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.
This article has been cited by other articles:
![]() |
Authors/Task Force Members:, G. Mancia, G. De Backer, A. Dominiczak, R. Cifkova, R. Fagard, G. Germano, G. Grassi, A. M. Heagerty, S. E. Kjeldsen, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) Eur. Heart J., June 11, 2007; (2007) ehm236v1. [Full Text] [PDF] |
||||
![]() |
M. Hernelahti, H. O. Tikkanen, J. Karjalainen, and U. M. Kujala Muscle Fiber-Type Distribution as a Predictor of Blood Pressure: A 19-Year Follow-Up Study Hypertension, May 1, 2005; 45(5): 1019 - 1023. [Abstract] [Full Text] [PDF] |
||||
![]() |
Y. Lotan, J. A. Cadeddu, J. J. Lee, C. G. Roehrborn, and S. M. Lippman Implications of the Prostate Cancer Prevention Trial: A Decision Analysis Model of Survival Outcomes J. Clin. Oncol., March 20, 2005; 23(9): 1911 - 1920. [Abstract] [Full Text] [PDF] |
||||
![]() |
B. Unal, J. A. Critchley, D. Fidan, and S. Capewell Life-Years Gained From Modern Cardiological Treatments and Population Risk Factor Changes in England and Wales, 1981-2000 Am J Public Health, January 1, 2005; 95(1): 103 - 108. [Abstract] [Full Text] [PDF] |
||||
![]() |
K. Armstrong, J. S. Schwartz, T. Randall, S. C. Rubin, and B. Weber Hormone Replacement Therapy and Life Expectancy After Prophylactic Oophorectomy in Women With BRCA1/2 Mutations: A Decision Analysis J. Clin. Oncol., March 15, 2004; 22(6): 1045 - 1054. [Abstract] [Full Text] [PDF] |
||||
![]() |
B. Unal, J. A. Critchley, and S. Capewell Explaining the Decline in Coronary Heart Disease Mortality in England and Wales Between 1981 and 2000 Circulation, March 9, 2004; 109(9): 1101 - 1107. [Abstract] [Full Text] [PDF] |
||||
![]() |
H. D. Sesso, R. S. Chen, G. J. L'Italien, P. Lapuerta, W. C. Lee, and R. J. Glynn Blood Pressure Lowering and Life Expectancy Based on a Markov Model of Cardiovascular Events Hypertension, November 1, 2003; 42(5): 885 - 890. [Abstract] [Full Text] [PDF] |
||||
![]() |
J A Critchley and S Capewell Substantial potential for reductions in coronary heart disease mortality in the UK through changes in risk factor levels J. Epidemiol. Community Health, April 1, 2003; 57(4): 243 - 247. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. E. Charlson, J. P. Allegrante, P. S. McKinley, J. C. Peterson, C. Boutin-Foster, G. Ogedegbe, and C. R. Young Improving health behaviors and outcomes after angioplasty: using economic theory to inform intervention Health Educ. Res., October 1, 2002; 17(5): 606 - 618. [Abstract] [Full Text] [PDF] |
||||
![]() |
G. J. Blake, P. M. Ridker, and K. M. Kuntz Projected life-expectancy gains with statin therapy for individuals with elevated c-reactive protein levels J. Am. Coll. Cardiol., July 3, 2002; 40(1): 49 - 55. [Abstract] [Full Text] [PDF] |
||||
![]() |
D. H. Taylor Jr, V. Hasselblad, S. J. Henley, M. J. Thun, and F. A. Sloan Benefits of Smoking Cessation for Longevity Am J Public Health, June 1, 2002; 92(6): 990 - 996. [Abstract] [Full Text] [PDF] |
||||
![]() |
J.A. Critchley and S. Capewell Why model coronary heart disease? Eur. Heart J., January 2, 2002; 23(2): 110 - 116. [Full Text] [PDF] |
||||
![]() |
K. M. Kessler Physical Activity and Cardiovascular Risk in Diabetic Women Ann Intern Med, November 20, 2001; 135(10): 930 - 931. [Full Text] [PDF] |
||||
![]() |
G. E. Fraser and D. J. Shavlik Ten Years of Life: Is It a Matter of Choice? Arch Intern Med, July 9, 2001; 161(13): 1645 - 1652. [Abstract] [Full Text] [PDF] |
||||
![]() |
W.B. Kannel Quest for an optimal population cardiovascular risk factor burden Eur. Heart J., January 2, 2001; 22(2): 105 - 107. [PDF] |
||||
![]() |
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] |
||||
![]() |
T. B. Seto, D. A. Taira, R. Berezin, M. S. Chauhan, D. E. Cutlip, K. K.L. Ho, R. E. Kuntz, and D. J. Cohen Percutaneous Coronary Revascularization in Elderly Patients: Impact on Functional Status and Quality of Life Ann Intern Med, June 20, 2000; 132(12): 955 - 958. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. VAN DE VATHORST and C. ALVAREZ-DARDET Doctors as judges: the verdict on responsibility for health J. Epidemiol. Community Health, March 1, 2000; 54(3): 162 - 164. [Full Text] |
||||
![]() |
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] |
||||
![]() |
D. A. Redelmeier and M. C. Weinstein Cost--Effectiveness of Regulations against Using a Cellular Telephone while Driving Med Decis Making, January 1, 1999; 19(1): 1 - 8. [Abstract] [PDF] |
||||
![]() |
E. Spencer, T. Swanson, W. J. Hueston, and D. L. Edberg Tools to Improve Documentation of Smoking Status: Continuous Quality Improvement and Electronic Medical Records Arch Fam Med, January 1, 1999; 8(1): 18 - 22. [Abstract] [Full Text] [PDF] |
||||
![]() |
T. Fahey Assessing heart disease risk in primary care BMJ, October 24, 1998; 317(7166): 1093 - 1094. [Full Text] |
||||
![]() |
J. C. Wright and M. C. Weinstein Gains in Life Expectancy from Medical Interventions -- Standardizing Data on Outcomes N. Engl. J. Med., August 6, 1998; 339(6): 380 - 386. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. A. Grover, S. Paquet, C. Levinton, L. Coupal, and H. Zowall Estimating the Benefits of Modifying Risk Factors of Cardiovascular Disease: A Comparison of Primary vs Secondary Prevention Arch Intern Med, March 23, 1998; 158(6): 655 - 662. [Abstract] [Full Text] [PDF] |
||||
![]() |
D. F. Skafar, R. Xu, J. Morales, J. Ram, and J. R. Sowers Female Sex Hormones and Cardiovascular Disease in Women J. Clin. Endocrinol. Metab., December 1, 1997; 82(12): 3913 - 3918. [Abstract] [Full Text] [PDF] |
||||
![]() |
D. Schrag, K. M. Kuntz, J. E. Garber, and J. C. Weeks Decision Analysis -- Effects of Prophylactic Mastectomy and Oophorectomy on Life Expectancy among Women with BRCA1 or BRCA2 Mutations N. Engl. J. Med., May 15, 1997; 336(20): 1465 - 1471. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. D. Krahn, G. Naglie, D. Naimark, D. A. Redelmeier, and A. S. Detsky Primer on Medical Decision Analysis: Part 4-Analyzing the Model and Interpreting the Results Med Decis Making, April 1, 1997; 17(2): 142 - 151. [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, I. Lowensteyn, K. L Esrey, Y. Steinert, L. Joseph, and M. Abrahamowicz Do doctors accurately assess coronary risk in their patients? Preliminary results of the coronary health assessment study BMJ, April 15, 1995; 310(6985): 975 - 978. [Abstract] [Full Text] |
||||
![]() |
W. Oderkirk Enthusiasm Misplaced?: Revisiting Cholesterol Screening J Holist Nurs, December 1, 1994; 12(4): 414 - 424. [Abstract] [PDF] |
||||
|
Circulation Home | Subscriptions | Archives | Feedback | Authors | Help | AHA Journals Home | Search Copyright © 1991 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited. |