The impact of prevention on reducing the burden of cardiovascular disease
The impact of prevention on reducing the burden of cardiovascular disease
复制标题
DOI：
10.1161/circulationaha.108.190186
复制
发表时间：
2008-07-29
期刊：
影响因子：
37.8
通讯作者：
Eddy, David
中科院分区：
文献类型：
--
作者：
Kahn, Richard;Robertson, Rose Marie;Eddy, David
心血管疾病（CVD）是普遍和昂贵的。虽然许多干预措施被推荐用于预防心血管疾病，但一套全面的预防活动对心血管疾病发病率，死亡率和成本的潜在影响从未被评估过。因此，我们确定了11项国家推荐的预防活动对CVD相关发病率、死亡率、研究设计和方法-我们使用的是来自美国人口代表性样本的个人特定数据（全国健康和营养教育调查四），以确定20岁至25岁的成年人的数量和特征。80年来，在美国的今天谁是候选人的不同预防活动有关心血管疾病。我们使用阿基米德模型创建了一个模拟人口，与真实的美国人口逐个匹配。然后，我们使用该模型模拟了一系列临床试验，这些试验检查了在未来30年内逐一或全部应用每种预防活动对各种活动候选人的影响，并将健康结果，生活质量和直接医疗成本与当前的预防和护理水平进行了比较。我们这样做的两套假设下的性能和遵守：100%的成功，为每个活动和较低水平的成功被认为是积极的，但仍然可行的。结果，大约78%的成年人年龄在20-80岁的今天在美国活着的候选人至少有一个预防活动。如果每个人都能参加他们适合的活动，心肌梗死和中风将分别减少63%和31%。如果假设更可行的性能水平，心肌梗死和中风将分别减少36%和20%。所有预防活动的实施将在未来30年内为美国成年人口增加2.21亿生命年和2.44亿质量调整生命年，或所有成年人的平均预期寿命增加1.3年。在具体的预防活动中，对美国人群最大的益处来自于向高危人群提供阿司匹林、控制糖尿病前期、减轻肥胖人群的体重、降低糖尿病患者的血压以及降低现有冠状动脉疾病（CAD）患者的LDL胆固醇。由于目前交付，并在目前的价格，大多数预防活动是昂贵的直接医疗费用时，考虑到戒烟是唯一的预防策略，是节省成本超过30 years. Conclusions，积极应用国家推荐的预防活动可以防止高比例的CAD事件和中风，否则预计会发生在美国的成年人今天。然而，由于目前正在开展这些活动，大多数预防活动将大大增加费用。如果预防战略要充分发挥其潜力，就必须找到降低成本和更有效地开展预防活动的方法。
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 United States.Research Design and Methods—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.Results—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 ≈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.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 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.