence-based prevention policies.
authors.affiliation: Department of Public Health, University of Liverpool, L69 3GB, UK, 2. Electronic address: moflaher@liverpool.ac.uk.
authors.forename: M
authors.initials: M
authors.lastname: O'Flaherty
authors.affiliation: Department of Public Health, University of Liverpool, L69 3GB, UK, 2.
authors.forename: P
authors.initials: P
authors.lastname: Bandosz
authors.affiliation: Population Health Research Institute, St Georges, University of London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Critchley
authors.affiliation: Department of Public Health, University of Liverpool, L69 3GB, UK, 2.
authors.forename: S
authors.initials: S
authors.lastname: Capewell
authors.affiliation: Department of Public Health, University of Liverpool, L69 3GB, UK, 2.
authors.forename: M
authors.initials: M
authors.lastname: Guzman-Castillo
authors.affiliation: Icelandic Heart Association, Iceland.
authors.forename: T
authors.initials: T
authors.lastname: Aspelund
authors.affiliation: Department of Pharmacology & Therapeutics, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland.
authors.forename: K
authors.initials: K
authors.lastname: Bennett
authors.affiliation: Department of Epidemiology & Public Health, University College Cork, Cork, Ireland.
authors.forename: K
authors.initials: K
authors.lastname: Kabir
authors.affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Björck
authors.affiliation: Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Prague, Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Bruthans
authors.affiliation: School of Veterinary Medicine, University of Glasgow, UK.
authors.forename: J W
authors.initials: JW
authors.lastname: Hotchkiss
authors.affiliation: UKCRC Centre of Excellence for Public Health, Queen's University, Belfast, UK.
authors.forename: J
authors.initials: J
authors.lastname: Hughes
authors.affiliation: Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Laatikainen
authors.affiliation: National Center of Epidemiology, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Palmieri
authors.affiliation: Medical University of Gdansk, Department of Hypertension and Diabetology, Poland.
authors.forename: T
authors.initials: T
authors.lastname: Zdrojewski
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000178:diet therapy / Q000401:mortality* / Q000517:prevention & control; D004041:Dietary Fats / Q000009:adverse effects; D005060:Europe; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009026:Mortality / Q000639:trends; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000401:mortality* / Q000639:trends; D017673:Sodium Chloride, Dietary / Q000009:adverse effects
chemical_list: D004041:Dietary Fats; D017673:Sodium Chloride, Dietary
keywords: Coronary heart disease; Food policy; Mortality trends; Physical activity; Policy modelling; Prevention; Smoking
references.citation: Eur J Prev Cardiol. 2013 Apr;20(2):310-21
references.pmid: 22403395
references.citation: BMJ. 2012 Jan 25;344:d8136
references.pmid: 22279114
references.citation: Am J Epidemiol. 2005 Oct 15;162(8):764-73
references.pmid: 16150890
references.citation: Heart. 1999 Apr;81(4):380-6
references.pmid: 10092564
references.citation: Am J Public Health. 2010 Apr;100(4):684-92
references.pmid: 19608958
references.citation: BMJ Open. 2013 Jul 03;3(7):
references.pmid: 23824313
references.citation: BMJ. 2014 Feb 06;348:g1088
references.pmid: 24503058
references.citation: Eur J Prev Cardiol. 2014 Jul;21(7):829-39
references.pmid: 23180867
references.citation: Lancet. 2011 Aug 27;378(9793):752-3
references.pmid: 21414659
references.citation: Lancet. 1990 Apr 7;335(8693):827-38
references.pmid: 1969567
references.citation: Bull World Health Organ. 2012 Jul 1;90(7):522-31
references.pmid: 22807598
references.citation: J Epidemiol Community Health. 2006 Apr;60(4):322-7
references.pmid: 16537349
references.citation: Cochrane Database Syst Rev. 2004;(3):CD004937
references.pmid: 15266549
references.citation: Heart. 2013 Feb;99(3):159-62
references.pmid: 22962283
references.citation: J Epidemiol Community Health. 2013 Feb;67(2):190-3
references.pmid: 22875078
references.citation: Value Health. 2014 Jul;17(5):517-24
references.pmid: 25128044
references.citation: PLoS Med. 2012;9(6):e1001242
references.pmid: 22723746
references.citation: BMJ. 1998 Apr 18;316(7139):1213-20
references.pmid: 9552999
references.citation: Lancet. 2012 Dec 15;380(9859):2095-128
references.pmid: 23245604
references.citation: Addiction. 2005 Oct;100(10):1526-36
references.pmid: 16185214
references.citation: Eur Heart J. 2009 May;30(9):1046-56
references.pmid: 19141562
references.citation: Lancet Neurol. 2011 Sep;10(9):819-28
references.pmid: 21775213
references.citation: PLoS One. 2012;7(7):e41842
references.pmid: 22844529
references.citation: Cancer Epidemiol Biomarkers Prev. 2010 Nov;19(11):2801-10
references.pmid: 20852009
references.citation: Lancet. 2012 Dec 15;380(9859):2224-60
references.pmid: 23245609
references.citation: Eur J Public Health. 2008 Jun;18(3):339-44
references.pmid: 17875578
references.citation: Science. 2012 Sep 21;337(6101):1482-7
references.pmid: 22997325
references.citation: Lancet. 2014 Aug 2;384(9941):427-37
references.pmid: 24797573
references.citation: Eur J Clin Nutr. 2006 Aug;60(8):965-70
references.pmid: 16482074
references.citation: BMJ. 2013 Apr 09;346:f1515
references.pmid: 23571838
references.citation: Nutr J. 2012 Jun 11;11:40
references.pmid: 22686621
references.citation: Int J Cardiol. 2013 Oct 3;168(3):2462-7
references.pmid: 23541608
references.citation: BMJ. 2011 Aug 11;343:d4995
references.pmid: 21835876
references.citation: PLoS One. 2010 Nov 12;5(11):e13957
references.pmid: 21103050
references.citation: PLoS Med. 2012;9(6):e1001237
references.pmid: 22719232
references.citation: Eur J Clin Nutr. 2012 Jun;66(6):710-5
references.pmid: 22491494