Population assessment of future trajectories in coronary heart disease mortality

Coronary heart disease (CHD) mortality rates have been decreasing in Iceland since the 1980s, largely reflecting improvements in cardiovascular risk factors. The purpose of this study was to predict future CHD mortality in Iceland based on potential risk factor trends. The previously validated IMPAC...

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Published inPloS one Vol. 9; no. 1; p. e85800
Main Authors Thorolfsdottir, Rosa Björk, Aspelund, Thor, Capewell, Simon, Critchley, Julia, Gudnason, Vilmundur, Andersen, Karl
Format Journal Article
LanguageEnglish
Published United States Public Library of Science 21.01.2014
Public Library of Science (PLoS)
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Summary:Coronary heart disease (CHD) mortality rates have been decreasing in Iceland since the 1980s, largely reflecting improvements in cardiovascular risk factors. The purpose of this study was to predict future CHD mortality in Iceland based on potential risk factor trends. The previously validated IMPACT model was used to predict changes in CHD mortality between 2010 and 2040 among the projected population of Iceland aged 25-74. Calculations were based on combining: i) data on population numbers and projections (Statistics Iceland), ii) population risk factor levels and projections (Refine Reykjavik study), and iii) effectiveness of specific risk factor reductions (published meta-analyses). Projections for three contrasting scenarios were compared: (1) If the historical risk factor trends of past 30 years were to continue, the declining death rates of past decades would level off, reflecting population ageing. (2) If recent trends in risk factors (past 5 years) continue, this would result in a death rate increasing from 49 to 70 per 100,000. This would reflect a recent plateau in previously falling cholesterol levels and recent rapid increases in obesity and diabetes prevalence. 3) Assuming that in 2040 the entire population enjoys optimal risk factor levels observed in low risk cohorts, this would prevent almost all premature CHD deaths before 2040. The potential increase in CHD deaths with recent trends in risk factor levels is alarming both for Iceland and probably for comparable Western populations. However, our results show considerable room for reducing CHD mortality. Achieving the best case scenario could eradicate premature CHD deaths by 2040. Public health policy interventions based on these predictions may provide a cost effective means of reducing CHD mortality in the future.
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Competing Interests: The authors have declared that no competing interests exist.
Conceived and designed the experiments: SC VG KA. Performed the experiments: RBT TA SC JC VG KA. Analyzed the data: RBT TA SC JC VG KA. Contributed reagents/materials/analysis tools: TA SC JC VG KA. Wrote the paper: RBT TA SC JC VG KA.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0085800