CV Mortality: How Much Is Preventable by Risk Factor Modification?
If the five leading risk factors were reduced or elevated in the United States, what proportion of cardiovascular mortality would be prevented?
This analysis used data from the Behavioral Risk Factor Surveillance System (BRFSS) and the National Health and Nutrition Examination Survey (NHANES). BRFSS data were collected from 2009-2010 and NHANES data from 1988-1994, 1999-2004, and through 2006. Hazard ratios for cardiovascular mortality were estimated using ICD-10 codes and the NHANES data. Data on self-reported risk factors were collected using BRFSS. Adults ages 45-79 years were included. Estimate of preventable cardiovascular death was calculated by two methods. First, the estimated preventable deaths were calculated if the US population eliminated all risk factors (elevated cholesterol, diabetes, hypertension, obesity, and smoking). Second, the estimated preventable deaths were calculated if the best achieved levels were defined as the mean prevalence of the five states with the lowest levels for each of the risk factors.
As of 2010, most adults reported one or more cardiovascular risk factors (81.7% [95% confidence interval, 80.5%-82.9%] for men and 80.0% [95% CI, 78.4%-81.6%] for women). Hypertension and elevated cholesterol levels were the most prevalent risk factors for both men and women. The proportion of cardiovascular mortality associated with complete elimination of elevated cholesterol, diabetes, hypertension, obesity, and smoking would be 54% for men and 49.6% for women as of 2009-2010. If risk factors were reduced in all states to a similar level observed in the top achieving US states, the estimated preventable deaths ranged from 0 to 7%. Southern states would have the largest reduction in preventable cardiovascular mortality, while western states would have the smallest reductions.
The investigators concluded that major modifiable cardiovascular risk factors collectively account for approximately 50% of all cardiovascular deaths among US adults. However, even if all US states achieved risk reductions of the currently best performing states, cardiovascular deaths would not decrease significantly.
These data suggest that continued efforts to reduce the prevalence of cardiovascular risk factors, even in the currently best performing states, need to be a public health priority.
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