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. 2014 Jan 21;9(1):e85800.
doi: 10.1371/journal.pone.0085800. eCollection 2014.

Population assessment of future trajectories in coronary heart disease mortality

Rosa Björk Thorolfsdottir  1 , Thor Aspelund  1 , Simon Capewell  2 , Julia Critchley  3 , Vilmundur Gudnason  1 , Karl Andersen  1
Affiliations

Population assessment of future trajectories in coronary heart disease mortality

Rosa Björk Thorolfsdottir et al. PLoS One. .

Abstract

Background: Coronary heart disease (CHD) mortality rates have been decreasing in Iceland since the 1980s, largely reflecting improvements in cardiovascular risk factors. The purpose of this study was to predict future CHD mortality in Iceland based on potential risk factor trends.

Methods and findings: The previously validated IMPACT model was used to predict changes in CHD mortality between 2010 and 2040 among the projected population of Iceland aged 25-74. Calculations were based on combining: i) data on population numbers and projections (Statistics Iceland), ii) population risk factor levels and projections (Refine Reykjavik study), and iii) effectiveness of specific risk factor reductions (published meta-analyses). Projections for three contrasting scenarios were compared: (1) If the historical risk factor trends of past 30 years were to continue, the declining death rates of past decades would level off, reflecting population ageing. (2) If recent trends in risk factors (past 5 years) continue, this would result in a death rate increasing from 49 to 70 per 100,000. This would reflect a recent plateau in previously falling cholesterol levels and recent rapid increases in obesity and diabetes prevalence. 3) Assuming that in 2040 the entire population enjoys optimal risk factor levels observed in low risk cohorts, this would prevent almost all premature CHD deaths before 2040.

Conclusions: The potential increase in CHD deaths with recent trends in risk factor levels is alarming both for Iceland and probably for comparable Western populations. However, our results show considerable room for reducing CHD mortality. Achieving the best case scenario could eradicate premature CHD deaths by 2040. Public health policy interventions based on these predictions may provide a cost effective means of reducing CHD mortality in the future.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Future CHD mortality rate among 25–74 year old Icelanders in three different risk factor scenarios.
Figure 2
Figure 2. Estimated deaths per 100.000 prevented or added in 2040.
Estimated deaths by risk factor change, under three risk factor scenarios.
Figure 3
Figure 3. Future CHD mortality rate among 25–74 year old Icelanders.
Future CHD mortality in two different risk factor scenarios and a proposal to obtainable goals.
See this image and copyright information in PMC

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