The Potential Impact of Policies and Structural Interventions in Reducing Cardiovascular Disease (CVD) and Mortality: A Systematic Review of Simulation Based Studies.
Research Paper
Alcohol pricing policies, like setting certain prices for alcohol beverages, could halt around 2,631 cases of cardiovascular disease every year in the UK. They are more impactful than the NHS Health Check program, which aims to prevent about 750 cases per year.”
Uthman et al. 2023
Summary
This study aimed to explore the potential effects of various policy changes on the prevention of heart disease. By searching two large medical databases, the researchers identified studies that employed computer models to estimate the impact of these policies on heart disease rates. In total, 54 studies matched our criteria. These studies considered a diverse range of policy interventions. Some delved into food and nutrition, investigating aspects like unhealthy food taxes, healthy food subsidies, stricter food regulations, and nutritional assistance programs. Others examined the impact of policies targeting tobacco and alcohol, encompassing smoking bans, nationwide tobacco control measures, and alcohol taxation. Further policies assessed included routine health checkups, global health goals, and measures to enhance air quality.
One significant challenge lies in the varied approaches and models each study employed, making direct comparisons difficult. Furthermore, there’s a gap in understanding how these policies might influence one another, as the studies did not consider potential interactions between them. While these policies show promise in the computer models, more comprehensive research is needed to fully appreciate their combined and long-term effects on heart health in real-world scenarios. As of now, the researchers recognize the potential of these interventions, but further studies will determine their true impact on reducing heart disease rates.
What emerged in previous studies
Prior studies highlight the preventable nature of most cardiovascular disease (CVD) cases. They emphasize risk factors like high blood pressure, smoking, high cholesterol, diabetes, physical inactivity, obesity, poor diet, and alcohol use.
There is a growing understanding about population-level policies. Community policies excel in effectiveness, cost-efficiency, and equality compared to individual efforts.
The present research aims to do a comprehensive systemic review to assess outcomes, unintended consequences, costs, and feasibility of community interventions. The objective is analyzing effectiveness of community policies to alleviate CVD to enhance longevity and health.
Highlights
- Effectiveness of population-wide strategies
- 54 simulation-based studies support the efficacy of population-wide strategies in lowering the burden of CVD.
- Broad intervention proves effective with regard to bringing positive population-wide health impact.
- Diet and nutrition initiatives and taxation
- Taxation on tobacco, salt, sugar, and alcohol emerges as the most helpful structural intervention.
- Simulation studies as crucial tools
- Simulation and modeling studies are invaluable tools to researchers to estimate the impact of interventions on a population without large-scale, resource-intensive randomized controlled trials (RCTs).
- Related contexts are interventions of increased physical activity or dietary modifications.
- Subpopulation insights
- Modeling studies are helpful to assess the effectiveness of dietary changes in reducing CVD risk in older adults.
- Simulation and modeling studies uniquely support the assessment of multifactorial strategies on population health.
Abstract
Background
The aim of the study was to investigate the potential effect of different structural interventions for preventing cardiovascular disease.
Methods
Medline and EMBASE were searched for peer-reviewed simulation-based studies of structural interventions for prevention of cardiovascular disease. The researchers performed a systematic narrative synthesis.
Results
A total of 54 studies met the inclusion criteria. Diet, nutrition, tobacco and alcohol control and other programmes are among the policy simulation models explored. Food tax and subsidies, healthy food and lifestyles policies, palm oil tax, processed meat tax, reduction in ultra-processed foods, supplementary nutrition assistance programmes, stricter food policy and subsidised community-supported agriculture were among the diet and nutrition initiatives. Initiatives to reduce tobacco and alcohol use included a smoking ban, a national tobacco control initiative and a tax on alcohol. Others included the NHS Health Check, WHO 25 × 25 and air quality management policy.
Future Work and Limitations
There is significant heterogeneity in simulation models, making comparisons of output data impossible. While policy interventions typically include a variety of strategies, none of the models considered possible interrelationships between multiple policies or potential interactions. Research that investigates dose–response interactions between numerous modifications as well as longer-term clinical outcomes can help us better understand the potential impact of policy-level interventions.
Conclusions
The reviewed studies underscore the potential of structural interventions in addressing cardiovascular diseases. Notably, interventions in areas such as diet, tobacco, and alcohol control demonstrate a prospective decrease in cardiovascular incidents. However, to realize the full potential of such interventions, there is a pressing need for models that consider the interplay and cumulative impacts of multiple policies. Rigorous research into holistic and interconnected interventions will pave the way for more effective policy strategies in the future.
Larger context
Alcohol is a major risk factor for cardiovascular diseases. In January 2022, Movendi International produced the Special Feature on Alcohol and Cardiovascular disease to document the state of the art.
Key element of this Special Feature is the landmark policy brief of the World Heart Federation.
The World Heart Federation released a policy brief establishing that no amount of alcohol is good for the heart. The brief calls for urgent and decisive action to tackle the unprecedented rise in alcohol-related death and disability worldwide.
In May 2023, Movendi International released another, updated, and improved Special Feature on alcohol and heart disease. This Special Feature on Alcohol and Heart Disease provides a state of the art overview of what we know about alcohol’s role in multiple heart conditions and alcohol as contributing cause to heart disease risk factors. This feature includes information about how Big Alcohol manufactures doubt about alcohol and heart disease.
In 2023, Movendi International published three additional resources.
In May 2023, the new World Heart Report provided the first in-depth analysis of CVD risk and mortality data worldwide, and unique analysis of country-level policy implementation to mitigate CVDs. The new report also addressed alcohol as one of the major risk factors for heart disease globally and outlined the solutions countries can use to prevent and reduce CVDs caused by alcohol.
In March 2023, a brand new report on alcohol and blood pressure summarized the best scientific research and provided a state-of-the-art overview of alcohol’s substantial causal role in the genesis of hypertension and related diseases. Movendi International addressed the potential of alcohol policy to help prevent hypertension and related diseases and suggests three concrete solutions.
In February 2023, a landmark study provided up-to-date and comprehensive estimates on the global alcohol cardiomyopathy (ACM) burden from 1990 to 2019.
The absolute number of prevalent cases, DALYs cases and deaths due to alcohol cardiomyopathy significantly increased between 1990 and 2019. ACM remains an important global public health concern.
Source Website: National Institute for Health and Care Research
