Circulation, Vol 83, 1194-1201, Copyright © 1991 by American Heart Association
J Tsevat, MC Weinstein, LW Williams, AN Tosteson and L Goldman
BACKGROUND. Despite much evidence that modifying risk factors for coronary
heart disease can decrease morbidity and mortality, little is known about
the impact of risk-factor modification on life expectancy. METHODS AND
RESULTS. We used the Coronary Heart Disease Policy Model, a
state-transition computer simulation of the US population, to forecast
potential gains in life expectancy from risk-factor modification for the
cohort of Americans turning age 35 in 1990. Among 35-year-old men, we
projected that the population-wide increase in life expectancy would be
about 1.1 years from strict blood pressure control, 0.8 years from smoking
cessation, 0.7 years from reduction of serum cholesterol to 200 mg/dl, and
about 0.6 years from weight loss to ideal body weight. For women, reducing
cholesterol to 200 mg/dl would have the greatest estimated impact-a gain of
0.8 years-whereas smoking cessation, blood pressure control, or weight loss
would yield population-wide gains of 0.7, 0.4, and 0.4 years, respectively.
Gains for 35-year-old individuals having a given risk factor are greater.
We estimate that, on average, male smokers would gain 2.3 years from
quitting smoking; males with hypertension would gain 1.1-5.3 years from
reducing their diastolic blood pressure to 88 mm Hg; men with serum
cholesterol levels exceeding 200 mg/dl would gain 0.5-4.2 years from
lowering their serum cholesterol level to 200 mg/dl; and overweight men
would gain an average of 0.7-1.7 years from achieving ideal body weight.
Corresponding projected gains for at-risk women are 2.8 years from quitting
smoking, 0.9-5.7 years from lowering blood pressure, 0.4-6.3 years from
decreasing serum cholesterol, and 0.5-1.1 years from losing weight.
Eliminating coronary heart disease mortality is estimated to extend the
average life expectancy of a 35-year-old man by 3.1 years and a 35-year-old
woman by 3.3 years. CONCLUSIONS. Population-wide gains in life expectancy
from single risk-factor modifications are modest, but gains to individuals
at risk can be more substantial.
ARTICLES
Expected gains in life expectancy from various coronary heart disease risk factor modifications [published erratum appears in Circulation 1991 Dec;84(6):2610]
Department of Medicine, Beth Israel Hospital, Boston, MA.
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