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.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
Project #
Application #
Study Section
Dissemination and Implementation Research in Health Study Section (DIRH)
Program Officer
Boyington, Josephine
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Tufts University
Other Domestic Higher Education
United States
Zip Code
Micha, Renata; Peñalvo, Jose L; Cudhea, Frederick et al. (2017) Association Between Dietary Factors and Mortality From Heart Disease, Stroke, and Type 2 Diabetes in the United States. JAMA 317:912-924
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
Mozaffarian, Dariush (2017) Foods, nutrients, and health: when will our policies catch up with nutrition science? Lancet Diabetes Endocrinol 5:85-88
Conrad, Zach; Rehm, Colin D; Wilde, Parke et al. (2017) Cardiometabolic Mortality by Supplemental Nutrition Assistance Program Participation and Eligibility in the United States. Am J Public Health 107:466-474
Wang, Qianyi; Afshin, Ashkan; Yakoob, Mohammad Yawar et al. (2016) Impact of Nonoptimal Intakes of Saturated, Polyunsaturated, and Trans Fat on Global Burdens of Coronary Heart Disease. J Am Heart Assoc 5:
Pearson-Stuttard, Jonathan; Guzman-Castillo, Maria; Penalvo, Jose L et al. (2016) Modeling Future Cardiovascular Disease Mortality in the United States: National Trends and Racial and Ethnic Disparities. Circulation 133:967-78
Rehm, Colin D; Peñalvo, José L; Afshin, Ashkan et al. (2016) Dietary Intake Among US Adults, 1999-2012. JAMA 315:2542-53
Mozaffarian, Dariush (2016) Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review. Circulation 133:187-225
Smith, Jessica D; Hou, Tao; Hu, Frank B et al. (2015) A Comparison of Different Methods for Evaluating Diet, Physical Activity, and Long-Term Weight Gain in 3 Prospective Cohort Studies. J Nutr 145:2527-34
Mozaffarian, Dariush; Ludwig, David S (2015) The 2015 US Dietary Guidelines: Lifting the Ban on Total Dietary Fat. JAMA 313:2421-2

Showing the most recent 10 out of 13 publications