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Exploring potential mortality reductions in 9 European countries by improving diet and lifestyle: A modelling approach

Journal article
Authors M. O'Flaherty
P. Bandosz
J. Critchley
S. Capewell
M. Guzman-Castillo
T. Aspelund
K. Bennett
K. Kabir
Lena Björck
J. Bruthans
J. W. Hotchkiss
J. Hughes
T. Laatikainen
L. Palmieri
T. Zdrojewski
Published in International Journal of Cardiology
Volume 207
Pages 286-291
ISSN 0167-5273
Publication year 2016
Published at Institute of Health and Care Sciences
Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 286-291
Language en
Keywords Coronary heart disease, Mortality trends, Policy modelling, Prevention, Food policy, Smoking, Physical, coronary-heart-disease, cardiovascular mortality, trends, ireland, decline, rates, cholesterol, policies, smoking, sweden, Cardiovascular System & Cardiology
Subject categories Cardiovascular medicine


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 25-74 years). 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. (C) 2016 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY license.

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