Prevalence of cardiovascular risk factors in a middle-income country and estimated cost of a treatment strategy

Pascal Bovet,Anne Gabriel,Fred Paccaud,Conrad Shamlaye,Walter Riesen

doi:10.1186/1471-2458-6-9

Abstract

BackgroundWe assessed the prevalence of risk factors for cardiovascular disease (CVD) in a middle-income country in rapid epidemiological transition and estimated direct costs for treating all individuals at increased cardiovascular risk, i.e. following the so-called "high risk strategy".MethodsSurvey of risk factors using an age- and sex-stratified random sample of the population of Seychelles aged 25–64 in 2004. Assessment of CVD risk and treatment modalities were in line with international guidelines. Costs are expressed as US$ per capita per year.Results1255 persons took part in the survey (participation rate of 80.2%). Prevalence of main risk factors was: 39.6% for high blood pressure (≥140/90 mmHg or treatment) of which 59% were under treatment; 24.2% for high cholesterol (≥6.2 mmol/l); 20.8% for low HDL-cholesterol (<1.0 mmol/l); 9.3% for diabetes (fasting glucose ≥7.0 mmol/l); 17.5% for smoking; 25.1% for obesity (body mass index ≥30 kg/m2) and 22.1% for the metabolic syndrome. Overall, 43% had HBP, high cholesterol or diabetes and substantially increased CVD risk. The cost for medications needed to treat all high-risk individuals amounted to US $45.6, i.e. $11.2 for high blood pressure, $3.8 for diabetes, and $30.6 for dyslipidemia (using generic drugs except for hypercholesterolemia). Cost for minimal follow-up medical care and laboratory tests amounted to $22.6.ConclusionHigh prevalence of major risk factors was found in a rapidly developing country and costs for treatment needed to reduce risk factors in all high-risk individuals exceeded resources generally available in low or middle income countries. Our findings emphasize the need for affordable cost-effective treatment strategies and the critical importance of population strategies aimed at reducing risk factors in the entire population.

Highlights

We assessed the prevalence of risk factors for cardiovascular disease (CVD) in a middle-income country in rapid epidemiological transition and estimated direct costs for treating all individuals at increased cardiovascular risk, i.e. following the so-called "high risk strategy"
It has been estimated that high blood pressure (HBP) accounts for as much as 5.0% of the total mortality in middle-income countries, tobacco for 4.0%, high cholesterol for 2.1% and obesity for 2.7% [5]
In assessing CVD risk, we considered the following associated risk factors: age ≥55 for men (≥65 for women), obesity, high blood cholesterol (≥6.2 mmol/l), and low HDL-cholesterol

Summary

Introduction

We assessed the prevalence of risk factors for cardiovascular disease (CVD) in a middle-income country in rapid epidemiological transition and estimated direct costs for treating all individuals at increased cardiovascular risk, i.e. following the so-called "high risk strategy". Cardiovascular diseases (CVD) have become a leading cause of mortality and morbidity in developing countries and rates are expected to rise further over the few decades [1,2,3,4]. It has been estimated that high blood pressure (HBP) accounts for as much as 5.0% of the total mortality in middle-income countries, tobacco for 4.0%, high cholesterol for 2.1% and obesity for 2.7% [5]. CVD occurs typically at a younger age in developing than developed countries with important consequences such as loss of revenue at household level and loss of productivity at macroeconomic level. Participants were free to participate and gave written informed consent

Methods

Results

Discussion

Conclusion