Cost-effective prevention of cardiovascular disease

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DESCRIPTION (provided by applicant): The purpose of this International Research Scientist Development Award is to prepare the applicant, Thomas A Gaziano, for a career as an independent investigator in cost-effective prevention of cardiovascular disease (CVD) in developing countries. Dr. Gaziano proposes to devise a simple bloodless screening tool in two established cohorts in the US for predicting those at highest risk for CVD and then to assess the cost effectiveness of such a strategy in South Africa and India. Current international guidelines assess risk of CVD on the basis of multiple risk factors including cholesterol and diabetes status. However, the cost of blood testing and a lack of trained staff to obtain samples make these guidelines impractical in developing countries. The research plan consists of three specific aims. 1. To develop a simple screening mechanism with easily obtainable risk factors for CVD --age, tobacco, systolic blood pressure, and an obesity measure (BMI)-- and compare it to a commonly used tool requiring costly blood drawing of lipids and glucose in addition to age, tobacco status, and blood pressure. 2. To compare the two screening tools for CVD derived in specific aim 1 in a cost-effective analysis using the following strategies: screening without blood sampling, screening with blood sampling, and a third strategy of a two step process of first assessing risk with no blood testing to identify a subset of the population who might benefit from higher cost screening with blood testing. This analysis will be based on cost and risk factor prevalence data in the Sentinel Surveillance for CVD in India Study and the Demographic and Health Survey in South Africa. 3. Using the simplified risk score, and the state-transition model to improve estimates of the potential burden disease in South Africa and India.