Value of Primordial and Primary Prevention for Cardiovascular Disease A Policy Statement From the American Heart Association
Value of Primordial and Primary Prevention for Cardiovascular Disease A Policy Statement From the American Heart Association
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DOI：
10.1161/cir.0b013e3182285a81
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发表时间：
2011-08-23
期刊：
影响因子：
37.8
通讯作者：
Whitsel, Laurie P.
中科院分区：
文献类型：
--
作者：
Weintraub, William S.;Daniels, Stephen R.;Whitsel, Laurie P.
动脉粥样硬化的过程可能开始于青年，并持续数十年，导致非致命性和致命性心血管事件，包括心肌梗死、中风和猝死。通过原始和初级预防，心血管疾病在很大程度上是可以预防的。临床试验证据令人信服地表明，药物治疗的风险因素可以防止事件。这些数据不太确定，但也高度暗示，旨在消除烟草使用、限制盐摄入、鼓励体育锻炼和改善饮食的适当公共政策和生活方式干预可以预防事件。人们一直担心，以原始和初级预防为目标的努力是否有价值（即，这种干预措施是否值得我们为之付出代价）。虽然关于急性疾病治疗价值的问题可以通过成本效益分析来解决，但评估预防性干预措施所涉及的长期框架使成本效益分析变得困难，而且必然存在缺陷。尽管如此，本政策声明中审查的成本效益分析在很大程度上表明，公共政策，社区努力和药物干预都可能具有成本效益，并且与共同基准相比通常可以节省成本。心血管疾病的直接医疗和间接成本很高，2010年接近4500亿美元，预计到2030年将上升到每年超过1万亿美元，这使其成为一个关键的医疗和社会问题。预防心血管疾病也将为发展一个更健康、更有生产力的社会提供巨大价值。（循环。2011;124：967-990）。
The process of atherosclerosis may begin in youth and continue for decades, leading to both nonfatal and fatal cardiovascular events, including myocardial infarction, stroke, and sudden death. With primordial and primary prevention, cardiovascular disease is largely preventable. Clinical trial evidence has shown convincingly that pharmacological treatment of risk factors can prevent events. The data are less definitive but also highly suggestive that appropriate public policy and lifestyle interventions aimed at eliminating tobacco use, limiting salt consumption, encouraging physical exercise, and improving diet can prevent events. There has been concern about whether efforts aimed at primordial and primary prevention provide value (ie, whether such interventions are worth what we pay for them). Although questions about the value of therapeutics for acute disease may be addressed by cost-effectiveness analysis, the long time frames involved in evaluating preventive interventions make cost-effectiveness analysis difficult and necessarily flawed. Nonetheless, cost-effectiveness analyses reviewed in this policy statement largely suggest that public policy, community efforts, and pharmacological intervention are all likely to be cost-effective and often cost saving compared with common benchmarks. The high direct medical care and indirect costs of cardiovascular disease-approaching $450 billion a year in 2010 and projected to rise to over $1 trillion a year by 2030-make this a critical medical and societal issue. Prevention of cardiovascular disease will also provide great value in developing a healthier, more productive society. (Circulation. 2011;124:967-990.)