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Total Cardiovascular Risk Approach to Improve Efficiency of Cardiovascular Prevention in Resource Constrain Settings Publisher Pubmed



Mendis S1 ; Lindholm LH2 ; Anderson SG3 ; Alwan A1 ; Koju R4 ; Onwubere BJC5 ; Kayani AM6 ; Abeysinghe N7 ; Duneas A8 ; Tabagari S9 ; Fan W10 ; Sarrafzadegan N11 ; Nordet P1 ; Whitworth J12 Show All Authors
Authors
  1. Mendis S1
  2. Lindholm LH2
  3. Anderson SG3
  4. Alwan A1
  5. Koju R4
  6. Onwubere BJC5
  7. Kayani AM6
  8. Abeysinghe N7
  9. Duneas A8
  10. Tabagari S9
  11. Fan W10
  12. Sarrafzadegan N11
  13. Nordet P1
  14. Whitworth J12
  15. Heagerty A3
Show Affiliations
Authors Affiliations
  1. 1. Noncommunicable Diseases and Mental Health Cluster, World Health Organization, Geneva, Switzerland
  2. 2. Public Health and Clinical Medicine, Umea University, Sweden
  3. 3. Division of Cardiovascular and Endocrine Sciences, University of Manchester, Manchester, United Kingdom
  4. 4. Kathmandu University Teaching Hospital, Kathmandu, Nepal
  5. 5. Department of Medicine, University of Nigeria Teaching Hospital, Nigeria
  6. 6. Armed Forces and National Institute of Cardiology, Rawalpindi, Pakistan
  7. 7. Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka
  8. 8. Preventive Cardiology Department, Cuban Institute of Cardiology, Havana, Cuba
  9. 9. Aieti Medical School, Tbilisi, Georgia
  10. 10. Chinese Centre for Disease Control and Prevention, Beijing, China
  11. 11. Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences (IUMS), Isfahan, Iran
  12. 12. John Curtin School of Medical Research, Canberra, Australia

Source: Journal of Clinical Epidemiology Published:2011


Abstract

Objectives: To determine the population distribution of cardiovascular risk in eight low- and middle-income countries and compare the cost of drug treatment based on cardiovascular risk (cardiovascular risk thresholds ≥30%/≥40%) with single risk factor cutoff levels. Study Design and Setting: Using World Health Organization (WHO) and the International Society of Hypertension risk prediction charts, cardiovascular risk was categorized in a cross-sectional study of 8,625 randomly selected people aged 40-80 years (mean age, 54.6 years) from defined geographic regions of Nigeria, Iran, China, Pakistan, Georgia, Nepal, Cuba, and Sri Lanka. Cost estimates for drug therapy were calculated for three countries. Results: A large fraction (90.0-98.9%) of the study population has a 10-year cardiovascular risk <20%. Only 0.2-4.8% are in the high-risk categories (≥30%). Adopting a total risk approach and WHO guidelines recommendations would restrict unnecessary drug treatment and reduce the drug costs significantly. Conclusion: Adopting a total cardiovascular risk approach instead of a single risk factor approach reduces health care expenditure by reducing drug costs. Therefore, limited resources can be more efficiently used to target high-risk people who will benefit the most. This strategy needs to be complemented with population-wide measures to shift the cardiovascular risk distribution of the whole population. © 2011 Elsevier Inc. All rights reserved.
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