Atella V, Brady A, Catapano A L, Critchley J, Graham I M, Hobbs F D R, Leal J, Lindgren P, Vanuzzo D, Volpe M, Wood D, Paoletti R
Department of Economics, University of Rome Tor Vergata, Rome, Italy.
Atheroscler Suppl. 2009 Jun 10;10(1):3-21. doi: 10.1016/S1567-5688(09)70003-0.
In Europe, cardiovascular disease (CVD) represents the main cause of morbidity and mortality, costing countries euro 190 billion yearly (2006). CVD prevention remains unsatisfactory across Europe largely due to poor control of CVD risk factors (RFs), growing incidence of obesity and diabetes, and sedentary lifestyle/poor dietary habits. Hypercholesterolaemia is a proven CVD RF, and LDL-C lowering slows atherosclerotic progression and reduces major coronary events. Lipid-lowering therapy is cost-effective, and intensive treatment of high-risk patients further improves cost effectiveness. In Italy, models indicate that improved cholesterol management translates into potential yearly savings of euro 2.9-4 billion. Identifying and eliminating legislative and administrative barriers is essential to providing optimal lipid care to high-risk patients. Public health and government policy can influence clinical practice rapidly, and guideline endorsement via national health policy may reduce the CVD burden and change physician and patient behaviour. Action to reduce CVD burden should ideally include the integration of strategies to lower the incidence of major CV events, improvement in total CV risk estimation, database monitoring of CVD trends, and development of population educational initiatives on CVD prevention. Failure to bridge the gap between science and health policy, particularly in relation to lipid management, could result in missed opportunities to reverse the burgeoning epidemic of CVD in Europe.
在欧洲,心血管疾病(CVD)是发病和死亡的主要原因,每年给各国造成1900亿欧元的损失(2006年)。欧洲各地的心血管疾病预防工作仍不尽人意,主要原因是心血管疾病风险因素(RFs)控制不佳、肥胖和糖尿病发病率不断上升以及久坐不动的生活方式/不良饮食习惯。高胆固醇血症是已被证实的心血管疾病风险因素,降低低密度脂蛋白胆固醇(LDL-C)可减缓动脉粥样硬化进程并减少主要冠状动脉事件。降脂治疗具有成本效益,对高危患者进行强化治疗可进一步提高成本效益。在意大利,模型表明改善胆固醇管理每年可节省29亿至40亿欧元。识别并消除立法和行政障碍对于为高危患者提供最佳脂质护理至关重要。公共卫生和政府政策可迅速影响临床实践,通过国家卫生政策认可指南可能减轻心血管疾病负担并改变医生和患者的行为。减轻心血管疾病负担的行动理想情况下应包括整合降低主要心血管事件发病率的策略、改进总体心血管疾病风险评估、对心血管疾病趋势进行数据库监测以及开展有关心血管疾病预防的人群教育倡议。未能弥合科学与卫生政策之间的差距,尤其是在脂质管理方面,可能导致错失扭转欧洲心血管疾病迅速蔓延趋势的机会。