Estimation of the burden of cardiovascular disease attributable to modifiable risk factors and cost-effectiveness analysis of preventative interventions to reduce this burden in Argentina

Rubinstein, Adolfo; Colantonio, Lisandro; Bardach, Ariel; Caporale, Joaquín; Martí, Sebastián García; Kopitowski, Karin; Alcaraz, Andrea; Gibbons, Luz; Augustovski, Federico; Pichón-Rivière, Andrés
January 2010
BMC Public Health;2010, Vol. 10 Issue 1, p627
Academic Journal
Background: Cardiovascular disease (CVD) is the primary cause of mortality and morbidity in Argentina representing 34.2% of deaths and 12.6% of potential years of life lost (PYLL). The aim of the study was to estimate the burden of acute coronary heart disease (CHD) and stroke and the cost-effectiveness of preventative population-based and clinical interventions. Methods: An epidemiological model was built incorporating prevalence and distribution of high blood pressure, high cholesterol, hyperglycemia, overweight and obesity, smoking, and physical inactivity, obtained from the Argentine Survey of Risk Factors dataset. Population Attributable Fraction (PAF) of each risk factor was estimated using relative risks from international sources. Total fatal and non-fatal events, PYLL and Disability Adjusted Life Years (DALY) were estimated. Costs of event were calculated from local utilization databases and expressed in international dollars (I$). Incremental cost-effectiveness ratios (ICER) were estimated for six interventions: reducing salt in bread, mass media campaign to promote tobacco cessation, pharmacological therapy of high blood pressure, pharmacological therapy of high cholesterol, tobacco cessation therapy with bupropion, and a multidrug strategy for people with an estimated absolute risk > 20% in 10 years. Results: An estimated total of 611,635 DALY was lost due to acute CHD and stroke for 2005. Modifiable risk factors explained 71.1% of DALY and more than 80% of events. Two interventions were cost-saving: lowering salt intake in the population through reducing salt in bread and multidrug therapy targeted to persons with an absolute risk above 20% in 10 years; three interventions had very acceptable ICERs: drug therapy for high blood pressure in hypertensive patients not yet undergoing treatment (I$ 2,908 per DALY saved), mass media campaign to promote tobacco cessation amongst smokers (I$ 3,186 per DALY saved), and lowering cholesterol with statin drug therapy (I$ 14,432 per DALY saved); and one intervention was not found to be cost-effective: tobacco cessation with bupropion (I$ 59,433 per DALY saved) Conclusions: Most of the interventions selected were cost-saving or very cost-effective. This study aims to inform policy makers on resource-allocation decisions to reduce the burden of CVD in Argentina.


Related Articles

  • Strategies for maintaining heart health. Hazzard, William R.; Wei, Jeanne // Patient Care;11/15/2001, Vol. 35 Issue 21, p56 

    Offers ideas on coping and managing cardiovascular conditions in older patients. Diagnosis of hypertension; Correlation between age and atherosclerosis; Symptoms of coronary artery disease; Mortality associated with heart failure.

  • Treatment of older persons with hypercholesterolemia with and without cardiovascular disease. Aronow, Wilbert S.; Aronow, W S // Journals of Gerontology Series A: Biological Sciences & Medical ;Mar2001, Vol. 56 Issue 3, pM138 

    Hypercholesterolemia is a risk factor for new coronary events in older men and women. Secondary prevention trials have demonstrated in persons with coronary artery disease (CAD) and hypercholesterolemia that statin drugs reduced in older persons all-cause mortality, cardiovascular mortality,...

  • Novel biomarkers add little to conventional risk factors. Lindsay, Alistair // Heart;Nov2009, Vol. 92 Issue 21, p19 

    The article focuses on the utilization of several biomarkers including C-reactive protein (CRP), cystatin C, and B-type natriuretic peptide (BNP) in identifying the cardiovascular risk factors. A study was conducted to test whether these biomarkers can be considered as risk elements for...

  • The Efficacy Of Thrombolytic Treatment On Patients Who Are Above 75 Years Of Age. Keles, Telat; Akar, Nihal; Gürsel, Koray; Canbay, Alper; Sahin, Deniz; Durmaz, Tahir; Diker, Erdem; Aydogdu, Sinan // Internet Journal of Cardiology;2006, Vol. 3 Issue 1, p2 

    Background: For acute myocardial infarction (AMI) patients above the age of 75, the efficacy of thrombolytic treatment could not be demonstrated clearly. Recently, depending on the data obtained from observational studies, it has been advocated that thrombolytic treatment might not be showing...

  • Cardiovascular disease risk assessment in older women: can we improve on Framingham? British Women's Heart and Health prospective cohort study. May, M.; Lawlor, D. A.; Brindle, P.; Patel, R.; Ebrahim, S. // Heart;Oct2006, Vol. 92 Issue 10, p1396 

    Objectives: To develop a cardiovascular risk assessment tool that is feasible and easy to use in primary care (general practice (GP) model). Design: Prospective cohort study. Setting: 23 towns in the United Kingdom. Participants: 3582 women aged 60 to 79 years who were free of coronary heart...

  • Cholesterol-lowering agents underutilized in older persons.  // Geriatrics;Nov98, Vol. 53 Issue 11, p16 

    Focuses on the inadequate cholesterol-lowering therapy received by older person with a history of coronary heart disease reported by the Cardiovascular Health Study. Remarks from the study co-author by Curt D. Furberg; Details on the study; Importance of cholesterol-lowering agents in...

  • Statin Therapy in Very Elderly Patients with CAD. Miller, Karl E. // American Family Physician;3/15/2003, Vol. 67 Issue 6, p1354 

    Discusses the study 'Statin Therapy Is Associated With Reduced Mortality Across All Age Groups of Individuals With Significant Coronary Disease, Including Very Elderly Patients,' by C.A. Maycock et al., from the November 20, 2002 issue of the 'Journal of American College Cardiology.'

  • Four commonly seen cardiovascular diseases. Flack, John M.; O'Connor, Christopher M.; Wei, Jeanne Y.; Labson, Lucy H. // Patient Care;5/15/1998, Vol. 32 Issue 9, p98 

    Presents information on the four common cardiovascular diseases seen in elderly patients. Identification of these diseases; Example of techniques that have changed some of the rules on managing cardiovascular disease in older patients; Tips for diagnosing these diseases. INSETS: Expected...

  • Non-response bias in a study of cardiovascular diseases, functional status and self-rated... Hoeymans, Nancy; Freskens, Edith J.M.; Van Den Bos, Geertrudis A. M.; Kromhout, Daan // Age & Ageing;Jan1998, Vol. 27 Issue 1, p35 

    Provides a study which investigates to what extent differences in health status between respondents and drop-outs, which affected the associations between cardiovascular diseases, functional status and self-related health, in the longitudinal health survey of the Zutphen Elderly Study in elderly...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics