Americans leading healthier lives, reducing risk of death from heart disease, UCSF study finds

By Bill Gordon

American adults are leading healthier lives and thus are significantly reducing
their risk of heart disease mortality, according to a new University of
California, San Francisco study recently published in The Journal of American
College of Cardiology (October 1, 2001).

“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

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

Goldman noted 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, Harvard 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, Harvard School of Public Health, Department of Health
Policy and Management; and Lawrence Williams, MS, Brigham and Women’s Hospital,
Boston, Massachusetts.