Abstract
BackgroundDespite many decades of declining mortality rates in the Western world, cardiovascular disease remains the leading cause of death worldwide. In this research we evaluate the optimal mix of lifestyle, pharmaceutical and population-wide interventions for primary prevention of cardiovascular disease.Methods and FindingsIn a discrete time Markov model we simulate the ischaemic heart disease and stroke outcomes and cost impacts of intervention over the lifetime of all Australian men and women, aged 35 to 84 years, who have never experienced a heart disease or stroke event. Best value for money is achieved by mandating moderate limits on salt in the manufacture of bread, margarine and cereal. A combination of diuretic, calcium channel blocker, ACE inhibitor and low-cost statin, for everyone with at least 5% five-year risk of cardiovascular disease, is also cost-effective, but lifestyle interventions aiming to change risky dietary and exercise behaviours are extremely poor value for money and have little population health benefit.ConclusionsThere is huge potential for improving efficiency in cardiovascular disease prevention in Australia. A tougher approach from Government to mandating limits on salt in processed foods and reducing excessive statin prices, and a shift away from lifestyle counselling to more efficient absolute risk-based prescription of preventive drugs, could cut health care costs while improving population health.
Highlights
Despite many decades of declining mortality rates in the Western world [1,2], cardiovascular disease (CVD) remains the leading cause of death worldwide [3]
We include two interventions targeting the whole population, a community heart health program and mandatory reduction of salt in the manufacture of breads, margarines and cereals; six interventions targeting those at increased risk of disease with pharmacological agents, diuretics, ACE inhibitors, calcium channel blockers, beta-blockers, statins and aspirin; and three interventions targeting those at increased risk of disease with interventions to change behaviour, dietary advice from a doctor or dietitian, referral to a more intensive lifestyle program with specialised counselling, and advice from a doctor to switch to phytosterol-enriched margarine
Mandating more moderate use of salt in breads, margarines and cereals is the most effective (Table 2) and cost-effective (Table 3) strategy for primary prevention of CVD; it produces the biggest improvements in population health, and can save money for the health sector
Summary
Despite many decades of declining mortality rates in the Western world [1,2], cardiovascular disease (CVD) remains the leading cause of death worldwide [3]. In countries such as the United States (US), United Kingdom (UK) and Australia, the majority of cardiovascular burden could be prevented by better addressing key risks, such as blood pressure and cholesterol levels [4,5,6]. Despite many decades of declining mortality rates in the Western world, cardiovascular disease remains the leading cause of death worldwide. In this research we evaluate the optimal mix of lifestyle, pharmaceutical and populationwide interventions for primary prevention of cardiovascular disease
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