This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Goldman, L. Articles by Williams, L. W. Search for Related Content PubMed PubMed Citation Articles by Goldman, L. Articles by Williams, L. W.

Circulation, Vol 80, 254-260, Copyright © 1989 by American Heart Association

ARTICLES

Relative impact of targeted versus populationwide cholesterol interventions on the incidence of coronary heart disease. Projections of the Coronary Heart Disease Policy Model

L Goldman, MC Weinstein and LW Williams
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115

We used the Coronary Heart Disease Policy Model, a state-transition computer simulation, to assess the absolute and relative effects of two different national cholesterol interventions: a targeted program to identify and treat all individuals with elevated serum cholesterol levels (greater than or equal to 250 mg/dl) versus a populationwide program to reduce everyone's serum cholesterol level. Based on the assumptions inherent in our model, which uses the Framingham Heart Study coefficients, we estimate the targeted program would reduce projected coronary heart disease absolute incidence by 8-10% in men ages 35-54 years and by 1-4% in men ages 55-74 years. Our model suggests that similar reductions in coronary heart disease incidence could be achieved by a 10 mg/dl populationwide reduction in serum cholesterol levels. In women, the targeted program would yield greater relative and absolute benefits and would be equivalent to a approximately 23 mg/dl populationwide reduction in serum cholesterol. We conclude that it would be inadvisable to rely solely on targeted cholesterol reduction programs to reduce national coronary heart disease.

This article has been cited by other articles:

				K. A. Phillips, M. G. Shlipak, P. Coxson, P. A. Heidenreich, M. G. M. Hunink, P. A. Goldman, L. W. Williams, M. C. Weinstein, and L. Goldman Health and Economic Benefits of Increased {beta}-Blocker Use Following Myocardial Infarction JAMA, December 6, 2000; 284(21): 2748 - 2754. [Abstract] [Full Text] [PDF]

				J. R. Beck and S. G. Pauker Does DEALE-ing Stack the Deck? Med Decis Making, October 1, 1999; 19(4): 503 - 504. [PDF]

				L. Goldman, P. Coxson, M. G. M. Hunink, P. A. Goldman, A. N. A. Tosteson, M. Mittleman, L. Williams, and M. C. Weinstein The relative influence of secondary versus primary prevention using the National Cholesterol Education Program Adult Treatment Panel II guidelines J. Am. Coll. Cardiol., September 1, 1999; 34(3): 768 - 776. [Abstract] [Full Text] [PDF]

				A. L Hersh, W. C Black, and A. N. Tosteson Estimating the population impact of an intervention: a decision-analytic approach Statistical Methods in Medical Research, August 1, 1999; 8(4): 311 - 330. [Abstract] [PDF]

				A. N.A. Tosteson, M. C. Weinstein, M. G.M. Hunink, M. A. Mittleman, L. W. Williams, P. A. Goldman, and L. Goldman Cost-Effectiveness of Populationwide Educational Approaches to Reduce Serum Cholesterol Levels Circulation, January 7, 1997; 95(1): 24 - 30. [Abstract] [Full Text]

				S. A. Grover, K. Gray-Donald, L. Joseph, M. Abrahamowicz, and L. Coupal Life Expectancy Following Dietary Modification or Smoking Cessation: Estimating the Benefits of a Prudent Lifestyle Arch Intern Med, August 8, 1994; 154(15): 1697 - 1704. [Abstract] [PDF]

				E. Y. Brown, C. M. Viscoli, and R. I. Horwitz Preventive Health Strategies and the Policy Makers' Paradox Ann Intern Med, April 1, 1992; 116(7): 593 - 597. [Abstract] [PDF]

				L. Goldman, M. C. Weinstein, P. A. Goldman, and L. W. Williams Cost-effectiveness of HMG-CoA Reductase Inhibition for Primary and Secondary Prevention of Coronary Heart Disease JAMA, March 6, 1991; 265(9): 1145 - 1151. [Abstract] [PDF]