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Total cardiovascular risk approach to improve efficiency of cardiovascular prevention in resource constrain settings

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... Full description

Journal Title: Journal of clinical epidemiology 2011, Vol.64 (12), p.1451-1462
Main Author: Mendis, Shanthi
Other Authors: Lindholm, Lars H , Anderson, Simon G , Alwan, Ala , Koju, Rajendra , Onwubere, Basden J.C , Kayani, Azhar Mahmood , Abeysinghe, Nihal , Duneas, Alfredo , Tabagari, Sergo , Fan, Wu , Sarraf-Zadegan, Nizal , Nordet, Porfirio , Whitworth, Judith , Heagerty, Anthony
Format: Electronic Article Electronic Article
Language: English
Subjects:
Adult
Aged
Aged, 80 and over
Armed Forces
Arterial hypertension. Arterial hypotension
Atherosclerosis
Biological and medical sciences
Blood and lymphatic vessels
Cardiology
Cardiology. Vascular system
Cardiovascular disease
Cardiovascular diseases
Cardiovascular Diseases - economics
Cardiovascular Diseases - epidemiology
Cardiovascular Diseases - etiology
Cardiovascular Diseases - prevention & control
China - epidemiology
Cost saving
Cost-Benefit Analysis
Cross-Sectional Studies
Cuba - epidemiology
Developing Countries - economics
Epidemiology
Female
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Georgia - epidemiology
Health policy
Health Resources - economics
Health Resources - supply & distribution
Health Sciences
Heart attacks
Humans
Hypercholesterolemia - epidemiology
Hypercholesterolemia - prevention & control
Hypertension
Hypertension - epidemiology
Hypertension - prevention & control
Hälsovetenskaper
Internal Medicine
Iran - epidemiology
Male
Medical and Health Sciences
Medical colleges
Medical sciences
Medicin och hälsovetenskap
Middle Aged
Miscellaneous
Mortality
Nepal - epidemiology
Nigeria - epidemiology
Pakistan - epidemiology
Patient Selection
Prevention
Prevention and actions
Preventive cardiology
Public health
Public Health, Global Health, Social Medicine and Epidemiology
Public health. Hygiene
Public health. Hygiene-occupational medicine
Risk
Risk Assessment
Risk Factors
Sri Lanka - epidemiology
World Health Organization
Quelle: Alma/SFX Local Collection
Publisher: New York, NY: Elsevier Inc
ID: ISSN: 0895-4356
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recordid: cdi_swepub_primary_oai_DiVA_org_umu_50405
title: Total cardiovascular risk approach to improve efficiency of cardiovascular prevention in resource constrain settings
format: Article
creator:
  • Mendis, Shanthi
  • Lindholm, Lars H
  • Anderson, Simon G
  • Alwan, Ala
  • Koju, Rajendra
  • Onwubere, Basden J.C
  • Kayani, Azhar Mahmood
  • Abeysinghe, Nihal
  • Duneas, Alfredo
  • Tabagari, Sergo
  • Fan, Wu
  • Sarraf-Zadegan, Nizal
  • Nordet, Porfirio
  • Whitworth, Judith
  • Heagerty, Anthony
subjects:
  • Adult
  • Aged
  • Aged, 80 and over
  • Armed Forces
  • Arterial hypertension. Arterial hypotension
  • Atherosclerosis
  • Biological and medical sciences
  • Blood and lymphatic vessels
  • Cardiology
  • Cardiology. Vascular system
  • Cardiovascular disease
  • Cardiovascular diseases
  • Cardiovascular Diseases - economics
  • Cardiovascular Diseases - epidemiology
  • Cardiovascular Diseases - etiology
  • Cardiovascular Diseases - prevention & control
  • China - epidemiology
  • Cost saving
  • Cost-Benefit Analysis
  • Cross-Sectional Studies
  • Cuba - epidemiology
  • Developing Countries - economics
  • Epidemiology
  • Female
  • Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
  • Georgia - epidemiology
  • Health policy
  • Health Resources - economics
  • Health Resources - supply & distribution
  • Health Sciences
  • Heart attacks
  • Humans
  • Hypercholesterolemia - epidemiology
  • Hypercholesterolemia - prevention & control
  • Hypertension
  • Hypertension - epidemiology
  • Hypertension - prevention & control
  • Hälsovetenskaper
  • Internal Medicine
  • Iran - epidemiology
  • Male
  • Medical and Health Sciences
  • Medical colleges
  • Medical sciences
  • Medicin och hälsovetenskap
  • Middle Aged
  • Miscellaneous
  • Mortality
  • Nepal - epidemiology
  • Nigeria - epidemiology
  • Pakistan - epidemiology
  • Patient Selection
  • Prevention
  • Prevention and actions
  • Preventive cardiology
  • Public health
  • Public Health, Global Health, Social Medicine and Epidemiology
  • Public health. Hygiene
  • Public health. Hygiene-occupational medicine
  • Risk
  • Risk Assessment
  • Risk Factors
  • Sri Lanka - epidemiology
  • World Health Organization
ispartof: Journal of clinical epidemiology, 2011, Vol.64 (12), p.1451-1462
description: 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
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0895-4356
fulltext: fulltext
issn:
  • 0895-4356
  • 1878-5921
  • 1878-5921
url: Link


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titleTotal cardiovascular risk approach to improve efficiency of cardiovascular prevention in resource constrain settings
sourceAlma/SFX Local Collection
creatorMendis, Shanthi ; Lindholm, Lars H ; Anderson, Simon G ; Alwan, Ala ; Koju, Rajendra ; Onwubere, Basden J.C ; Kayani, Azhar Mahmood ; Abeysinghe, Nihal ; Duneas, Alfredo ; Tabagari, Sergo ; Fan, Wu ; Sarraf-Zadegan, Nizal ; Nordet, Porfirio ; Whitworth, Judith ; Heagerty, Anthony
creatorcontribMendis, Shanthi ; Lindholm, Lars H ; Anderson, Simon G ; Alwan, Ala ; Koju, Rajendra ; Onwubere, Basden J.C ; Kayani, Azhar Mahmood ; Abeysinghe, Nihal ; Duneas, Alfredo ; Tabagari, Sergo ; Fan, Wu ; Sarraf-Zadegan, Nizal ; Nordet, Porfirio ; Whitworth, Judith ; Heagerty, Anthony
descriptionAbstract 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.
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publisherNew York, NY: Elsevier Inc
subjectAdult ; Aged ; Aged, 80 and over ; Armed Forces ; Arterial hypertension. Arterial hypotension ; Atherosclerosis ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology ; Cardiology. Vascular system ; Cardiovascular disease ; Cardiovascular diseases ; Cardiovascular Diseases - economics ; Cardiovascular Diseases - epidemiology ; Cardiovascular Diseases - etiology ; Cardiovascular Diseases - prevention & control ; China - epidemiology ; Cost saving ; Cost-Benefit Analysis ; Cross-Sectional Studies ; Cuba - epidemiology ; Developing Countries - economics ; Epidemiology ; Female ; Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ; Georgia - epidemiology ; Health policy ; Health Resources - economics ; Health Resources - supply & distribution ; Health Sciences ; Heart attacks ; Humans ; Hypercholesterolemia - epidemiology ; Hypercholesterolemia - prevention & control ; Hypertension ; Hypertension - epidemiology ; Hypertension - prevention & control ; Hälsovetenskaper ; Internal Medicine ; Iran - epidemiology ; Male ; Medical and Health Sciences ; Medical colleges ; Medical sciences ; Medicin och hälsovetenskap ; Middle Aged ; Miscellaneous ; Mortality ; Nepal - epidemiology ; Nigeria - epidemiology ; Pakistan - epidemiology ; Patient Selection ; Prevention ; Prevention and actions ; Preventive cardiology ; Public health ; Public Health, Global Health, Social Medicine and Epidemiology ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Risk ; Risk Assessment ; Risk Factors ; Sri Lanka - epidemiology ; World Health Organization
ispartofJournal of clinical epidemiology, 2011, Vol.64 (12), p.1451-1462
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7Abeysinghe, Nihal
8Duneas, Alfredo
9Tabagari, Sergo
10Fan, Wu
11Sarraf-Zadegan, Nizal
12Nordet, Porfirio
13Whitworth, Judith
14Heagerty, Anthony
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descriptionAbstract 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.
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2Aged, 80 and over
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5Atherosclerosis
6Biological and medical sciences
7Blood and lymphatic vessels
8Cardiology
9Cardiology. Vascular system
10Cardiovascular disease
11Cardiovascular diseases
12Cardiovascular Diseases - economics
13Cardiovascular Diseases - epidemiology
14Cardiovascular Diseases - etiology
15Cardiovascular Diseases - prevention & control
16China - epidemiology
17Cost saving
18Cost-Benefit Analysis
19Cross-Sectional Studies
20Cuba - epidemiology
21Developing Countries - economics
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25Georgia - epidemiology
26Health policy
27Health Resources - economics
28Health Resources - supply & distribution
29Health Sciences
30Heart attacks
31Humans
32Hypercholesterolemia - epidemiology
33Hypercholesterolemia - prevention & control
34Hypertension
35Hypertension - epidemiology
36Hypertension - prevention & control
37Hälsovetenskaper
38Internal Medicine
39Iran - epidemiology
40Male
41Medical and Health Sciences
42Medical colleges
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44Medicin och hälsovetenskap
45Middle Aged
46Miscellaneous
47Mortality
48Nepal - epidemiology
49Nigeria - epidemiology
50Pakistan - epidemiology
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60Risk Assessment
61Risk Factors
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titleTotal cardiovascular risk approach to improve efficiency of cardiovascular prevention in resource constrain settings
authorMendis, Shanthi ; Lindholm, Lars H ; Anderson, Simon G ; Alwan, Ala ; Koju, Rajendra ; Onwubere, Basden J.C ; Kayani, Azhar Mahmood ; Abeysinghe, Nihal ; Duneas, Alfredo ; Tabagari, Sergo ; Fan, Wu ; Sarraf-Zadegan, Nizal ; Nordet, Porfirio ; Whitworth, Judith ; Heagerty, Anthony
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1Aged
2Aged, 80 and over
3Armed Forces
4Arterial hypertension. Arterial hypotension
5Atherosclerosis
6Biological and medical sciences
7Blood and lymphatic vessels
8Cardiology
9Cardiology. Vascular system
10Cardiovascular disease
11Cardiovascular diseases
12Cardiovascular Diseases - economics
13Cardiovascular Diseases - epidemiology
14Cardiovascular Diseases - etiology
15Cardiovascular Diseases - prevention & control
16China - epidemiology
17Cost saving
18Cost-Benefit Analysis
19Cross-Sectional Studies
20Cuba - epidemiology
21Developing Countries - economics
22Epidemiology
23Female
24Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
25Georgia - epidemiology
26Health policy
27Health Resources - economics
28Health Resources - supply & distribution
29Health Sciences
30Heart attacks
31Humans
32Hypercholesterolemia - epidemiology
33Hypercholesterolemia - prevention & control
34Hypertension
35Hypertension - epidemiology
36Hypertension - prevention & control
37Hälsovetenskaper
38Internal Medicine
39Iran - epidemiology
40Male
41Medical and Health Sciences
42Medical colleges
43Medical sciences
44Medicin och hälsovetenskap
45Middle Aged
46Miscellaneous
47Mortality
48Nepal - epidemiology
49Nigeria - epidemiology
50Pakistan - epidemiology
51Patient Selection
52Prevention
53Prevention and actions
54Preventive cardiology
55Public health
56Public Health, Global Health, Social Medicine and Epidemiology
57Public health. Hygiene
58Public health. Hygiene-occupational medicine
59Risk
60Risk Assessment
61Risk Factors
62Sri Lanka - epidemiology
63World Health Organization
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0Mendis, Shanthi
1Lindholm, Lars H
2Anderson, Simon G
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4Koju, Rajendra
5Onwubere, Basden J.C
6Kayani, Azhar Mahmood
7Abeysinghe, Nihal
8Duneas, Alfredo
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11Sarraf-Zadegan, Nizal
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atitleTotal cardiovascular risk approach to improve efficiency of cardiovascular prevention in resource constrain settings
jtitleJournal of clinical epidemiology
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date2011
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volume64
issue12
spage1451
epage1462
pages1451-1462
issn
00895-4356
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abstractAbstract 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.
copNew York, NY
pubElsevier Inc
pmid21530172
doi10.1016/j.jclinepi.2011.02.001
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