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How many cardiovascular events can be prevented with optimal management of high-risk Canadians?
Daniel T Grima1, Lawrence A Leiter, Shaun G Goodman
1Cornerstone Research Group Inc., Burlington.
Insights
Optimal use of statins, aspirin (ASA), and ACE inhibitors can significantly reduce cardiovascular (CV) events in high-risk Canadians. Adhering to guidelines can prevent over 143,000 additional CV events in the next decade.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Evidence supports statins, acetylsalicylic acid (ASA), and angiotensin-converting enzyme inhibitors (ACEI) for high-risk cardiovascular (CV) patients.
- Current practice shows a gap between evidence-based recommendations and actual patient care.
Purpose of the Study:
- To quantify the potential reduction in CV events with optimal vascular protection therapy in high-risk Canadians.
- To assess the impact of guideline-adherent therapy on cardiovascular event prevention.
Main Methods:
- Utilized 2003 Canadian Community Health Survey data to estimate high-risk populations.
- Employed a state transition model, risk equations, registry data, and clinical trial efficacy to project 10-year CV events.
- Calculated event reductions based on current care versus optimal therapy scenarios.
Main Results:
- Current statin, ASA, and ACEI use in 2.2 million high-risk Canadians prevents ~400,000 CV events over 10 years.
- Universal optimal use of these therapies could prevent an additional 143,000 CV events compared to current care.
- Demonstrates significant potential for further CV event reduction through improved treatment adherence.
Conclusions:
- Cardiovascular disease remains a significant burden in Canada despite advances in management.
- Canadian physicians can substantially reduce this burden by optimizing care for high-risk patients according to clinical guidelines.
- Optimal management of high-risk individuals represents a key opportunity to improve cardiovascular health outcomes.
Background:
Strong evidence exists to support the use of statins, acetylsalicylic acid (ASA) and angiotensin-converting enzyme inhibitors (ACEI) in patients at high risk of cardiovascular (CV) events; however, current practice pattern data indicate that a significant care gap exists between evidence and practice.
Objectives:
To quantify the reduction in CV events that may be obtained with the optimal use of vascular protection therapy in Canadians at high risk of cardiovascular events.
Methods:
Canadian Community Health Survey data from 2003 were used to estimate the prevalence of heart disease and/or diabetes, which were applied to an age-specific population in Canada to calculate the total number of high-risk patients. The number of events over 10 years was estimated using a state transition model, published risk equations, practice pattern data from Canadian registries and published therapy efficacy from clinical trials.
Results:
Among 2.2 million high-risk Canadians, current care with statin, ASA and ACEI therapy has reduced the estimated occurrence of CV events over the next 10 years by approximately 400,000 from 1.01 million. Universal use of combination statin, ASA and ACEI therapy for high-risk patients, compared with current care, would prevent as many as 143,000 more CV events over the next 10 years.
Conclusions:
Great advances in the management of CV disease have been made; however, CV disease remains a substantial burden to patients and to the Canadian health care system. Canadian physicians have the opportunity to further reduce this burden through optimal management of high-risk patients based on clinical guidelines.
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