James Lightwood

Projected Effect of Dietary Salt Reductions on Future Cardiovascular Disease

BACKGROUND The U.S. diet is high in salt, with the majority coming from processed foods. Reducing dietary salt is a potentially important target for the improvement of public health. METHODS We used the Coronary Heart Disease (CHD) Policy Model to quantify the benefits of potentially achievable, population-wide reductions in dietary salt of up to 3 g per day (1200 mg of sodium per day). We estimated the rates and costs of cardiovascular disease in subgroups defined by age, sex, and race; compared the effects of salt reduction with those of other interventions intended to reduce the risk of cardiovascular disease; and determined the cost-effectiveness of salt reduction as compared with the treatment of hypertension with medications. RESULTS Reducing dietary salt by 3 g per day is projected to reduce the annual number of new cases of CHD by 60,000 to 120,000, stroke by 32,000 to 66,000, and myocardial infarction by 54,000 to 99,000 and to reduce the annual number of deaths from any cause by 44,000 to 92,000. All segments of the population would benefit, with blacks benefiting proportionately more, women benefiting particularly from stroke reduction, older adults from reductions in CHD events, and younger adults from lower mortality rates. The cardiovascular benefits of reduced salt intake are on par with the benefits of population-wide reductions in tobacco use, obesity, and cholesterol levels. A regulatory intervention designed to achieve a reduction in salt intake of 3 g per day would save 194,000 to 392,000 quality-adjusted life-years and

Short-term Economic and Health Benefits of Smoking Cessation Myocardial Infarction and Stroke

10 billion to

Declines in Acute Myocardial Infarction After Smoke-Free Laws and Individual Risk Attributable to Secondhand Smoke

24 billion in health care costs annually. Such an intervention would be cost-saving even if only a modest reduction of 1 g per day were achieved gradually between 2010 and 2019 and would be more cost-effective than using medications to lower blood pressure in all persons with hypertension. CONCLUSIONS Modest reductions in dietary salt could substantially reduce cardiovascular events and medical costs and should be a public health target.

Comparing Impact and Cost-Effectiveness of Primary Prevention Strategies for Lipid-Lowering

BACKGROUND Most analyses of the economic benefits of smoking cessation consider long-term effects, which are often not of interest to public and private policy makers. These analyses fail to account for the time course of the short-run cost savings from the rapid decline in risk of acute myocardial infarction (AMI) and stroke. METHODS AND RESULTS We estimate the time course of the fall in risk of AMI and stroke after smoking cessation and simulate the impact of a 1% absolute reduction in smoking prevalence on the number of and short-term direct medical costs associated with the prevented AMIs and strokes. In the first year, there would be 924+/-679 (mean+/-SD) fewer hospitalizations for AMI and 538+/-508 for stroke, resulting in an immediate savings of

The Impact of the Aging Population on Coronary Heart Disease in the United States

44+/-26 million. A 7-year program that reduced smoking prevalence by 1% per year would result in a total of 63,840+/-15,521 fewer hospitalizations for AMI and 34,261+/-9133 fewer for stroke, resulting in a total savings of

Forecasting the future economic burden of current adolescent overweight: an estimate of the coronary heart disease policy model.

3.20+/-0.59 billion in costs, and would prevent approximately 13,100 deaths resulting from AMI that occur before people reach the hospital. Creating a new nonsmoker reduces anticipated medical costs associated with AMI and stroke by

Effect of the California Tobacco Control Program on Personal Health Care Expenditures

47 in the first year and by

Black Box Warning Contraindicated Comedications: Concordance Among Three Major Drug Interaction Screening Programs

853 during the next 7 years (discounting 2.5% per year). CONCLUSIONS Although primary prevention of smoking among teenagers is important, reducing adult smoking pays more immediate dividends, both in terms of health improvements and cost savings.

Cost-effectiveness of bupropion, nortriptyline, and psychological intervention in smoking cessation.

Background— The estimated effects of recent pubic and workplace smoking restriction laws suggest that they produce significant declines in community rates of heart attack. The consistency of these declines with existing estimates of the relative risk of heart attack in individuals attributable to passive smoking exposure is poorly understood. The objective is to determine the consistency of estimates of reductions in community rates of heart attacks resulting from smoking restriction laws with estimates of the relative risk of heart disease in individuals exposed to passive smoking. Methods and Results— Meta-analyses of existing estimates of declines in community rates were compared with a mathematical model of the relationship between individual risk and community rates. The outcome measure is the ratio of community rates of acute myocardial infarction (after divided by before implementation of a smoking restriction law). There is a significant drop in the rate of acute myocardial infarction hospital admissions associated with the implementation of strong smoke-free legislation. The primary reason for heterogeneity in results of different studies is the duration of follow-up after adoption of the law. The pooled random-effects estimate of the rate of acute myocardial infarction hospitalization 12 months after implementation of the law is 0.83 (95% confidence interval, 0.80 to 0.87), and this benefit grows with time. This drop in admissions is consistent with a range of plausible individual risk and exposure scenarios. Conclusion— Passage of strong smoke-free legislation produces rapid and substantial benefits in terms of reduced acute myocardial infarctions, and these benefits grow with time.

Smoking cessation in heart failure: it is never too late∗☆

Context Which lipid-lowering policies with statins are cost-effective? Contribution This modeling exercise found that the Adult Treatment Panel III guidelines, which recommend treatment based on cholesterol level and estimated coronary heart disease risk, are reasonably cost-effective if statins cost about