"Reductions in heart disease risk factors, such as smoking, blood pressure and cholesterol levels, represent a major public triumph," said Lee Goldman, MD, MPH, lead author of the study and chair of the UCSF Department of Medicine. "We found that substantial reductions in heart disease risk factors are well worth the cost, in part because of reductions achieved by the American public's positive changes in lifestyle and habits."
In fact, UCSF researchers found that reductions in heart disease risk factors dramatically reduced the number of heart disease related deaths among Americans by 430,000 annually - and overall deaths by 740,000 annually.
Goldman adds that most of the decline in heart disease related deaths were due to reductions in blood pressure and cholesterol levels, while reductions in non-heart disease related mortality were attributed to a fall in smoking rates.
UCSF researchers analyzed the data of the Coronary Heart Disease (CHD) Policy Model, a validated computer simulation model of heart disease among the Americans between the ages of 35 and 84.
Using this information, they estimated the blood pressure and cholesterol levels and the smoking characteristics of the US adult population during the period of 1981 to 1990 and then projected those estimates to 2015. The researchers then estimated the costs of the population-wide medical efforts initiated to reduce heart disease risk factors (ie: blood pressure and cholesterol screening and treatments, anti-smoking campaigns, smoking cessation programs) and their impact on heart disease incidence, prevalence, and mortality.
UCSF researchers report that from 1981 to 1990 much of the reduction in cholesterol levels was due to population-wide dietary changes, which is cost-effective and yields modest, yet significant, results in millions of people. For the reduction of high blood pressure, the widespread use of medications, albeit rather expensive, were still found to be cost-effective.
In regards to smoking reduction, smoking cessation programs were reported to have substantial benefits over the short and long term and be cost-effective. In addition, many smokers tend to quit on their own with very limited medical inputs.
Goldman noteed that in addition to saving lives, health care efforts intended to reduce heart disease risk factors were also cost-effective by medical standards. For example, such efforts cost an estimated $44,000 per person during the ten-year period between 1981-1990. If reductions in risk factors are maintained from 1991-2015, the UCSF researchers project that the efforts would cost only about $3,200 per person per year and prevent 3.6 million heart disease related deaths and 1.2 million non-heart disease related deaths over the 35-year period.
Other authors on the study include Pamela Coxson, PhD, UCSF Department of Medicine; Paula A. Goldman, MPH, Havard School of Public Health, Department of Health Policy and Management, Boston; Maria G.M. Hunink, MD, PhD, Erasmus University Medical Center, Rotterdam, The Netherlands, Department of Radiology and Department of Epidemiology and Biostatistics; Kathryn A. Phillips, PhD, UCSF Department of Medicine and UCSF Institute for Health Policy Studies; Milton C. Weinstein, PhD, Havard School of Public Health, Department of Health Policy and Management; and Lawrence Williams, MS, Brigham and Women's Hospital, Boston, Massachusetts.