Healthy People 2000: The Rationale and Potential Efficacy of Preventive Nutrition in Heart Disease: The Framingham Offspring-Spouse Study

BACKGROUND: To examine the rationale for preventive nutrition intervention and the potential efficacy of nutrition-related risk factor modification on heart disease incidence, the cardiovascular disease risk and dietary profiles of Framingham (Mass) men and women, 30 to 79 years old (n=1798 and 1845, respectively), were compared with the Healthy People 2000: National Health Promotion and Disease Prevention Objectives for the Nation and used to project the 10-year incidence of coronary heart disease with and without lowering serum cholesterol levels. METHODS: Data for this report are derived from the 1984 to 1988 cycle III examinations of the Framingham offspring-spouse cohort. Estimates of the reduction in coronary heart disease risk associated with modifications in serum cholesterol levels and other cardiovascular disease risk factors are projected using Framingham models. RESULTS: About 40% met guidelines for desirable total cholesterol levels (<5.17 mmol/L [<200 mg/dL]); 20% were hypertensive; one quarter smoked; and 10% of women and 20% of men were obese. Twenty-four-hour dietary data, adjusted for estimates of usual intake, indicated that about 50% to 80% met dietary cholesterol (<300 mg) and 55% to 94% met sodium (<3 g/d) objectives. In contrast, mean total fat intakes were high (38% of total energy), and only 6% to 9% of subjects met total fat, 9% to 14% met saturated fat, and fewer than 3% met dietary fiber guidelines. Ten-year cumulative incidence for coronary heart disease was projected to be up to 25% lower with reduction in serum cholesterol level. CONCLUSION: Risk factor lowering, emphasizing preventive nutrition measures, is an important element of health care reform, particularly strategies to reduce cardiovascular disease rates and to promote population health.(Arch Intern Med. 1993;153:1549-1556)