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Determining optimal strategies for primary prevention of cardiovascular disease: systematic review,
Olalekan A Uthman1, Lena Al-Khudairy2, Chidozie U Nduka2
1Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK. olalekan.uthman@warwick.ac.uk.
Insights
This study synthesizes evidence on interventions for cardiovascular disease (CVD) primary prevention. Findings will guide policymakers in selecting cost-effective strategies to reduce CVD deaths and healthcare costs.
Area of Science:
- Public Health
- Epidemiology
- Health Economics
Background:
- Cardiovascular disease (CVD) remains a significant public health concern in the UK, with high mortality rates and substantial healthcare costs.
- Over 90% of first heart attacks are linked to modifiable risk factors such as smoking, poor diet, and hypertension.
- Effective primary prevention strategies are crucial to mitigate the burden of CVD.
Purpose of the Study:
- To systematically synthesize evidence on the comparative effectiveness and cost-effectiveness of various interventions for the primary prevention of CVD.
- To provide an overarching evidence base for policymakers and inform guidelines for CVD prevention strategies.
Main Methods:
- Systematic literature search of randomized controlled trials (RCTs) across major databases (MEDLINE, Embase, Cochrane Library).
- Inclusion of all intervention types for primary CVD prevention in adult populations, regardless of risk group targeting.
- Primary outcome: all-cause mortality; Secondary outcomes: CVD-specific mortality, major cardiovascular events, and cost-effectiveness (QALYs gained). Network meta-analysis will be employed if data permits.
Main Results:
- The synthesis will compare the effectiveness and cost-effectiveness of diverse primary CVD prevention interventions.
- Network meta-analysis will rank interventions and explore effect modification through subgroup and meta-regression analyses.
- Results will provide a comprehensive overview of evidence, surpassing individual pairwise meta-analyses.
Conclusions:
- The findings will be instrumental for policymakers in choosing optimal strategies for CVD primary prevention.
- This synthesis will enhance evidence-based decision-making for public health policies and planning.
- Crucial for establishing priorities and guidelines to reduce CVD burden and associated costs.
Background:
Despite recent improvements in the burden of cardiovascular disease (CVD) in the UK, deaths from CVD are relatively high compared with other high-income countries. An estimated 7 million people in the UK are living with CVD, and the healthcare cost is approximately £11 billion annually. In more than 90% of cases, the risk of a first heart attack is thought to be related to modifiable risk factors including smoking, poor diet, lipidemia, high blood pressure, inactivity, obesity and excess alcohol consumption. The aim of the study is to synthesise evidence for the comparative effectiveness and cost-effectiveness of different interventions for the primary prevention of CVD.
Methods:
We will systematically search databases (for example, MEDLINE (Ovid), Embase (Ovid), Cochrane Library) and the reference lists of previous systematic reviews for randomised controlled trials that assess the effectiveness and cost-effectiveness of any form of intervention aimed at adult populations for the primary prevention of CVD, including but not limited to lipid lowering medications, blood pressure lowering medications, antiplatelet agents, nutritional supplements, dietary interventions, health promotion programmes, physical activity interventions or structural and policy interventions. Interventions may or may not be targeted at high-risk groups. Publications from any year will be considered for inclusion. The primary outcome will be all cause mortality. Secondary outcomes will be cardiovascular diseases related mortality, major cardiovascular events, coronary heart disease, incremental costs per quality-adjusted life years gained. If data permits, we will use network meta-analysis to compare and rank effectiveness of different interventions, and test effect modification of intervention effectiveness using subgroup analyses and meta-regression analyses.
Discussion:
The results will be important for policymakers when making decisions between multiple possible alternative strategies to prevent CVD. Compared to results from existing multiple separate pairwise meta-analyses, this overarching synthesis of all relevant work will enhance decision-making. The findings will be crucial to inform evidence-based priorities and guidelines for policies and planning prevention strategies of CVD.
Systematic Review Registration:
PROSPERO CRD42019123940.
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