Coronary heart disease (CHD) death rates have been falling across most of Europe in recent decades. However, CHD remains the leading cause of mortality. Furthermore, substantial risk factor reductions have been achieved in some European countries, but not in others. This partly reflects rather patchy implementation of the most effective prevention policies. Our study therefore aimed to quantify the potential impact of future policy scenarios (reducing smoking, diet and physical inactivity) on future CHD mortality in diverse countries across Europe.
We updated previously validated IMPACT CHD mortality models in nine countries (Czech Republic, Finland, Iceland, Italy, Ireland, Northern Ireland, Poland, Scotland and Sweden). Using recent risk factor data, these models were extended from 2010 (baseline year) to predict potential reductions in CHD mortality to 2020 (in people aged 25–74 years). We then modelled the mortality reductions in each country expected with future policies to decrease cardiovascular risk factors. We compared three alternative policy scenarios: conservative, intermediate and optimistic improvements for smoking prevalence (absolute decreases of 5%, 10% and 15%), dietary saturated fat intake (1%, 2% and 3% decreases in energy, replaced by unsaturated fats), dietary salt (decreases of 10%, 20% and 30%), and physical activity (absolute increases of 5%, 10% and 15%). Probabilistic sensitivity analyses were then conducted.
Under the conservative, intermediate and optimistic policy scenarios, we estimated approximately 11%, 21% and 29% fewer CHD deaths respectively in 2020 in these countries. Depending on the future mortality trends assumed, this represented between 11,000 and 18,500 fewer CHD deaths for the optimistic scenario. For the conservative scenario, 5% absolute reductions in smoking prevalence could decrease CHD deaths in each country by 2–3% (e.g. approximately 40–80 fewer deaths in Ireland, 460–760 fewer deaths in Poland). Salt intake reductions of 10% could decrease CHD deaths by approximately 1.2–2.5%; and 1% reductions in saturated fat intake might decrease CHD deaths by some 1.5–2.2%. The 5% absolute increases in physical activity levels might decrease CHD deaths by just 0.8–1.4% (approximately 20–40 fewer deaths in Ireland, approximately 220–370 fewer deaths in Poland). These projections remained stable under a wide range of probabilistic sensitivity analyses.
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.