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American Journal of Epidemiology Vol. 121, No. 5: 697-704
Copyright © 1985 by The Johns Hopkins University School of Hygiene and Public Health

research-article

PROJECTED EFFECTS OF HIGH-RISK VERSUS POPULATION-BASED PREVENTION STRATEGIES IN CORONARY HEART DISEASE

THOMAS E. KOTTKE2,, PEKKA PUSKA2, JUKKA T. SALONEN3, JAAKKO TUOMILEHTO2 and AULIKKI NISSINEN2

1Department of Medicine, School of Medicine, and Division of Epidemiology, School of Public Health, University of Minnesota Minneapolis, MN
2Department of Epidemiology, National Public Health Institute Helsinki, Finland
3Department of Community Health, University of Kuopio Kuopio, Finland

Reprint requests to Dr. Thomas E. Kottke, Box 508 Mayo, 420 Delaware Street SE, University of Minne sota, Minneapolis, MN 55455

The potential benefits of a high-risk and a population strategy to prevent cardiova disease deaths by lowering total serum cholesterol and diastolic blood pressure were estimated. The first strategy concentrates on the top 10% of the risk distribution, and the second strategy changes risk factor distributions of the entire population. With the high-risk strategy, lowering total serum choles terol 20% and diastolic blood pressure to 90 mmHg would resutt In a 28% reduction In death from cardiovascular disease. Lowering total serum cholesterol to 190 mg/dl and diastolic blood pressure to 80 mmHg with this strategy would result in a 33 per cent reduction in death from cardiovascular disease. These expected changes approximate those expected by lowering total serum choles terol by 10% and diastolic blood pressure by 5% with the population strategy. Changes in total serum cholesterol (20% lowering) and diastolic blood pressure (10% lowering) that have been achieved in nutrition intervention trials would result in a 50% decline in cardiovascular disease death rates if applied to the whole population. If population mean total serum cholesterol could be lowered to 190 mg/dl and population mean diastolic blood pressure could be lowered to 80 mmHg, a 70% reduction in cardiovascular disease death rates would be expected. This suggests that only a population approach can prevent the majority of deaths from cardiovascular disease in a community.

blood pressure; cardiovascular diseases; cholesterol


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