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

Area of Science:

• Cardiovascular epidemiology
• Health economics
• Public health policy

Background:

• Cardiovascular diseases (CVDs) pose a significant burden globally, particularly in low- and middle-income countries (LMICs).
• Current CVD risk management often relies on single risk factor thresholds, potentially leading to suboptimal resource allocation and unnecessary drug treatments.

Purpose of the Study:

• To assess the population distribution of 10-year cardiovascular risk in eight LMICs.
• To compare the cost-effectiveness of drug treatment strategies based on total cardiovascular risk versus single risk factor cutoffs.

Main Methods:

• A cross-sectional study involving 8,625 participants aged 40-80 years from Nigeria, Iran, China, Pakistan, Georgia, Nepal, Cuba, and Sri Lanka.
• Utilized World Health Organization (WHO) and International Society of Hypertension risk prediction charts for risk categorization.
• Calculated drug therapy cost estimates for three selected countries.

Main Results:

• A substantial majority (90.0-98.9%) of the study population exhibited a 10-year cardiovascular risk below 20%.
• Only a small fraction (0.2-4.8%) fell into high-risk categories (≥30%).
• Implementing a total risk approach aligned with WHO guidelines demonstrated potential for significant reduction in drug costs by limiting unnecessary treatments.

Conclusions:

• Adopting a total cardiovascular risk strategy, rather than focusing on single risk factors, can substantially reduce healthcare expenditure by optimizing drug costs.
• This approach enables more efficient allocation of limited resources towards individuals who would benefit most from interventions.
• Complementary population-wide measures are essential to shift the overall cardiovascular risk distribution within the population.