Abstract for: How best to reduce cardiovascular risk? Dynamic modeling to integrate public health and medical science

A system dynamics model has been under development since 2007, supported by the federal CDC and NIH, for evaluating alternative interventions to reduce cardiovascular risk in a population. The Phase 1 model, presented at last year’s conference, focused on first-time cardiovascular events, risk factors, and costs, and was applied nationally and to Austin/Travis County, Texas. The expanded Phase 2 model includes the post-cardiovascular event population, post-event care, and recurrent events. The expanded model also depicts treatable borderline risk conditions (pre-hypertension, borderline cholesterol, and pre-diabetes) and former smokers. We will apply the expanded model again in Austin, and also for the heavily disadvantaged Delta region of Mississippi. The local applications support community planning about the likely impacts of interventions and their tradeoffs. We will also apply the model to explore (a) targeting interventions by age category or by gender; (b) lowering treatment targets for blood pressure, cholesterol, or blood glucose; (c) other risk factors (e.g., excess salt consumption, vitamin D deficiency, periodontal disease, and C-reactive protein); and (d) the effects of race and ethnicity. The results will provide evidence-based support for improved strategies combining public health and clinical interventions to reduce cardiovascular risk and its direct and indirect costs.