Costs Of Cardiovascular Disease Research Articles

Modelling the impact on avoidable cardiovascular disease burden and costs of interventions to lower SBP in the England population

The burden of disease from cardiovascular disease (CVD) remains significant in England. Blood pressure remains an important risk factor. Health gain through public health measures and improving treatment compliance are potentially likely to be high. We assess the impact of known cost-effective interventions in terms of the avoidable CVD burden and costs by comparing these strategies to the current situation. We modelled avoidable CVD outcomes simulating the English population aged over 16 years with Excel spreadsheets for the current prevention/treatment and following various interventions over a 10-year time frame. The outcome measures were avoidable incident heart disease and stroke events, deaths and disability-adjusted life years (DALYs). Costs are reported from the health service perspective. We analysed relative cost-effectiveness, undertook sensitivity analysis and measured relative impacts of different strategies on avoidable burden of disease. The assessed interventions have a potential to reduce the current burden of disease between 70 000 and about 1 million DALYs over the 10-year frame. Although all interventions were cost-effective, some (e.g. Salt reduction in the population and 'Dietary Approaches to Stop Hypertension-sodium', which modelled the impact of salt reduction and dietary approaches) were cost-saving. The cost-effectiveness of treatment strategies was sensitive to drug costs. Evidence-based interventions appropriately scaled up for both prevention and treatment of blood pressure lead to important additional potential health gains. There was noticeable variance in cost-effectiveness and impact among the different interventions at a population level. Taking into account impact, priority should be given to prevention to reduce blood pressure at a population level through reduced salt consumption.

Cost-effectiveness analysis of valsartan versus losartan and the effect of switching

Objectives:Losartan will shortly become generic, and this may encourage switching to the generic drug. However, valsartan was shown in a meta-analysis to be statistically superior in lowering blood pressure (BP) to losartan. This paper examines the costs of treatment with these two drugs and the potential consequences of switching established valsartan patients to generic losartan.Methods:A US payer cost-effectiveness model was developed incorporating the risk of cardiovascular disease (CVD) events related to systolic blood pressure (SBP) control comparing valsartan to continual losartan and switching from valsartan to generic losartan. The model, based upon a meta-analysis by Nixon et al. and Framingham equations, included first CVD event costs calculated from US administrative data sets and utility values from published sources. The modeled outcomes were number of CVD events, costs and incremental cost per quality-adjusted life-year (QALY) and life-year (LY).Results:Fewer patients had fatal and non-fatal CVD events with valsartan therapy compared with continual losartan and with patients switched from valsartan to generic losartan. The base-case model results indicated that continued treatment with valsartan had an incremental cost-effectiveness ratio of $27,268 and $25,460 per life year gained, and $32,313 and $30,170 per QALY gained, relative to continual losartan and switching treatments, respectively. Sensitivity analyses found that patient discontinuation post-switching was a sensitive parameter. Including efficacy offsets with lowered adherence or discontinuation resulted in more favorable ratios for valsartan compared to switching therapy.Limitations:The model does not evaluate post-primary CVD events and considers change in SBP from baseline level as the sole predictor of CVD risk.Conclusions:Valsartan appears to be cost-effective compared to switching to generic losartan and switching to the generic drug does not support a cost offset argument over the longer term. Physicians should continue to consider the needs of individual patient and not cost offsets.

Abstract P264: The Health and Economic Impact of Switching From Atorvastatin to Generic Simvastatin in the Netherlands

OBJECTIVES Since January 2009, Dutch clinicians have been required to rationalize the prescription of branded statins using an authorization form. This has led to significant switching of patients from atorvastatin to generic simvastatin. However, data from Q1 2009 indicated that 34% of this switching occurred at less than equipotent doses. We sought to assess the potential impact of this. METHODS A Markov micro-simulation model was populated with 1046 Dutch patients drawn from the PHARMO Institute database who were being prescribed atorvastatin in December 2008. Risks of cardiovascular disease (CVD) were estimated from a calibrated Framingham risk equation. Follow-up occurred for 20 years or until age 100. Decision analysis estimated the marginal effects of switching all patients to generic simvastatin. Dose-specific, lipid-modifying effects of the two statins and CVD costs were sourced from published data. Annual discount rates of 4% and 1.5% were applied to costs and health effects, respectively. RESULTS Of the 1046 subjects on atorvastatin, 207 (19.8%) were predicted to develop CVD over 20 years. In the switched-to-simvastatin group, the predicted number was 229 (21.9%), equating to a ‘number needed to harm’ of 48. Although switching led to a net cost saving of 549 Euro per subject, each also lost 0.015 life-years and 0.029 QALYs. These equated to ICERs of 36,653 Euro and 18,716 Euro per life-year and QALY gained, respectively (atorvastatin vs simvastatin). Sensitivity analyses, which included a 20% decrease in the percentage of switches to less potent simvastatin doses, indicated the results to be robust. CONCLUSIONS In the Netherlands, many patients are being switched from atorvastatin to generic simvastatin at inferior doses, which may be increasing CVD risk. Maintaining patients on atorvastatin is sound from a health economic perspective. [ Disclaimer: the views expressed in this abstract are only those of the authors, and not necessarily those of the PHARMO Institute.]

P1-201 Using epidemiology data for evaluating of economic burden of cardiovascular diseases in Russian federation

PurposeTo study the economic burden of cardiovascular diseases (CVD) in Russian Federation in 2006–2009.MethodsThe economic burden was calculated by the cost of illness method. The calculations included direct costs of...

ESC/EAS Guidelines for the management of dyslipidaemias: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS)

Cardiovascular disease (CVD) due to atherosclerosis of the arterial vessel wall and to thrombosis is the foremost cause of premature mortality and of disability-adjusted life years (DALYs) in Europe, and is also increasingly common in developing countries.1 In the European Union, the economic cost of CVD represents annually E192 billion1 in direct and indirect healthcare costs. The main clinical entities are coronary artery disease (CAD), ischaemic stroke, and peripheral arterial disease (PAD). The causes of these CVDs are multifactorial. Some of these factors relate to lifestyles, such as tobacco smoking, lack of physical activity, and dietary habits, and are thus modifiable. Other risk factors are also modifiable, such as elevated blood pressure, type 2 diabetes, and dyslipidaemias, or non-modifiable, such as age and male gender. These guidelines deal with the management of dyslipidaemias as an essential and integral part of CVD prevention. Prevention and treatment of dyslipidaemias should always be considered within the broader framework of CVD prevention, which is addressed in guidelines of the Joint European Societies’ Task forces on CVD prevention in clinical practice.2 – 5 The latest version of these guidelines was published in 20075; an update will become available in 2012. These Joint ESC/European Atherosclerosis Society (EAS) guidelines on the management of dyslipidaemias are complementary to the guidelines on CVD prevention in clinical practice and address not only physicians [e.g. general practitioners (GPs) and cardiologists] interested in CVD prevention, but also specialists from lipid clinics or metabolic units who are dealing with dyslipidaemias that are more difficult to classify and treat.

Executive Summary: Heart Disease and Stroke Statistics—2011 Update

Executive Summary: Heart Disease and Stroke Statistics—2011 Update

Forecasting the Future of Cardiovascular Disease in the United States

Cardiovascular disease (CVD) is the leading cause of death in the United States and is responsible for 17% of national health expenditures. As the population ages, these costs are expected to increase substantially. To prepare for future cardiovascular care needs, the American Heart Association developed methodology to project future costs of care for hypertension, coronary heart disease, heart failure, stroke, and all other CVD from 2010 to 2030. This methodology avoided double counting of costs for patients with multiple cardiovascular conditions. By 2030, 40.5% of the US population is projected to have some form of CVD. Between 2010 and 2030, real (2008$) total direct medical costs of CVD are projected to triple, from $273 billion to $818 billion. Real indirect costs (due to lost productivity) for all CVD are estimated to increase from $172 billion in 2010 to $276 billion in 2030, an increase of 61%. These findings indicate CVD prevalence and costs are projected to increase substantially. Effective prevention strategies are needed if we are to limit the growing burden of CVD.

Retiring early with cardiovascular disease — impact on individual's financial assets

Cardiovascular disease (CVD) is the third highest cause of early retirement due to illness in Australia [ [1] Schofield D. Shrestha R. Passey M. Earnest A. Fletcher S. Chronic disease and labour force participation among older Australians. Med J Aust. 2008; 189: 447-450 PubMed Google Scholar ], and places a significant economic burden on individuals and governments due to illness related early retirement [ [2] Schofield D., Shrestha R, Percival R, Passey M, Kelly S, Callander E, Economic impacts of illness in older workers: how illness reduces income and tax revenue. Under review. Google Scholar ]. Early retirement is also likely to reduce an individual's savings and wealth. Yet studies have investigated the links between wealth and ill health [ 3 Rosen H.S. Wu S. Portfolio choice and health status. J Financ Econ. 2004; 72: 457-484 Crossref Scopus (196) Google Scholar , 4 Wenzlow A.T. Mullahy J. Robert S.A. Wolfe B.L. An empirical investigation of the relationship between health and wealth using the Survey of Consumer Preferences. Institute for Research on Poverty, University of Wisconsin-Madison, 2004 Google Scholar ]. Those who have investigated the indirect costs of CVD have mainly focused on the cost of lost productivity or earnings [ 5 Pestana J.A.X. Steyn K. Leiman A. Hartzenberg G.M. The direct and indirect costs of cardiovascular disease in South Africa in 1991. S Afr Med J. 1996; 86: 679-684 PubMed Google Scholar , 6 Wang G. Zheng Z.J. Heath G. Macera C. Pratt M. Buchner D. Economic burden of cardiovascular disease associated with excess body weight in US adults. Am J Prev Med. 2002; 23: 1-6 Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar , 7 Leal J. Luengo-Fernandez R. Gray A. Petersen S. Rayner M. Economic burden of cardiovascular diseases in the enlarged European Union. Eur Heart J. 2006; 27: 1610-1619 Crossref PubMed Scopus (510) Google Scholar , 8 Chan B. Coyte P. Heick C. Economic impact of cardiovascular disease in Canada. Can J Cardiol. 1996; 12: 1000 PubMed Google Scholar , 9 Access Economics The shifting burden of cardiovascular disease in Australia. Heart Foundation, 2005 Google Scholar , 10 Access Economics The growing cost of obesity in 2008: three years on. Diabetes Australia, Canberra2008 Google Scholar ]. This letter presents the findings of a study that quantifies the value of wealth held by Australians aged 45–64 years in 2009 who have retired early due to CVD and also compares this to what they could have accumulated had they not developed CVD — the value of savings and wealth held by individuals who managed to remain healthy and employed.

Acceptance of a Polypill Approach to Prevent Cardiovascular Disease Among a Sample of U.S. Physicians

ObjectiveTo examine US physicians' self-reported knowledge about the Polypill, factors considered in deciding whether to prescribe it, and acceptance of prescribing it for cardiovascular disease (CVD) prevention. MethodsNumerical scales of 0 (lowest) to 5 (highest) were used to assess self-reported knowledge and importance of factors relevant to making a decision to prescribe a Polypill. Characteristics of physicians indicating they would prescribe a Polypill were compared. ResultsAmong 952 physicians surveyed February through March 2010, mean self-rated knowledge about the Polypill was 2.0±1.5. Importance of degree of CVD event reduction, cost, and side effects were rated with means of 4.4, 4.3, and 4.3, respectively. 83% of respondents indicated they would “definitely” or “probably” prescribe it for high-risk patients; 62% would do so for moderate risk patients. Physicians with self-rated knowledge at ≥75th percentile were more likely to indicate they would prescribe a Polypill for moderate risk (adjusted OR 2.16; 95% CI 1.60–2.93) and high-risk (adjusted OR 1.57; 95% CI 1.07–2.32) patients. ConclusionAmong this sample of physicians, there is relatively high acceptance of prescribing a Polypill for CVD prevention despite relatively modest knowledge about it.

Results of a Markov model analysis to assess the cost-effectiveness of statin therapy for the primary prevention of cardiovascular disease in Korea: The Korean Individual-Microsimulation Model for Cardiovascular Health Interventions

Background: Although hyperlipidemia is well recognized as a risk factor for cardiovascular disease (CVD), there has been no appraisal of the economic impact of statin therapy in Korea. Objective: The aim of this model analysis was to determine the cost-effectiveness of statin therapy versus no treatment for the primary prevention of CVD over a lifetime in Korea, from a health care system perspective. Methods: We developed the Korean Individual-Microsimulation Model for Cardiovascular Health Interventions (KIMCHI), an epidemiologic and economic Markov model of first-onset CVD in Korea in which all individuals began the simulation in the health state alive without CVD, and moved among the 4 health states ( alive without CVD, alive with CVD, dead from CVD, and dead from non-CVD causes) in yearly cycles for any specified time horizon, up to 40 years. KIMCHI was populated with 372 subjects from the 2005 Korean National Health and Nutrition Examination Survey (KNHNES) who were aged ≥45 years, did not have a history of myocardial infarction or ischemic stroke, and met current Korean reimbursement criteria for treatment with lipid-lowering medications. The probability of first-onset CVD was estimated for each study participant individually, based on an Asian population—specific risk equation that relied on an individual's sex, age, serum total cholesterol, systolic blood pressure, current smoking status, diabetes mellitus status, and body mass index. Statin treatment was represented by a hybrid of atorvastatin and simvastatin (the most popular statins in Korea), the lipid-modifying effects of which were de rived from a published meta-analysis. Data regarding utilities and costs of CVD (both those covered and not covered by insurance) were derived from published local sources. Results: In the base case, the estimated incremental costutility ratio was 15,134,284 Korean won (KRW) per quality-adjusted life-year (QALY) gained, and the estimated incremental cost-effectiveness ratio was 20,657,829 KRW per life-year gained (LYG) (1200 KRW ≈ US $1). Based on a willingness-to-pay (WTP) threshold of 30 million KRW per QALY saved, there was a 93.7% probability that statin therapy would be cost-effective. Given a WTP threshold of 20 million KRW per QALY, there was a 53.8% probability of being cost-effective. The probabilities at WTP thresholds of 30 and 20 million KRW per LYG were 62.4% and 25.8%, respectively. Conclusions: Based on this analysis using data from the 2005 KNHNES and the KIMCHI model, statin therapy is likely to be cost-effective for the primary prevention of CVD among Koreans aged ≥45 years. The probability of being cost-effective was greater at a threshold of 30 million KRW per QALY (93.7%) than at 20 million KRW per QALY (53.8%).

A review of the cost of cardiovascular disease

In Canada, 74,255 deaths (33% of all deaths) in 2003 were due to cardio-vascular disease (CVD). As one of the most costly diseases, CVD represents a major economic burden on health care systems. The purpose of the present study was to review the literature on the economic costs of CVD in Canada and other developed countries (United States, Europe and Australia) published from 1998 to 2006, with a focus on Canada. Of 1656 screened titles and abstracts, 34 articles were reviewed including six Canadian studies and 17 American studies. While considerable variation was observed among studies, all studies indicated that the costs of treating CVD-related conditions are significant, outlining a convincing case for CVD prevention programs.

Effect of Lower Targets for Blood Pressure and LDL Cholesterol on Atherosclerosis in Diabetes: The SANDS Randomized Trial

Context Individuals with diabetes are at increased risk for cardiovascular disease (CVD), but more aggressive targets for risk factor control have not been tested. Objective To compare progression of subclinical atherosclerosis in adults with type 2 diabetes treated to reach aggressive targets of low-density lipoprotein cholesterol (LDL-C) of 70 mg/dL or lower and systolic blood pressure (SBP) of 115 mm Hg or lower vs standard targets of LDL-C of 100 mg/dL or lower and SBP of 130 mm Hg or lower. Design, Setting, and Participants A randomized, open-label, blinded-to-end point, 3-year trial from April 2003-July 2007 at 4 clinical centers in Oklahoma, Arizona, and South Dakota. Participants were 499 American Indian men and women aged 40 years or older with type 2 diabetes and no prior CVD events. Interventions Participants were randomized to aggressive (n=252) vs standard (n=247) treatment groups with stepped treatment algorithms defined for both. Main Outcome Measures Primary end point was progression of atherosclerosis measured by common carotid artery intimal medial thickness (IMT). Secondary end points were other carotid and cardiac ultrasonographic measures and clinical events. Results Mean target LDL-C and SBP levels for both groups were reached and maintained. Mean (95% confidence interval) levels for LDL-C in the last 12 months were 72 (69-75) and 104 (101-106) mg/dL and SBP levels were 117 (115-118) and 129 (128-130) mm Hg in the aggressive vs standard groups, respectively. Compared with baseline, IMT regressed in the aggressive group and progressed in the standard group (−0.012 mm vs 0.038 mm; P 2 vs 1.05 mm 2 ; P 2.7 vs −1.2 g/m 2.7 ; P = .03) in the aggressive group. Rates of adverse events (38.5% and 26.7%; P = .005) and serious adverse events (n = 4 vs 1; P = .18) related to blood pressure medications were higher in the aggressive group. Clinical CVD events (1.6/100 and 1.5/100 person-years; P = .87) did not differ significantly between groups. Conclusions Reducing LDL-C and SBP to lower targets resulted in regression of carotid IMT and greater decrease in left ventricular mass in individuals with type 2 diabetes. Clinical events were lower than expected and did not differ significantly between groups. Further follow-up is needed to determine whether these improvements will result in lower long-term CVD event rates and costs and favorable risk-benefit outcomes. Trial Registration clinicaltrials.gov Identifier: NCT00047424

Economic burden of cardiovascular diseases in China

Cardiovascular diseases (CVD) have become the principle cause of death and disability among the middle-aged and elderly both in urban and rural areas of China. The objective of this study is to estimate the direct costs of CVD in China. Direct costs were estimated for the Chinese population with CVD in 2003 by sex, age, geography, type of medical condition and medical insurance, and then calculated based on the 2003 National Health Services Survey. The annual average direct medical cost and direct nonmedical cost were 4238.3 Yuan (US$529.8) and 153.9 Yuan (US$19.2) in urban areas, 2302.5 Yuan (US$278.1) and 416.4 Yuan (US$50.3) in rural areas, respectively. On average, only 23.9% of outpatient costs and 35.2% in-patient costs could be paid by various kinds of medical insurance. This disease burden led to 209.0 billion Yuan (US$26.1 billion) in direct costs in 2003. The strong positive association between CVD, and the economic burden to families and society, demonstrates the need for greater investment to prevent CVD in China.

The Impact of Prevention on Reducing the Burden of Cardiovascular Disease

OBJECTIVE—Cardiovascular disease (CVD) is prevalent and expensive. While many interventions are recommended to prevent CVD, the potential effects of a comprehensive set of prevention activities on CVD morbidity, mortality, and costs have never been evaluated. We therefore determined the effects of 11 nationally recommended prevention activities on CVD-related morbidity, mortality, and costs in the U.S.RESEARCH DESIGN AND METHODS—We used person-specific data from a representative sample of the U.S. population (National Health and Nutrition Education Survey IV) to determine the number and characteristics of adults aged 20–80 years in the U.S. today who are candidates for different prevention activities related to CVD. We used the Archimedes model to create a simulated population that matched the real U.S. population, person by person. We then used the model to simulate a series of clinical trials that examined the effects over the next 30 years of applying each prevention activity one by one, or altogether, to those who are candidates for the various activities and compared the health outcomes, quality of life, and direct medical costs to current levels of prevention and care. We did this under two sets of assumptions about performance and compliance: 100% success for each activity and lower levels of success considered aggressive but still feasible.RESULTS—Approximately 78% of adults aged 20–80 years alive today in the U.S. are candidates for at least one prevention activity. If everyone received the activities for which they are eligible, myocardial infarctions and strokes would be reduced by ∼63% and 31%, respectively. If more feasible levels of performance are assumed, myocardial infarctions and strokes would be reduced ∼36% and 20%, respectively. Implementation of all prevention activities would add ∼221 million life-years and 244 million quality-adjusted life-years to the U.S. adult population over the coming 30 years, or an average of 1.3 years of life expectancy for all adults. Of the specific prevention activities, the greatest benefits to the U.S. population come from providing aspirin to high-risk individuals, controlling pre-diabetes, weight reduction in obese individuals, lowering blood pressure in people with diabetes, and lowering LDL cholesterol in people with existing coronary artery disease (CAD). As currently delivered and at current prices, most prevention activities are expensive when considering direct medical costs; smoking cessation is the only prevention strategy that is cost-saving over 30 years.CONCLUSIONS—Aggressive application of nationally recommended prevention activities could prevent a high proportion of the CAD events and strokes that are otherwise expected to occur in adults in the U.S. today. However, as they are currently delivered, most of the prevention activities will substantially increase costs. If preventive strategies are to achieve their full potential, ways must be found to reduce the costs and deliver prevention activities more efficiently.

The Impact of Prevention on Reducing the Burden of Cardiovascular Disease

Cardiovascular disease (CVD) is prevalent and expensive. While many interventions are recommended to prevent CVD, the potential effects of a comprehensive set of prevention activities on CVD morbidity, mortality, and costs have never been evaluated. We therefore determined the effects of 11 nationally recommended prevention activities on CVD-related morbidity, mortality, and costs in the United States. We used person-specific data from a representative sample of the US population (National Health and Nutrition Education Survey IV) to determine the number and characteristics of adults aged 20-80 years in the United States today who are candidates for different prevention activities related to CVD. We used the Archimedes model to create a simulated population that matched the real US population, person by person. We then used the model to simulate a series of clinical trials that examined the effects over the next 30 years of applying each prevention activity one by one, or altogether, to those who are candidates for the various activities and compared the health outcomes, quality of life, and direct medical costs to current levels of prevention and care. We did this under two sets of assumptions about performance and compliance: 100% success for each activity and lower levels of success considered aggressive but still feasible. Approximately 78% of adults aged 20-80 years alive today in the United States are candidates for at least one prevention activity. If everyone received the activities for which they are eligible, myocardial infarctions and strokes would be reduced by 63% and 31%, respectively. If more feasible levels of performance are assumed, myocardial infarctions and strokes would be reduced 36% and 20%, respectively. Implementation of all prevention activities would add approximately 221 million life-years and 244 million quality-adjusted life-years to the US adult population over the coming 30 years, or an average of 1.3 years of life expectancy for all adults. Of the specific prevention activities, the greatest benefits to the US population come from providing aspirin to high-risk individuals, controlling pre-diabetes, weight reduction in obese individuals, lowering blood pressure in people with diabetes, and lowering LDL cholesterol in people with existing coronary artery disease (CAD). As currently delivered and at current prices, most prevention activities are expensive when considering direct medical costs; smoking cessation is the only prevention strategy that is cost-saving over 30 years. Aggressive application of nationally recommended prevention activities could prevent a high proportion of the CAD events and strokes that are otherwise expected to occur in adults in the United States today. However, as they are currently delivered, most of the prevention activities will substantially increase costs. If preventive strategies are to achieve their full potential, ways must be found to reduce the costs and deliver prevention activities more efficiently.

Effect of Lower Targets for Blood Pressure and LDL Cholesterol on Atherosclerosis in Diabetes

Individuals with diabetes are at increased risk for cardiovascular disease (CVD), but more aggressive targets for risk factor control have not been tested.To compare progression of subclinical atherosclerosis in adults with type 2 diabetes treated to reach aggressive targets of low-density lipoprotein cholesterol (LDL-C) of 70 mg/dL or lower and systolic blood pressure (SBP) of 115 mm Hg or lower vs standard targets of LDL-C of 100 mg/dL or lower and SBP of 130 mm Hg or lower.A randomized, open-label, blinded-to-end point, 3-year trial from April 2003-July 2007 at 4 clinical centers in Oklahoma, Arizona, and South Dakota. Participants were 499 American Indian men and women aged 40 years or older with type 2 diabetes and no prior CVD events.Participants were randomized to aggressive (n=252) vs standard (n=247) treatment groups with stepped treatment algorithms defined for both.Primary end point was progression of atherosclerosis measured by common carotid artery intimal medial thickness (IMT). Secondary end points were other carotid and cardiac ultrasonographic measures and clinical events.Mean target LDL-C and SBP levels for both groups were reached and maintained. Mean (95% confidence interval) levels for LDL-C in the last 12 months were 72 (69-75) and 104 (101-106) mg/dL and SBP levels were 117 (115-118) and 129 (128-130) mm Hg in the aggressive vs standard groups, respectively. Compared with baseline, IMT regressed in the aggressive group and progressed in the standard group (-0.012 mm vs 0.038 mm; P < .001); carotid arterial cross-sectional area also regressed (-0.02 mm(2) vs 1.05 mm(2); P < .001); and there was greater decrease in left ventricular mass index (-2.4 g/m(2.7) vs -1.2 g/m(2.7); P = .03) in the aggressive group. Rates of adverse events (38.5% and 26.7%; P = .005) and serious adverse events (n = 4 vs 1; P = .18) related to blood pressure medications were higher in the aggressive group. Clinical CVD events (1.6/100 and 1.5/100 person-years; P = .87) did not differ significantly between groups.Reducing LDL-C and SBP to lower targets resulted in regression of carotid IMT and greater decrease in left ventricular mass in individuals with type 2 diabetes. Clinical events were lower than expected and did not differ significantly between groups. Further follow-up is needed to determine whether these improvements will result in lower long-term CVD event rates and costs and favorable risk-benefit outcomes.clinicaltrials.gov Identifier: NCT00047424.

Challenges Associated with Metabolic Syndrome

Approximately 2500 Americans die from cardiovascular disease (CVD) each day. Each year, CVD claims more lives than the next four leading causes of death combined. Direct and indirect costs of CVD are estimated to be Dollars 403.1 billion in 2006. Despite advancements in conventional therapy, the residual risk of CVD continues to rise. One component of the cardiometabolic risk is metabolic syndrome. Metabolic syndrome is a constellation of interrelated risk factors of metabolic origin including abdominal obesity, atherogenic dyslipidemia, elevated blood pressure, elevated plasma glucose level, and prothrombotic and proinflammatory states that promote atherosclerotic CVD and increase the risk of type 2 diabetes mellitus. Approximately 47 million residents of the United States have metabolic syndrome. Abdominal obesity and insulin resistance appear to be its predominant underlying risk factors. Abdominal adiposity is considered high-risk fat, and it is associated with insulin resistance, hyperglycemia, dyslipidemia, hypertension, and prothrombotic and/or proinflammatory states. Despite notable advances in cardiovascular risk management, the prevalence of cardiovascular events and type 2 diabetes remains high. First-line therapy for individuals with metabolic syndrome should be directed to the major CVD risk factors, namely, elevated low-density lipoprotein cholesterol levels, hypertension, and diabetes, and it should emphasize lifestyle modification. Until additional research better defines the most appropriate therapies, conventional cardiovascular risk factors, such as lipid levels, blood pressure, and diabetes, should be managed in individuals with metabolic syndrome according to nationally accepted clinical guidelines.

Reducing salt: A challenge for the meat industry

Intake of dietary sodium has been linked to hypertension and consequently increased risk of cardiovascular disease (CVD). The estimated cost of CVD to both the EU and US economies is €169B and $403B, respectively. Currently the daily sodium adult intake is approximately three times the recommended daily allowance (Ireland and UK) and therefore public health and regulatory authorities are recommending reducing dietary intake of sodium to 2.4 g (6 g salt) per day. Processed meat products comprise one of the major sources of sodium in the form of sodium chloride (salt). Salt has an essential function in meat products in terms of flavour, texture and shelf-life. Apart from lowering the level of salt added to products there are a number of approaches to reduce the sodium content in processed foods including the use of salt substitutes, in particular, potassium chloride (KCl) in combination with masking agents, the use of flavour enhancers which enhance the saltiness of products when used with salt and finally optimising the physical form of salt so that it becomes more functional and taste bioavailable. The ultimate goal of ingredient suppliers and meat processors is to produce reduced sodium meat products that consumers can enjoy as part of an ongoing healthier diet and lifestyle. This article reviews some of the technological aspects of reduced salt meat products and how the meat and food ingredient industries are responding to this current health issue.

Talking about…

Talking about…

Dietary Counseling Is an Important Component of Cardiac Rehabilitation

Cardiovascular disease (CVD) remains the number one cause of death in the United States ( 1 American Heart Association. Heart Disease and Stroke Statistics—2005 Update. Available at: http://www.americanheart.org/downloadable/heart/1105390918119HDSStats2005Update.pdf. Accessed June 9, 2005. Google Scholar ). CVD, which encompasses hypertension, coronary heart disease (CHD), congestive heart failure, stroke, and congenital heart defects, killed 931,108 Americans in 2001 ( 1 American Heart Association. Heart Disease and Stroke Statistics—2005 Update. Available at: http://www.americanheart.org/downloadable/heart/1105390918119HDSStats2005Update.pdf. Accessed June 9, 2005. Google Scholar ). CHD alone is the single largest cause of death among Americans; in 2004 it was estimated that 700,000 Americans would experience a coronary attack and 500,000 would have a recurrent attack. The total estimated direct and indirect cost of CVD for 2005 is $393.5 billion ( 1 American Heart Association. Heart Disease and Stroke Statistics—2005 Update. Available at: http://www.americanheart.org/downloadable/heart/1105390918119HDSStats2005Update.pdf. Accessed June 9, 2005. Google Scholar ). Many of the risk factors associated with CVD are modifiable through lifestyle interventions and can play a major role in reducing the personal, societal, and financial burden of the disease. S. S. Jonnalagadda is a manager, Clinical Practice and Standards of Care, Research and Development, Novartis Medical Nutrition, St Louis Park, MN.