O'Flaherty M, Bandosz P, Critchley J, Capewell S, Guzman-Castillo M, Aspelund T, Bennett K, Kabir K, Björck L, Bruthans J, Hotchkiss J W, Hughes J, Laatikainen T, Palmieri L, Zdrojewski T
Department of Public Health, University of Liverpool, L69 3GB, UK, 2.
Department of Public Health, University of Liverpool, L69 3GB, UK, 2.
Int J Cardiol. 2016 Mar 15;207:286-91. doi: 10.1016/j.ijcard.2016.01.147. Epub 2016 Jan 11.
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.
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.
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%.
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.
近几十年来，欧洲大部分地区的冠心病（CHD）死亡率有所下降。然而，整个欧洲尚未实现显著的风险因素降低。我们的目标是量化未来饮食和生活方式政策情景对9个欧洲国家冠心病死亡率的潜在影响。
我们更新了之前在9个欧洲国家验证过的IMPACT CHD模型，并将其扩展到2010 - 11年（基线年份），以预测到2020年（25 - 74岁）冠心病死亡率的降低情况。我们比较了三种情景：保守情景、中间情景和乐观情景，涉及吸烟流行率（绝对下降5%、10%和15%）；饱和脂肪摄入量（能量摄入量的百分比绝对下降1%、2%和3%，由不饱和脂肪替代）；盐（相对下降10%、20%和30%），以及身体活动不足（绝对下降5%、10%和15%）。进行了概率敏感性分析。
在保守情景、中间情景和乐观情景下，我们估计到2020年冠心病死亡人数将分别减少10.8%（95%置信区间：7.3 - 14.0）、20.7%（95%置信区间：15.6 - 25.2）和29.1%（95%置信区间：22.6 - 35.0）。对于乐观情景，吸烟绝对减少15%可使冠心病死亡人数减少8.9% - 11.6%；盐摄入量相对减少30%约可减少5.9 - 8.9%；饱和脂肪摄入量减少3%可减少6.3 - 7.5%，身体活动绝对增加15%可减少3.7 - 5.3%。
基于政策适度且可行地降低心血管风险因素（其他一些国家已经做到）可转化为欧洲未来冠心病死亡人数的大幅减少。然而，这需要欧盟更有效地实施强有力的循证预防政策。
