Quantifying policy options for reducing future coronary heart disease mortality in England: a modelling study

Area of Science:

• Public Health
• Epidemiology
• Cardiovascular Disease Research

Background:

• Coronary heart disease (CHD) remains a significant public health concern in England.
• Understanding the potential impact of risk factor modification on CHD mortality is crucial for effective prevention strategies.

Purpose of the Study:

• To estimate the number of CHD deaths in England in 2020 that could be prevented under four distinct risk factor change scenarios.
• To compare these scenarios against a baseline of static 2007 risk factor and mortality levels.

Main Methods:

• Utilized the IMPACTSEC model, extending it from a 2007 baseline.
• Modeled four scenarios: continuing recent trends, achieving optimal feasible levels, an intermediate level, and a worst-case scenario (plateauing/worsening).
• Analyzed potential CHD deaths by age, gender, and Index of Multiple Deprivation (IMD) quintiles.

Main Results:

• An estimated 97,000 CHD deaths are projected for 2020 under baseline conditions.
• Continuing recent trends could avert ~22,640 deaths; achieving optimal levels could avert ~39,720 deaths.
• The worst-case scenario projects an additional 16,170 deaths; optimal levels could halve the CHD mortality gap between the most and least deprived areas.

Conclusions:

• Implementing optimal preventive policies can lead to substantial CHD mortality reductions (up to 45%).
• Such policies are also effective in reducing socioeconomic disparities in cardiovascular disease mortality.
• Key risk factors contributing to mortality gains include reductions in systolic blood pressure, physical inactivity, and total cholesterol.