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Am J Public Health. 2014 Jul;104(7):1187-95. doi: 10.2105/AJPH.2013.301816. Epub 2014 May 15.

Using simulation to compare 4 categories of intervention for reducing cardiovascular disease risks.

Author information

Gary Hirsch is an independent consultant based in Wayland, MA. Jack Homer is with Homer Consulting, Voorhees, NJ. At the time of the study, Justin Trogdon was with RTI International, Research Triangle Park, NC. Kristina Wile is with Systems Thinking Collaborative, Stow, MA. Diane Orenstein is with the Centers for Disease Control and Prevention (CDC), Atlanta, GA.


The Prevention Impacts Simulation Model (PRISM) projects the multiyear impacts of 22 different interventions aimed at reducing risk of cardiovascular disease. We grouped these into 4 categories: clinical, behavioral support, health promotion and access, and taxes and regulation. We simulated impacts for the United States overall and also for a less-advantaged county with a higher death rate. Of the 4 categories of intervention, taxes and regulation reduce costs the most in the short term (through 2020) and long term (through 2040) and reduce deaths the most in the long term; they are second to clinical interventions in reducing deaths in the short term. All 4 categories combined were required to bring costs and deaths in the less-advantaged county down to the national level.

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