Cost-effective prevention of cardiovascular disease

描述(由申请者提供)：该国际研究科学家发展奖的目的是为申请者Thomas A Gaziano在发展中国家以高成本效益预防心血管疾病(CVD)作为一名独立研究员的职业生涯做准备。加齐亚诺博士建议在美国的两个既定队列中设计一种简单的无血筛查工具，用于预测那些心血管疾病风险最高的人，然后评估这种策略在南非和印度的成本效益。目前的国际指南根据包括胆固醇和糖尿病状况在内的多种风险因素来评估心血管疾病的风险。然而，血液检测的成本和缺乏训练有素的工作人员来获取样本，使得这些指导方针在发展中国家不切实际。研究计划包括三个具体目标。1.开发一种简单的筛选机制，该机制具有容易获得的心血管疾病危险因素--年龄、烟草、收缩压和肥胖测量(BMI)--并将其与除了年龄、烟草状况和血压之外还需要昂贵的抽血血脂和葡萄糖的常用工具进行比较。2.在成本效益分析中比较具体目标1中得出的两种心血管疾病筛查工具：不抽血筛查、抽血筛查，以及首先评估风险而不抽血的两步过程的第三个战略，以确定可能受益于较高费用抽血筛查的人群的一部分。这项分析将基于印度心血管疾病哨兵监测研究和南非人口与健康调查中的成本和风险因素流行数据。3.使用简化的风险评分和状态转换模型来改进对南非和印度潜在负担疾病的估计。

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.