School of Population Health, The University of Queensland, Herston, Queensland, Australia.
PLoS One. 2012;7(7):e41842. doi: 10.1371/journal.pone.0041842. Epub 2012 Jul 23.
Despite many decades of declining mortality rates in the Western world, cardiovascular disease remains the leading cause of death worldwide. In this research we evaluate the optimal mix of lifestyle, pharmaceutical and population-wide interventions for primary prevention of cardiovascular disease.
In a discrete time Markov model we simulate the ischaemic heart disease and stroke outcomes and cost impacts of intervention over the lifetime of all Australian men and women, aged 35 to 84 years, who have never experienced a heart disease or stroke event. Best value for money is achieved by mandating moderate limits on salt in the manufacture of bread, margarine and cereal. A combination of diuretic, calcium channel blocker, ACE inhibitor and low-cost statin, for everyone with at least 5% five-year risk of cardiovascular disease, is also cost-effective, but lifestyle interventions aiming to change risky dietary and exercise behaviours are extremely poor value for money and have little population health benefit.
There is huge potential for improving efficiency in cardiovascular disease prevention in Australia. A tougher approach from Government to mandating limits on salt in processed foods and reducing excessive statin prices, and a shift away from lifestyle counselling to more efficient absolute risk-based prescription of preventive drugs, could cut health care costs while improving population health.
尽管在西方世界，心血管疾病的死亡率在过去几十年中一直在下降，但它仍然是全球范围内的主要死因。在这项研究中，我们评估了生活方式、药物和全人群干预措施的最佳组合，以进行心血管疾病的一级预防。
在离散时间马尔可夫模型中，我们模拟了从未经历过心脏病或中风事件的 35 至 84 岁的所有澳大利亚男性和女性一生中，干预对缺血性心脏病和中风结局以及成本的影响。通过强制规定面包、人造黄油和谷物制造过程中盐的适度限量，可以实现最佳的性价比。对于至少有 5%五年心血管疾病风险的每个人，联合使用利尿剂、钙通道阻滞剂、ACE 抑制剂和低成本他汀类药物也是具有成本效益的，但旨在改变危险饮食和运动行为的生活方式干预措施的性价比非常低，对人群健康的益处也很小。
澳大利亚在改善心血管疾病预防效率方面有巨大的潜力。政府采取更严格的方法来强制规定加工食品中的盐限量并降低过高的他汀类药物价格，以及从生活方式咨询转向更有效的基于绝对风险的预防性药物处方，可能会在改善人群健康的同时降低医疗保健成本。
