1. Agenda Introduction Model purpose Overall plan Schema Discussion Next Steps

2. Model Purpose To create a population-based microsimulation model of cardiovascular disease (CVD) to assess the population health benefit and health care impact of: community-wide CVD prevention strategies and interventions clinical prevention

3. POHEM:Sodium Schematic Distal Risk Factors Intermediate Risk Factors Proximal Risk Factors Diseases & other outcomes Age Sex Immigrant status Canadian regions Family income Education Sociodemographic Food Sodium intake Food sources Food location Salt added Frequency Physical Activity* Smoking Alcohol Psychosocial Stress Body Mass Index* Blood Pressure* Lipid Levels* Diabetes (glucose)* AMI † CVA † Health Care Use Hospital admissions Physician visits Medication CHF † Death * Includes both measured (Canadian Health Measures Survey) and self-report (Canadian Community Health Survey) measures † From disease databases/registries developed using health administrative data (Canadian Chronic Disease Surveillance System) and health administrative data

4. Demographics Age Sex Births Deaths Immigration Emigration Canadian regions Interprovincial migration Ethnicity

5. Socioeconomic Position Education Family income Food insecurity

6. Health Behaviours Initial DataPrediction/ linked to disease in POHEM Dynamics Smoking √ Yes Alcohol √ (NPHS) FoodCCHS 2.2 Exercise √ (Claude’s work) StressCCHS 2.1NPHS √ - read into POHEM - dynamic in POHEM - no dynamic but feasible

7. Transitions Predictor Variable Transition Risk factorRisk factor to disease outcome Disease outcome to Disease outcome Agex Sexx Smokingx …

8. Outcomes AMI CVA CHF Health care use Death

9. Comparison of the Population Attributable Risk(99% CI) for Common Risk Factors in the INTERSTROKE and INTERHEART Studies INTERSTROKE (all stroke; 3000 cases, 3000 controls) INTERHEART (acute myocardial infarction; 15 152 cases, 14 820 controls) Hypertension34·6% (30·4–39·1)17·9% (15·7–20·4) Smoking18·9% (15·3–23·1)35·7% (32·5–39·1) Waist-to-Hip Ratio(abdominal obesity) 26·5% (18·8–36·0)20·1% (15·3–26·0) Diet Diet Risk Score18·8% (11·2–29·7).. Fruits and Vegetables Daily..13·7% (9·9–18·6) Regular Physical Activity28·5% (14·5–48·5)12·2% (5·5–25·1) Diabetes5·0% (2·6–9·5)9·9% (8·5–11·5) Alcohol Intake3·8% (0·9–14·4)6·7% (2·0–20·2) Psychosocial Stress All Psychosocial Factors..32·5% (25·1–40·8) Psychosocial Stress4·6% (2·1–9·6).. Depression5·2% (2·7–9·8).. Cardiac Causes6·7% (4·8–9·1).. Ratio of Apolipoproteins B to A124·9% (15·7–37·1)49·2% (43·8–54·5) Tu. Lancet. 2010; 376:74-75

11. Next Steps Year 1 CCHS 2.2 to CVA and AMI (closed population; Framingham Risk Function; Linked data – Canadian risk validation) Year 2 Food Model- if food content or food consumption changed, what is Canada’s intake with respect to: –Sodium –Calories –Trans fat Year 3 Life course (i.e. POHEM: + CVA, + Salt, + IHD, and additional risk algorithms) Year 5 POHEM: Food