Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.
Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
Comput Math Methods Med. 2019 Jan 29;2019:2123079. doi: 10.1155/2019/2123079. eCollection 2019.
Mathematical models offer the potential to analyze and compare the effectiveness of very different interventions to prevent future cardiovascular disease. We developed a comprehensive Markov model to assess the impact of three interventions to reduce ischemic heart diseases (IHD) and stroke deaths: (i) improved medical treatments in acute phase, (ii) secondary prevention by increasing the uptake of statins, (iii) primary prevention using health promotion to reduce dietary salt consumption.
We developed and validated a Markov model for the Tunisian population aged 35-94 years old over a 20-year time horizon. We compared the impact of specific treatments for stroke, lifestyle, and primary prevention on both IHD and stroke deaths. We then undertook extensive sensitivity analyses using both a probabilistic multivariate approach and simple linear regression (metamodeling).
The model forecast a dramatic mortality rise, with 111,134 IHD and stroke deaths (95% CI 106567 to 115048) predicted in 2025 in Tunisia. The salt reduction offered the potentially most powerful preventive intervention that might reduce IHD and stroke deaths by 27% (-30240 [-30580 to -29900]) compared with 1% for medical strategies and 3% for secondary prevention. The metamodeling highlighted that the initial development of a minor stroke substantially increased the subsequent probability of a fatal stroke or IHD death.
The primary prevention of cardiovascular disease via a reduction in dietary salt consumption appeared much more effective than secondary or tertiary prevention approaches. Our simple but comprehensive model offers a potentially attractive methodological approach that might now be extended and replicated in other contexts and populations.
数学模型具有分析和比较预防未来心血管疾病的非常不同干预措施的有效性的潜力。我们开发了一个综合的马尔可夫模型，以评估三种降低缺血性心脏病（IHD）和中风死亡的干预措施的影响：（i）改善急性阶段的医疗治疗，（ii）通过增加他汀类药物的使用来进行二级预防，（iii）通过健康促进减少饮食盐摄入量来进行一级预防。
我们为 35-94 岁的突尼斯人口开发并验证了一个马尔可夫模型，时间跨度为 20 年。我们比较了针对中风、生活方式和一级预防的特定治疗方法对 IHD 和中风死亡的影响。然后，我们使用概率多元方法和简单线性回归（元建模）进行了广泛的敏感性分析。
该模型预测死亡率将大幅上升，到 2025 年，突尼斯预计将有 111,134 例 IHD 和中风死亡（95%CI 106,567 至 115,048）。与医疗策略的 1%和二级预防的 3%相比，减少盐的摄入提供了最有力的潜在预防干预措施，可能会使 IHD 和中风死亡减少 27%（-30240 [-30580 至 -29900]）。元建模突出表明，轻度中风的初始发展会大大增加随后致命性中风或 IHD 死亡的概率。
通过减少饮食盐的摄入来预防心血管疾病的一级预防似乎比二级或三级预防方法更为有效。我们的简单但全面的模型提供了一种潜在有吸引力的方法学方法，现在可以在其他情况下和人群中扩展和复制。
