In the JournalsPerspective

More focus on BP control, diet may prevent 94.3 million premature deaths

Goodarz Danaei
Goodarz Danaei

BP control, sodium intake reduction and trans fatty acid elimination may prevent nearly 100 million global deaths within a 25-year period, according to a study published in Circulation.

“Focusing our resources on the combination of these three interventions can have a huge potential impact on cardiovascular health through 2040,” Goodarz Danaei, MD, associate professor of global health at Harvard T.H. Chan School of Public Health, said in a press release.

Vasilis Kontis, PhD, of the School of Public Health and MRC-PHE Centre for Environment and Health at Imperial College London, and colleagues analyzed data on the potential effects of sodium intake reduction, hypertension treatment and trans fat intake reduction on noncommunicable disease deaths between 2015 and 2040. Data were obtained from observational studies, meta-analyses of randomized trials and WHO’s projected mortality rates by cause in each country.

Researchers estimated that the three interventions may delay 94.3 million deaths by 2040 (95% CI, 85.7-102.7). An increase in high BP treatment coverage by 70% may delay 39.4 million deaths during this 25-year period (95% CI, 35.9-43). Another 40 million deaths could be prevented with a 30% reduction in sodium intake (95% CI, 35.1-44.6). The delay of an additional 14.8 million deaths may occur with the elimination of trans fat intake (95% CI, 14.7-15).

The largest effect from trans fat elimination was seen in South Asia, where 29.9% (95% CI, 28.9-31.1) of the 17.5 million deaths that would be delayed from 2015 to 2040 would occur. The largest proportion of premature delayed deaths — patients younger than 70 years — would occur in sub-Saharan Africa at 54.2% (95% CI, 51.3-57.3).

BP control, sodium intake reduction and trans fatty acid elimination may prevent nearly 100 million global deaths within a 25-year period, according to a study published in Circulation.
Source: Adobe Stock

“Successful global implementation would require increased investment in health care capacity and quality of care in the primary health care sector, and increased efforts to reduce sodium and eliminate trans fat intake through regulation and health promotion campaigns as well,” Kontis and colleagues wrote. “If countries commit resources to implement these highly cost-effective interventions, they will save lives and help achieve the targets set in the Sustainable Development Goals to reduce premature [noncommunicable diseases] deaths.” – by Darlene Dobkowski

Disclosures: Danaei and Kontis report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Goodarz Danaei
Goodarz Danaei

BP control, sodium intake reduction and trans fatty acid elimination may prevent nearly 100 million global deaths within a 25-year period, according to a study published in Circulation.

“Focusing our resources on the combination of these three interventions can have a huge potential impact on cardiovascular health through 2040,” Goodarz Danaei, MD, associate professor of global health at Harvard T.H. Chan School of Public Health, said in a press release.

Vasilis Kontis, PhD, of the School of Public Health and MRC-PHE Centre for Environment and Health at Imperial College London, and colleagues analyzed data on the potential effects of sodium intake reduction, hypertension treatment and trans fat intake reduction on noncommunicable disease deaths between 2015 and 2040. Data were obtained from observational studies, meta-analyses of randomized trials and WHO’s projected mortality rates by cause in each country.

Researchers estimated that the three interventions may delay 94.3 million deaths by 2040 (95% CI, 85.7-102.7). An increase in high BP treatment coverage by 70% may delay 39.4 million deaths during this 25-year period (95% CI, 35.9-43). Another 40 million deaths could be prevented with a 30% reduction in sodium intake (95% CI, 35.1-44.6). The delay of an additional 14.8 million deaths may occur with the elimination of trans fat intake (95% CI, 14.7-15).

The largest effect from trans fat elimination was seen in South Asia, where 29.9% (95% CI, 28.9-31.1) of the 17.5 million deaths that would be delayed from 2015 to 2040 would occur. The largest proportion of premature delayed deaths — patients younger than 70 years — would occur in sub-Saharan Africa at 54.2% (95% CI, 51.3-57.3).

BP control, sodium intake reduction and trans fatty acid elimination may prevent nearly 100 million global deaths within a 25-year period, according to a study published in Circulation.
Source: Adobe Stock

“Successful global implementation would require increased investment in health care capacity and quality of care in the primary health care sector, and increased efforts to reduce sodium and eliminate trans fat intake through regulation and health promotion campaigns as well,” Kontis and colleagues wrote. “If countries commit resources to implement these highly cost-effective interventions, they will save lives and help achieve the targets set in the Sustainable Development Goals to reduce premature [noncommunicable diseases] deaths.” – by Darlene Dobkowski

Disclosures: Danaei and Kontis report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

    Perspective
    Parag H. Joshi

    Parag H. Joshi

    This was a modeling study of measures with strong evidence for significantly impacting CV outcomes. In particular, the researchers evaluated the impact on worldwide rates of death if three measures were taken globally: improving hypertension diagnosis and control, reducing salt intake and getting rid of trans fats around the world.

    The investigators applied the reductions in mortality that would be expected based on prior meta-analyses to death rates across the world over 25 years from 2015 to 2040.

    As a result, the researchers found a huge number of deaths that are preventable.

    Up to 80% or 90% of heart disease has been estimated as being preventable, nearly 100 million lives. This study is an effective way of demonstrating how global health interventions can potentially have a profound impact, and the findings highlight how these interventions are work pursuing around the world.

    South Asia and Sub-Saharan Africa were the regions estimated to have the highest impact on improving longevity via these three measures. Up to 80% or 90% of heart disease has been estimated as being preventable with lifestyle changes, identifying risk factors, etc.

    However, it’s hard to answer whether this is realistic in these regions. In the U.S., we’ve done a better job at things like eliminating trans fats. There’s so much that goes into making these changes from a political and public health standpoint. There are a lot of potential obstacles in terms of how to enact this kind of change in South Asia or Sub-Saharan Africa for example, where there are tremendous disparities in care and challenges to public health in general. It would take local experts and policy makers in each of these regions to come together and make these decisions. These are regions with high rates of starvation and poor access to food overall. How can we improve the types of food people have access to when they are primarily worried about getting any food at all?

    The researchers took a realistic approach. They focused on targets that are potentially achievable such as reducing salt intake by 30% and improving the detection of hypertension and treatment of hypertension to about 70%.

    Without boots on the ground in those regions, it’s hard to know exactly how realistic or attainable these numbers are, but the overall principle is important. We may not hit 95 million lives saved, but if these interventions were applied to any degree, we would expect to see significant impacts.

    There are many assumptions and unknowns that go into this kind of modeling. What are the cost implications? The authors appropriately raised the question that if you eliminate sodium or if you eliminate trans fats, what are you replacing that with in diets? If you reduce sodium intake, does that lead to an uptake in other potentially harmful replacements? That aspect of nutrition and food-based research is always very important. It’s equally important to emphasize “what do you eliminate” and “what does it get replaced with.” That’s harder to anticipate, especially across the world with very different dietary patterns.

    The overall message here is very straightforward. This may not be achievable in the next 5 or 10 years, but it seems that moving in that direction would be wise across the world given such significant impacts that these measures can have. These kinds of efforts have been successfully employed in several countries where we can eliminate trans fats and we can cut sodium or have sodium alternatives. The main challenges are in the delivery of these interventions including the public health messaging aspect. How do you educate people as well modify as the food processing and manufacturing industry within each of those regions? That’s a huge undertaking that has to rely on policymakers within those regions to happen.

    • Parag H. Joshi, MD, MHS
    • Cardiology Today Next Gen Innovator
      Assistant Professor of Internal Medicine
      UTSouthwestern Medical Center, Dallas

    Disclosures: Joshi reports no relevant financial disclosures.