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

Parag H. Joshi, MD, MHS

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.