Abstract
Aim. To estimate incidence rate of first myocardial infarction (MI) with different outcomes and factors, it is influenced by, depending on the intensity of preventive measures in a population of middle-aged men during 15-year follow-up; to evaluate economic efficiency of primary medical prevention. Material and methods. Two populations of middle-aged men with a total of 6656 males (3488 men the group of active prevention and 3168 the group of comparison) were followed up over 15 years. Results. The group of active prevention revealed 22.1% reduced MI incidence rate during 5-year follow-up as compared to the second group, fatal MI incidence rate was 42.4% lower, p 0.05), while patients with clinical signs of ischemic heart disease (IHD) and no history of previous MI kept significant distinctions in first MI incidence rate (41% less in the first group, p<0.05). First MI incidence for the 10-year period was the least at risk factors (RF) absence and twice higher even at single RF presence. Combination of RF caused 4-5 fold increase in risk for MI. Life status of 81.3% of the enrolled men (5410 of 6656) followed over 15 years was received along with the monitoring of prognosis. Such indices as “life years saved” (LYS) and “quality-adjusted life years saved” (QALYS) for 1000 persons in the active prevention group were 53 and 51 years, respectively during the 5-year follow-up, 147 and 143 years – during the 10-year follow-up. In the long-term actual expenses for 1 LYS were 3.4-fold less than annual gross domestic product (GDP) value, at that charges for primary prevention – 4-fold less, which has been for the first time demonstrated using factual data and not mathematic modeling usually used in scientific literature. Conclusion. The long-term prospective follow-up has demonstrated that the risk of first MI can be reduced by means of active and systematic prevention. Cost-effectiveness of primary prevention, including the one of MI, has been conclusively showed. The results allowed to validate the reasonability of active multifactorial prevention in the settings of primary healthcare, which makes it possible to define scientific-based recommendations for real practice.
Highlights
The study was based on repeatedly published results of the "Coronary heart disease multifactorial prevention" trial [12,13], dealt with a population of middle-aged men (40-59 years old at the beginning of the study), resident at the area of medical care of two out-patient clinics
The total of 6656 examined subjects from two out-patient clinics were enrolled in the prospective follow-up, which included 3488 men of the active prevention group and 3168 - of the group of comparison
Frequency of control preventive visits in this group depended on the initial cardiovascular risk and varied between one visit per week and two visits per year
Summary
The study was based on repeatedly published results of the "Coronary heart disease multifactorial prevention" trial [12,13], dealt with a population of middle-aged men (40-59 years old at the beginning of the study), resident at the area of medical care of two out-patient clinics (full-design study). This article estimates results of the 5-, 10- and 15-year followup of the two compared cohorts, in which we had followed life status and verified all cases of death due to CVD including MI by unified protocol Data collection, both epidemiological indices and end points (all-cause mortality, cases of MI), was carried out in accordance with a strict protocol with standardization of all methods of preventive examination [12,13]. All charges were calculated using post-hoc analysis in accordance with 2008 year prices for 1000 men of each group of follow-up (the group of active prevention and the group of comparison). Critical level of significance at testing of statistic hypothesizes was taken equal to 0.05
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