Evaluating the Effectiveness of New York City Health Policy Initiatives in Reducing Cardiovascular Disease Mortality, 1990–2011

Abstract

Beginning in 2002, New York City (NYC) implemented numerous policies and programs targeting cardiovascular disease (CVD) risk factors. Using death certificates, we analyzed trends in NYC-specific and US mortality rates from 1990 to 2011 for all causes, any CVD, atherosclerotic CVD (ACVD), coronary artery disease (CAD), and stroke. Joinpoint analyses quantified annual percent change (APC) and evaluated whether decreases in CVD mortality accelerated after 2002 in either NYC or the total US population. Our analyses included 1,149,217 NYC decedents. The rates of decline in mortality from all causes, any CVD, and stroke in NYC did not change after 2002. Among men, the decline in ACVD mortality accelerated during 2002-2011 (APC = -4.8%, 95% confidence interval (CI): -6.1, -3.4) relative to 1990-2001 (APC = -2.3%, 95% CI: -3.1, -1.5). Among women, ACVD rates began declining more rapidly in 1993 (APC = -3.2%, 95% CI: -3.8, -2.7) and again in 2006 (APC = -6.6%, 95% CI: -8.9, -4.3) as compared with 1990-1992 (APC = 1.6%, 95% CI: -2.7, 6.0). In the US population, no acceleration of mortality decline was observed in either ACVD or CAD mortality rates after 2002. Relative to 1990-2001, atherosclerotic CVD and CAD rates began to decline more rapidly during the 2002-2011 period in both men and women-a pattern not observed in the total US population, suggesting that NYC initiatives might have had a measurable influence on delaying or reducing ACVD mortality.

10-Year Resource Utilization and Costs for Cardiovascular Care

“…Moreover, implementation of community or health system policies may become more palatable if economic advantages, such as that estimated within MESA, were realized in long-term CVD costs of care. In a recent example, New York City health policy initiatives on improving healthy eating behaviors and tobacco control were associated with reductions in CVD mortality (31). The dramatic differences in cost among MESA subgroups provide insight into the substantive health care costs that could be averted by reducing the burden of risk factors (i.e., CACS) and preventing atherosclerotic disease development.…”

New insights into ANGPLT3 in controlling lipoprotein metabolism and risk of cardiovascular diseases

“…However, once this balance is broken, the individuals may suffer from dyslipidemia, characterized by elevation of plasma LDL-C, TG and reduction of plasma HDL-C [ 7 , 8 ]. Evidence have revealed that dyslipidemia has a closely relationship with the morbidity of cardiovascular diseases (CVD) [ 9 , 10 ], which can lead to a high mortality rate in general population in both developed and developing countries all over the world [ 11 ]. Therefore, in order to reduce the risk of CVD and to develop effective therapeutic approaches against these conditions, it is important to understand the molecular metabolism underlying dyslipidemia.…”