Cardiovascular disease (CVD) is the leading cause of death in the US and globally. In the US, the estimated direct and indirect costs of CVD exceed half a trillion dollars each year. These burdens may increase further with the aging of the population, escalating healthcare costs, improved patient survival following cardiac events, and increasing rates of major CVD risk factors such as obesity and diabetes. Our own work and that of many others has demonstrated that poor dietary habits are a major preventable cause of CVD. Our prior work has shown that excess salt and trans fats and insufficient polyunsaturated fats (in place of saturated fats), fruits and vegetables, and seafood omega-3 fats each account for tens of thousands of CVD deaths in the US each year. High intakes of sugar-sweetened beverages (SSBs) and processed meats and inadequate intake of nuts and whole grains also contribute to CVD risk. Clearly, achieving dietary change to improve CVD is a major challenge that needs to be addressed. Considering that most CVD is premature and can be prevented or delayed, the trillion-dollar question is """"""""which interventions are most effective to improve diet and reduce CVD?"""""""" We propose to evaluate the comparative-effectiveness of evidence-based population interventions to improve diet (Aim 1). We will focus on population-level approaches as these are more sustainable and less costly compared to individual-level ones. We will select the most promising population interventions based on the results of our preliminary work, and quantify their effect sizes on diet based on pooling the published evidence. We will primarily focus on effect sizes for fruits and vegetables, dietary fats, salt, an SSBs. Depending on data availability, we will secondarily consider seafood omega-3 fats, nuts, whole grains, and processed meats. We will use the results of Aim 1 to subsequently evaluate the comparative-effectiveness of evidence-based population dietary interventions to reduce CVD mortality in the US by age and sex, using nationally-representative data (Aim 2). There is clearly an urgent need to develop a consistent methodology to compare the impact of different population interventions on CVD in the US context. As part of this effort, we will develop and extend from our prior work three different models. The assessment of the comparative-effectiveness of evidence-based population strategies to improve diet and reduce CVD, and the development of a consistent methodology to perform such an assessment, are each novel, and will provide essential insights for evidence-based preventive efforts in the US, and also identify important gaps for future studies. Application of that knowledge will be imperative in extending healthy life and reducing enormous and ever-increasing burdens of CVD in the US.

Public Health Relevance

This proposed research will evaluate the comparative-effectiveness of evidence-based population interventions to improve diet and reduce CVD, including the development of consistent methods to perform such assessments. This work will provide essential insights for evidence-based preventive efforts in the US, and also identify important gaps for future studies.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL115189-02
Application #
8719160
Study Section
Dissemination and Implementation Research in Health Study Section (DIRH)
Program Officer
Boyington, Josephine
Project Start
2013-08-15
Project End
2017-03-31
Budget Start
2014-06-01
Budget End
2015-03-31
Support Year
2
Fiscal Year
2014
Total Cost
$720,503
Indirect Cost
$157,363
Name
Harvard University
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
149617367
City
Boston
State
MA
Country
United States
Zip Code
02115
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Brown, Alison G M; Houser, Robert F; Mattei, Josiemer et al. (2018) Diet quality among US-born and foreign-born non-Hispanic blacks: NHANES 2003-2012 data. Am J Clin Nutr 107:695-706
Micha, Renata; Karageorgou, Dimitra; Bakogianni, Ioanna et al. (2018) Effectiveness of school food environment policies on children's dietary behaviors: A systematic review and meta-analysis. PLoS One 13:e0194555
Rosettie, Katherine L; Micha, Renata; Cudhea, Frederick et al. (2018) Comparative risk assessment of school food environment policies and childhood diets, childhood obesity, and future cardiometabolic mortality in the United States. PLoS One 13:e0200378
Wilde, Parke Edward; Conrad, Zach; Rehm, Colin D et al. (2018) Reductions in national cardiometabolic mortality achievable by food price changes according to Supplemental Nutrition Assistance Program (SNAP) eligibility and participation. J Epidemiol Community Health 72:817-824
Pearson-Stuttard, Jonathan; Kypridemos, Chris; Collins, Brendan et al. (2018) Estimating the health and economic effects of the proposed US Food and Drug Administration voluntary sodium reformulation: Microsimulation cost-effectiveness analysis. PLoS Med 15:e1002551
Afshin, Ashkan; Peñalvo, José L; Del Gobbo, Liana et al. (2017) The prospective impact of food pricing on improving dietary consumption: A systematic review and meta-analysis. PLoS One 12:e0172277
Brown, Alison G M; Houser, Robert F; Mattei, Josiemer et al. (2017) Hypertension among US-born and foreign-born non-Hispanic Blacks: National Health and Nutrition Examination Survey 2003-2014 data. J Hypertens 35:2380-2387
Peñalvo, José L; Cudhea, Frederick; Micha, Renata et al. (2017) The potential impact of food taxes and subsidies on cardiovascular disease and diabetes burden and disparities in the United States. BMC Med 15:208
Pearson-Stuttard, Jonathan; Bandosz, Piotr; Rehm, Colin D et al. (2017) Comparing effectiveness of mass media campaigns with price reductions targeting fruit and vegetable intake on US cardiovascular disease mortality and race disparities. Am J Clin Nutr 106:199-206

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