预防加拿大人群中的心血管疾病：治疗高血压或血脂异常有哪些潜在益处？

Preventing cardiovascular disease among Canadians: what are the potential benefits of treating hypertension or dyslipidemia?

作者信息

Grover Steven A, Coupal Louis, Kaouache Mohammed, Lowensteyn Ilka

机构信息

Centre for the Analysis of Cost-Effective Care, Division of General Internal Medicine, The Montreal General Hospital, Montreal, Canada.

出版信息

Can J Cardiol. 2007 May 1;23(6):467-73. doi: 10.1016/s0828-282x(07)70786-9.

DOI:10.1016/s0828-282x(07)70786-9

PMID:17487292

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2650667/

Abstract

BACKGROUND

Treatments for hypertension and dyslipidemia to prevent the development of cardiovascular disease compete for the same finite number of health care dollars. Therefore, the potential benefits of treating Canadians without cardiovascular disease or diabetes who would currently be targeted by the national treatment guidelines were estimated and compared.

STUDY DESIGN

Canadian Heart Health Surveys data were used to estimate the number of Canadians requiring intervention. The Cardiovascular Life Expectancy Model, a previously validated Markov model, was used to calculate the increased life expectancy and decreased morbidity associated with treating risk factors to target.

RESULTS

Among 8.44 million adults 40 to 74 years of age without cardiovascular disease or diabetes, it was estimated that approximately 2.33 million would require treatment for dyslipidemia and 2.34 million for hypertension. The estimated Framingham 10-year coronary risk averaged 12.4% versus 9.6%, respectively. Treating dyslipidemia was associated with an average increased life expectancy of 1.67 years and 1.81 years of life free of cardiovascular disease. Treating hypertension was expected to increase life expectancy by 0.94 years and years of life free of cardiovascular disease by 1.29 years. The population benefits associated with treating dyslipidemia or hypertension would be 2.5 million and 1.4 million person years of life saved, respectively. Overall, the person years of treatment required to save one year of life was estimated to average 20 years for dyslipidemia therapy and 38 years for hypertension.

CONCLUSIONS

The potential benefits associated with treating hypertension or dyslipidemia to prevent cardiovascular disease are substantial. However, compared with hypertension guidelines, dyslipidemia guidelines target higher-risk patients. Accordingly, given the relative efficacy of each treatment, the forecasted benefits associated with treating dyslipidemia are substantially greater than those associated with hypertension therapy.

摘要

背景

用于预防心血管疾病的高血压和血脂异常治疗方法在争夺同样数量有限的医疗保健资金。因此，对目前符合国家治疗指南目标的无心血管疾病或糖尿病的加拿大人进行治疗的潜在益处进行了估计和比较。

研究设计

利用加拿大心脏健康调查数据估计需要干预的加拿大人数量。心血管预期寿命模型是一个先前经过验证的马尔可夫模型，用于计算针对危险因素进行治疗所带来的预期寿命增加和发病率降低。

结果

在844万年龄在40至74岁之间无心血管疾病或糖尿病的成年人中，估计约有233万人需要进行血脂异常治疗，234万人需要进行高血压治疗。估计的弗明汉10年冠心病风险平均分别为12.4%和9.6%。治疗血脂异常与平均预期寿命增加1.67年以及无心血管疾病的寿命增加1.81年相关。治疗高血压预计可使预期寿命增加0.94年，无心血管疾病的寿命增加1.29年。与治疗血脂异常或高血压相关的人群受益分别为挽救250万人年和140万人年的生命。总体而言，估计每挽救1年生命所需的治疗人年数，血脂异常治疗平均为20年，高血压治疗为38年。