ORCID Profile
0000-0003-0847-6110
Current Organisations
Northwestern University
,
Northwestern Memorial HealthCare Corp
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Publisher: Elsevier BV
Date: 04-2013
Publisher: Wiley
Date: 18-12-2012
DOI: 10.1111/JCH.12049
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2020
Abstract: Life expectancy in the United States has recently declined, in part attributable to premature cardiometabolic mortality. We characterized national trends in premature cardiometabolic mortality, overall, and by race‐sex groups. Using death certificates from the Centers for Disease Control and Prevention's Wide‐Ranging Online Data for Epidemiologic Research, we quantified premature deaths ( years of age) from heart disease, cerebrovascular disease, and diabetes mellitus from 1999 to 2018. We calculated age‐adjusted mortality rates (AAMRs) and years of potential life lost (YPLL) from each cardiometabolic cause occurring at years of age. We used Joinpoint regression to identify an inflection point in overall cardiometabolic AAMR trends. Average annual percent change in AAMRs and YPLL was quantified before and after the identified inflection point. From 1999 to 2018, annual premature deaths from heart disease (117 880 to 128 832), cerebrovascular disease (18 765 to 20 565), and diabetes mellitus (16 553 to 24 758) as an underlying cause of death increased. By 2018, 19.7% of all heart disease deaths, 13.9% of all cerebrovascular disease deaths, and 29.1% of all diabetes mellitus deaths were premature. AAMRs and YPLL from heart disease and cerebrovascular disease declined until the inflection point identified in 2011, then remained unchanged through 2018. Conversely, AAMRs and YPLL from diabetes mellitus did not change through 2011, then increased through 2018. Black men and women had higher AAMRs and greater YPLL for each cardiometabolic cause compared with White men and women, respectively. Over one‐fifth of cardiometabolic deaths occurred at years of age. Recent stagnation in cardiometabolic AAMRs and YPLL are compounded by persistent racial disparities.
Publisher: Springer Science and Business Media LLC
Date: 26-01-2021
DOI: 10.1186/S12889-021-10237-6
Abstract: Incarceration has been associated with higher cardiovascular risk, yet data evaluating its association with cardiovascular disease events are limited. The study objective was to evaluate the association between incarceration and incident fatal and non-fatal cardiovascular disease (CVD) events. Black and white adults from the community-based Coronary Artery Risk Development in Young Adult (CARDIA) study (baseline 1985–86, n = 5105) were followed through August 2017. Self-reported incarceration was measured at baseline (1985–1986) and Year 2 (1987–1988), and fatal and non-fatal cardiovascular disease events, including coronary heart disease, stroke, and heart failure, and all-cause mortality, were captured through 2017. Analyses were completed in September 2019. Cumulative CVD incidence rates and Cox proportional hazards were compared overall by incarceration status. An interaction between incarceration and race was identified, so results were also analyzed by sex-race groups. 351 (6.9%) CARDIA participants reported a history of incarceration. Over 29.0 years mean follow-up, CVD incidence rate was 3.52 per 1000 person-years in participants with a history of incarceration versus 2.12 per 1000 person-years in participants without a history of incarceration (adjusted HR = 1.33 [95% CI, 0.90–1.95]). Among white men, incarceration was associated with higher risk of incident cardiovascular disease (adjusted HR = 3.35 [95% CI, 1.54–7.29) and all-cause mortality (adjusted HR = 2.52 [95% CI, 1.32–4.83]), but these associations were not statistically significant among other sex-race groups after adjustment. Incarceration was associated with incident cardiovascular disease rates, but associations were only significant in one sex-race group after multivariable adjustment.
Publisher: Elsevier BV
Date: 11-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2013
DOI: 10.1161/CIRCOUTCOMES.113.000112
Abstract: Treatment and control of vascular risk factors reduce the likelihood of recurrent stroke. Present nationally representative data are sparse regarding secondary prevention treatment and control rates. We evaluated sex- and race-stratified blood pressure, cholesterol, and hemoglobin A1c levels and treatment and control rates in 1154 self-reported stroke survivors from the National Health and Nutrition Examination Surveys 1999 to 2010. We used weighted linear regression to estimate time trends. Participants were 54% to 61% women, 70% to 76% white, and had a mean age of 63 to 66 years. For blood pressure, treatment rates remained unchanged in men, but in women, treatment rates increased from 41% in 1999 to 2000 to 65% in 2009 to 2010 ( P =0.03), and control rates increased from 23% to 79% ( P =0.03). Treatment rates remained unchanged in non-Hispanic whites, non-Hispanic blacks, and Mexican Americans, although control rates increased in non-Hispanic whites from 50% in 1999 to 2002 to 69% in 2007 to 2010 ( P =0.04). For cholesterol, treatment rates increased from 30% to 40% in men ( P =0.02) and from 28% to 36% ( P .01) in women, but control rates increased only in men, from 62% to 87% ( P .01). Cholesterol treatment rates increased only in non-Hispanic blacks, from 18% to 37% ( P =0.02). By sex and race, there was no change in dysglycemia treatment and control. Despite improvements in blood pressure treatment and control and cholesterol treatment for women and cholesterol treatment and control for men, stroke secondary prevention through treatment and control of vascular risk factors remains suboptimal. Urgent action is needed to improve secondary prevention to reduce stroke morbidity and mortality in this high-risk group.
Publisher: Elsevier BV
Date: 12-2020
Publisher: American Medical Association (AMA)
Date: 06-2016
Publisher: Elsevier BV
Date: 05-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2022
DOI: 10.1161/CIRCHEARTFAILURE.121.009229
Abstract: Multisociety guidelines recommend a goal systolic blood pressure (BP) mm Hg and a hemoglobin A1c (HbA1c) % in patients with heart failure (HF), regardless of ejection fraction. Few studies have described BP and glycemic control in ambulatory patients with HF and racial and ethnic disparities in this subset of the population. We evaluated prevalence of uncontrolled BP and HbA1c in non-Hispanic Black, non-Hispanic White, and Mexican American adults aged ≥20 years with self-reported HF (National Health and Nutrition Examination Surveys: 2001–2018). Prevalence ratios (95% CI) for uncontrolled BP and HbA1c were calculated by race and ethnicity and adjusted for sex, age, treatment, and socioeconomic status. In secondary analyses, we examined trends in the prevalence of uncontrolled BP and HbA1c. Uncontrolled BP was present in 48% (95% CI, 49%–56%) of adults with HF (representing 2.3 million people). Non-Hispanic Black participants had a higher prevalence of uncontrolled BP compared with non-Hispanic White participants (53% [48%–58%] compared with 47% [43%–51%], P .05). In adjusted models, non-Hispanic Black participants were 1.19 (1.02–1.39) times more likely to have uncontrolled BP than non-Hispanic White participants. Overall, uncontrolled HbA1c was found in 8% (6%, 10%) with no differences by race and ethnicity. Prevalence of uncontrolled BP improved over time but uncontrolled risk factors remained high—2017 to 2018: 41% (36%, 47%) and 7% (5%, 12%) had uncontrolled BP and HbA1c, respectively. We document an unacceptably high prevalence of uncontrolled BP and HbA1c in a nationally representative, ambulatory HF s le with significant differences in BP control by race and ethnicity.
Publisher: SAGE Publications
Date: 17-06-2016
Abstract: Platelet adhesion is mediated by von Willebrand factor (vWF), and disintegrin-like and metalloprotease domain with thrombospondin type-1 motif, number 13 (ADAMTS13) is a protease that cleaves vWF. A change in the balance between vWF and ADAMTS13 in favor of thrombosis might occur shortly before ischemic cardiovascular (CV) events. To determine whether vWF, ADAMTS13, and the ratio of vWF and ADAMTS13 change during the months preceding an acute CV event. Prospective longitudinal observational study. Outpatient. A total of 595 participants with peripheral artery disease (PAD). Blood s les were obtained every 2 months for up to 3 years and hemostatic factors examined at intervals preceding events. Sixty-one participants (cases) experienced events and were matched to 122 PAD controls. During the 2-month interval prior to an event, cases (n = 48) had higher levels of the vWF and ADAMTS13 than controls (n = 95 P = .05), but significance was lost after adjusting for the baseline differences in myocardial infarction, unstable angina, and stroke. During the 10 months prior to an event, median values for vWF and the ratio of vWF and ADAMTS13 were higher in cases than in controls, but the differences were not statistically significant. However, in a subset of 20 patients with complete bimonthly data, there was a trend toward an increase in the ratio in the 10 months prior to a CV event ( P = .04). In patients with PAD experiencing an ischemic CV event, a significant increase in the ratio of vWF to ADAMTS13 prior to the event could not be confirmed, although there was a weak trend in this direction.
Publisher: SAGE Publications
Date: 07-12-2015
Abstract: Whether circulating biomarker levels increase shortly before an ischemic heart disease (IHD) event is unknown. We studied whether levels of D-dimer, C-reactive protein (CRP), and serum amyloid A (SAA) are higher within 2 months of an IHD event compared to time periods more than 2 months before the IHD event. We assembled 595 participants with peripheral artery disease (PAD) and followed them for up to 3 years. Blood s les were obtained every 2 months. The primary outcome was IHD events: myocardial infarctions, unstable angina, or IHD death. We used a nested case–control design. Fifty participants (cases) had events and were each matched by age, sex, duration in the study, and number of blood draws to two controls without events. Among cases, the mean D-dimer value of 1.105 obtained within 2 months of the event was higher than values obtained 10 months (0.68 mg/L, p .001), 12 months (0.71 mg/L, p=0.001), 16 months (0.65 mg/L, p=0.008), 20 months ( p=0.032), 22 months ( p=0.033), 26 months ( p=0.038), and 32 months ( p=0.04) before the event. Compared to controls, median D-dimer levels in cases were higher 4 months ( p=0.017), 6 months ( p=0.005), and 8 months ( p=0.028) before the event. Values of CRP and SAA obtained within two months of an IHD event not consistently higher than values obtained during the prior months. In PAD participants with an IHD event, D-dimer was higher within 2 months of the event, compared to most values obtained 10 to 32 months previously. D-dimer was also higher in cases as compared to controls during most visits within 8 months of the IHD event.
Publisher: American Medical Association (AMA)
Date: 10-01-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 13-01-2016
Abstract: Saturated fat ( SFA ), ω‐6 (n‐6) polyunsaturated fat ( PUFA ), and trans fat ( TFA ) influence risk of coronary heart disease ( CHD ), but attributable CHD mortalities by country, age, sex, and time are unclear. National intakes of SFA , n‐6 PUFA , and TFA were estimated using a Bayesian hierarchical model based on country‐specific dietary surveys food availability data and, for TFA , industry reports on fats/oils and packaged foods. Etiologic effects of dietary fats on CHD mortality were derived from meta‐analyses of prospective cohorts and CHD mortality rates from the 2010 Global Burden of Diseases study. Absolute and proportional attributable CHD mortality were computed using a comparative risk assessment framework. In 2010, nonoptimal intakes of n‐6 PUFA , SFA , and TFA were estimated to result in 711 800 (95% uncertainty interval [UI] 680 700–745 000), 250 900 (95% UI 236 900–265 800), and 537 200 (95% UI 517 600–557 000) CHD deaths per year worldwide, accounting for 10.3% (95% UI 9.9%–10.6%), 3.6%, (95% UI 3.5%–3.6%) and 7.7% (95% UI 7.6%–7.9%) of global CHD mortality. Tropical oil–consuming countries were estimated to have the highest proportional n‐6 PUFA – and SFA ‐attributable CHD mortality, whereas Egypt, Pakistan, and Canada were estimated to have the highest proportional TFA ‐attributable CHD mortality. From 1990 to 2010 globally, the estimated proportional CHD mortality decreased by 9% for insufficient n‐6 PUFA and by 21% for higher SFA, whereas it increased by 4% for higher TFA , with the latter driven by increases in low‐ and middle‐income countries. Nonoptimal intakes of n‐6 PUFA , TFA , and SFA each contribute to significant estimated CHD mortality, with important heterogeneity across countries that informs nation‐specific clinical, public health, and policy priorities.
Publisher: Elsevier BV
Date: 03-2017
Publisher: Oxford University Press (OUP)
Date: 14-08-2015
DOI: 10.1093/IJE/DYV150
Publisher: Elsevier BV
Date: 10-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 17-07-2015
Abstract: We determined whether poorer 6‐minute walk performance and lower physical activity levels are associated with higher rates of ischemic heart disease ( IHD ) events in people with lower extremity peripheral artery disease ( PAD ). Five hundred ten PAD participants were identified from Chicago‐area medical centers and followed prospectively for 19.0±9.5 months. At baseline, participants completed the 6‐minute walk and reported number of blocks walked during the past week (physical activity). IHD events were systematically adjudicated and consisted of new myocardial infarction, unstable angina, and cardiac death. For 6‐minute walk, IHD event rates were 25/170 (14.7%) for the third (poorest) tertile, 10/171 (5.8%%) for the second tertile, and 6/169 (3.5%) for the first (best) tertile ( P =0.003). For physical activity, IHD event rates were 21/154 (13.6%) for the third (poorest) tertile, 15/174 (8.6%) for the second tertile, and 5/182 (2.7%) for the first (best) tertile ( P =0.001). Adjusting for age, sex, race, smoking, body mass index, comorbidities, and physical activity, participants in the poorest 6‐minute walk tertile had a 3.28‐fold (95% CI 1.17 to 9.17, P =0.024) higher hazard for IHD events, compared with those in the best tertile. Adjusting for confounders including 6‐minute walk, participants in the poorest physical activity tertile had a 3.72‐fold (95% CI 1.24 to 11.19, P =0.019) higher hazard for IHD events, compared with the highest tertile. Six‐minute walk and physical activity predict IHD event rates in PAD . Further study is needed to determine whether interventions that improve 6‐minute walk, physical activity, or both can reduce IHD events in PAD .
Publisher: Elsevier BV
Date: 08-2014
Publisher: Springer Science and Business Media LLC
Date: 06-02-2019
Publisher: Wiley
Date: 14-03-2017
Publisher: Springer Science and Business Media LLC
Date: 22-09-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 22-04-2015
Abstract: Nationally representative data evaluating recent trends and future projections of vascular risk factor treatment and control rates in secondary prevention of ischemic heart disease are sparse. We evaluated sex‐ and race‐stratified cholesterol, blood pressure, and hemoglobin A1c levels and risk factor treatment and control rates in 1580 in iduals who self‐reported a history of myocardial infarction from The National Health and Nutrition Examination Surveys ( NHANES ) 1999 to 2012. We used weighted linear regression to estimate time trends and created forward linear projections to 2020. Participants were 30% to 41% women, 73% to 85% white, and had a mean age of 63 to 66 years. Cholesterol treatment rates increased and reached above 80% in men and women by 2011–2012, with significant increases in control rates (as then defined) in men to 85% in 2011–2012, with projections to reach 100% by 2020. Cholesterol treatment rates significantly increased in non‐Hispanic whites and Hispanics. Statin use increased significantly to 73% of myocardial infarction survivors by 2011–2012, and aspirin use increased significantly but only to 28% by 2011–2012. There were no changes in blood pressure treatment or control rates by sex, and hypertension treatment increased only in non‐Hispanic blacks. Projected hypertension control rates remained suboptimal. While temporal trends suggest improvements in cholesterol treatment, unchanged treatment and control of blood pressure and persistently low aspirin use represent missed opportunities. Urgent action is needed to improve secondary prevention rates projected by 2020 to reduce recurrent events in this high‐risk group.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 29-05-2012
DOI: 10.1161/CIRCULATIONAHA.111.070722
Abstract: The American Heart Association's 2020 Strategic Impact Goals target a 20% relative improvement in overall cardiovascular health with the use of 4 health behavior (smoking, diet, physical activity, body mass) and 3 health factor (plasma glucose, cholesterol, blood pressure) metrics. We sought to define current trends and forward projections to 2020 in cardiovascular health. We included 35 059 cardiovascular disease–free adults (aged ≥20 years) from the National Health and Nutrition Examination Survey 1988–1994 and subsequent 2-year cycles during 1999–2008. We calculated population prevalence of poor, intermediate, and ideal health behaviors and factors and also computed a composite, in idual-level Cardiovascular Health Score for all 7 metrics (poor=0 points intermediate=1 point ideal=2 points total range, 0–14 points). Prevalence of current and former smoking, hypercholesterolemia, and hypertension declined, whereas prevalence of obesity and dysglycemia increased through 2008. Physical activity levels and low diet quality scores changed minimally. Projections to 2020 suggest that obesity and impaired fasting glucose/diabetes mellitus could increase to affect 43% and 77% of US men and 42% and 53% of US women, respectively. Overall, population-level cardiovascular health is projected to improve by 6% overall by 2020 if current trends continue. In idual-level Cardiovascular Health Score projections to 2020 (men=7.4 [95% confidence interval, 5.7–9.1] women=8.8 [95% confidence interval, 7.6–9.9]) fall well below the level needed to achieve a 20% improvement (men=9.4 women=10.1). The American Heart Association 2020 target of improving cardiovascular health by 20% by 2020 will not be reached if current trends continue.
Publisher: Wiley
Date: 20-12-2012
DOI: 10.1002/OBY.20181
Abstract: In light of the worldwide epidemic of obesity, and in recognition of hypertension as a major factor in the cardiovascular morbidity and mortality associated with obesity, The Obesity Society and The American Society of Hypertension agreed to jointly sponsor a position paper on obesity-related hypertension to be published jointly in the journals of each society. The purpose is to inform the members of both societies, as well as practicing clinicians, with a timely review of the association between obesity and high blood pressure, the risk that this association entails, and the options for rational, evidenced-based treatment. The position paper is ided into six sections plus a summary as follows: pathophysiology, epidemiology and cardiovascular risk, the metabolic syndrome, lifestyle management in prevention and treatment, pharmacologic treatment of hypertension in the obese, and the medical and surgical treatment of obesity in obese hypertensive patients.
Publisher: American Medical Association (AMA)
Date: 19-09-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 28-03-2017
DOI: 10.1161/CIR.0000000000000467
Abstract: The Million Hearts Initiative has a goal of preventing 1 million heart attacks and strokes—the leading causes of mortality—through several public health and healthcare strategies by 2017. The American Heart Association and American College of Cardiology support the program. The Cardiovascular Risk Reduction Model was developed by Million Hearts and the Center for Medicare & Medicaid Services as a strategy to assess a value-based payment approach toward reduction in 10-year predicted risk of atherosclerotic cardiovascular disease (ASCVD) by implementing cardiovascular preventive strategies to manage the “ABCS” (aspirin therapy in appropriate patients, blood pressure control, cholesterol management, and smoking cessation). The purpose of this special report is to describe the development and intended use of the Million Hearts Longitudinal ASCVD Risk Assessment Tool. The Million Hearts Tool reinforces and builds on the “2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk” by allowing clinicians to estimate baseline and updated 10-year ASCVD risk estimates for primary prevention patients adhering to the appropriate ABCS over time, alone or in combination. The tool provides updated risk estimates based on evidence from high-quality systematic reviews and meta-analyses of the ABCS therapies. This novel approach to personalized estimation of benefits from risk-reducing therapies in primary prevention may help target therapies to those in whom they will provide the greatest benefit, and serves as the basis for a Center for Medicare & Medicaid Services program designed to evaluate the Million Hearts Cardiovascular Risk Reduction Model.
Publisher: SAGE Publications
Date: 12-02-2016
Abstract: We studied whether slower community walking speed and whether greater time spent lying down or sleeping were associated with higher mortality in people with lower extremity peripheral artery disease (PAD). Participants with an ankle–brachial index (ABI) 0.90 were identified from Chicago medical centers. At baseline, participants reported their usual walking speed outside their home and the number of hours they spent lying down or sleeping per day. Cause of death was adjudicated using death certificates and medical record review. Analyses were adjusted for age, sex, race, comorbidities, ABI, and other confounders. Of 1314 PAD participants, 189 (14.4%) died, including 63 cardiovascular disease (CVD) deaths. Mean follow-up was 34.9 months ± 18.1. Relative to average or normal pace (2–3 miles/hour), slower walking speed was associated with greater CVD mortality: no walking at all: hazard ratio (HR) = 4.17, 95% confidence interval (CI) = 1.46–11.89 casual strolling (0–2 miles/hour): HR = 2.24, 95% CI = 1.16–4.32 brisk or striding ( miles/hour): HR = 0.55, 95% CI = 0.07–4.30. These associations were not significant after additional adjustment for the six-minute walk. Relative to sleeping or lying down for 8–9 hours, fewer or greater hours sleeping or lying down were associated with higher CVD mortality: 4–7 hours: HR = 2.08, 95% CI = 1.06–4.05 10–11 hours: HR = 4.07, 95% CI = 1.86–8.89 ⩾12 hours: HR = 3.75, 95% CI = 1.47–9.62. These associations were maintained after adjustment for the six-minute walk. In conclusion, slower walking speed outside the home and less than 8 hours or more than 9 hours lying down per day are potentially modifiable behaviors associated with increased CVD mortality in patients with PAD.
Publisher: SAGE Publications
Date: 15-12-2016
Abstract: The prognostic significance of acute pulmonary events in people with lower extremity peripheral artery disease (PAD) is unknown. We hypothesized that an acute pulmonary event (hospitalization for pneumonia and/or chronic lower respiratory disease (CLRD) exacerbation) would be associated with a higher rate of subsequent ischemic heart disease (IHD) events in PAD. A total of 569 PAD participants were systematically identified from among patients in Chicago medical practices and followed longitudinally. Hospitalizations after enrollment were evaluated and adjudicated for pulmonary events. The primary outcome was adjudicated myocardial infarctions, unstable angina, and IHD death. Of 569 PAD participants, 34 (6.0%) were hospitalized for a pulmonary event (11 CLRD exacerbation and 23 pneumonia) during a mean follow-up of 1.52 years±0.80. Participants hospitalized for a pulmonary event had a higher rate of subsequent IHD events than those not hospitalized for a pulmonary event (10/34 (29%) vs 38/535 (7.1%), p .001). After adjusting for age, sex, race, comorbidities, and other confounders, a pulmonary hospitalization was associated with an increased risk of a subsequent IHD event (hazard ratio (HR) = 12.42, 95% confidence interval (CI) = 5.35 to 28.86, p .001). Non-pulmonary hospitalizations were also associated with IHD events (HR = 3.39, 95% CI = 1.78 to 6.44, p .001), but this association was less strong compared to pulmonary hospitalizations and IHD events ( p = 0.011 for difference in the strength of association). In conclusion, hospitalization for an acute pulmonary event was associated with higher risk for subsequent IHD events in PAD. Future study should examine whether hospitalization for pulmonary events warrants increased surveillance or potential intervention to prevent IHD events in PAD.
Publisher: Proceedings of the National Academy of Sciences
Date: 07-09-2021
Abstract: The contribution of midlife vascular risk factors to brain structure and cognition in late life is well established. In this large cohort of midlife in iduals, we replicated and extended previous findings of relationships between functional brain network connectivity and executive function in the context of white matter hyperintensities (WMH) and extended them to our measure of cumulative blood pressure exposure over 30 y from young adulthood. We report mediation of the relationship between WMH and executive function via functional connectivity. Our results support conclusions that neuroplastic reorganization of network connectivity may follow disruption to white matter tracks and furthermore suggest that this reorganization occurs early in the preclinical stage, prior to the onset of overt disease.
Publisher: Elsevier BV
Date: 03-2017
Publisher: Springer Science and Business Media LLC
Date: 09-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 25-06-2013
DOI: 10.1161/CIRCULATIONAHA.112.000769
Abstract: The American Heart Association (AHA) 2020 Strategic Impact Goal proposes a 20% improvement in cardiovascular health of all Americans. We aimed to estimate the potential reduction in coronary heart disease (CHD) deaths. We used data on 40 373 adults free of cardiovascular disease from the National Health and Nutrition Examination Survey (NHANES 1988–2010). We quantified recent trends for 6 metrics (total cholesterol, systolic blood pressure, physical inactivity, smoking, diabetes mellitus, and obesity) and generated linear projections to 2020. We projected the expected number of CHD deaths in 2020 if 2006 age- and sex-specific CHD death rates remained constant, which would result in ≈480 000 CHD deaths in 2020 (12% increase). We used the previously validated IMPACT CHD model to project numbers of CHD deaths in 2020 under 2 different scenarios: (1) Assuming a 20% improvement in each cardiovascular health metric, we project 365 000 CHD deaths in 2020 (range 327 000–403 000) a 24% decrease reflecting modest reductions in total cholesterol (−41 000), systolic blood pressure (−36 000), physical inactivity (−12 000), smoking (−10 000), diabetes mellitus (−10 000), and obesity (−5000) (2) Assuming that recent risk factor trends continue to 2020, we project 335 000 CHD deaths (range 274 000–386 000), a 30% decrease reflecting improvements in total cholesterol, systolic blood pressure, smoking, and physical activity (≈167 000 fewer deaths), offset by increases in diabetes mellitus and body mass index (≈24 000 more deaths). Two contrasting scenarios of change in cardiovascular health metrics could prevent 24% to 30% of the CHD deaths expected in 2020, though with differing effects by age. Unfavorable continuing trends in obesity and diabetes mellitus would have substantial adverse effects. This analysis demonstrates the utility of modelling to inform health policy.
Location: United States of America
Location: United States of America
No related grants have been discovered for Donald Lloyd-Jones.