Background Stroke and Cardiovascular Diseases (CVD) are the main cause of premature deaths globally. Over a third of stroke deaths occur in developing countries, including Turkey. There is substantial potential to reduce stroke mortality burden, particularly by improving diet and health behaviours at the population level. Our aim is to estimate the potential impact of improving diet and reducing smoking prevalence on future CVD and stroke deaths in Turkey up to 2022.
Methods We developed a Markov model for the Turkish population over 35 years old. The model follows the stroke free population in 2012 over a time horizon of 10 years. Key model inputs were obtained from Turkish sources (population and mortality data, incidence estimated using DISMOD and case fatality rates from hospital based stroke registry). Effect sizes for changes in nutrients and smoking on mortality were obtained from the literature. We simulated three scenarios: S1, baseline scenario; S2, a conservative scenario simulating a daily reduction in dietary salt by 1 g, trans-fat by 0.5%, and saturated fat by 1%, a 5% decrease in smoking prevalence in the population and increasing fruit and vegetable (F&V) intake by 1 portion/day; S3, simulating a daily reduction in dietary salt by 3 g, trans-fat by 1%, saturated fat by 3%, a 10% decrease in smoking prevalence and increasing F&V intake by 2 portions/day. Uncertainty was explored using a probabilistic sensitivity analysis.
Results We forecast that approximately 655,177 (range 524,142 to 786,212) deaths may occur between 2012 and 2022 (S1). The conservative changes (S2) in food policy could result in approximately 58,000 fewer CVD deaths (30,786–119,990) in 10 years. This would represent an 11% reduction in total CVD and stroke deaths in 2022. Feasible changes (S3) might prevent some 113,000 (62,580–326,700) fewer CVD deaths. This could result in approximately a 17% reduction in total CVD and stroke deaths in 2022. Approximately 32%, 29%, 11% and 6% of that figure could be attributed to a decreased consumption of trans-fat, dietary salt, saturated fats and fall in smoking prevalence and 22% could be attributed to increased F&V consumption.
Conclusion Substantial burden of CVD and stroke deaths in Turkey can be prevented by using feasible and evidence-based food policies: increasing portions of F/V and reducing excess consumption of trans-fat, saturated fat, dietary salt and decreasing smoking prevalence. Substantial reductions in stroke burden can be gained in a decade.
- cardiovascular and stroke deaths
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