Cardiovascular disease is a major global health problem, both in developed and less-developed countries--accounting for around 20% and 8% of total disability-adjusted life years (DALYs), respectively. Systolic blood pressure above 115 millimetres of mercury accounts for two-thirds of strokes and almost half of ischaemic heart disease. High cholesterol is another major risk factor for cardiovascular disease--concentrations above 3.8 mmol per litre account for around 18% of strokes and 55% of ischaemic heart disease.
Christopher Murray and colleagues from the World Health Organisation, and investigators from the Netherlands and New Zealand, assessed the cost-effectiveness of implementing major health interventions to reduce death and disability from cardiovascular disease worldwide. They evaluated 17 non-personal and personal factors that could impact on the reduction of cardiovascular disease. Non-personal health interventions included health education through the mass media (focusing on the reduction of blood pressure, cholesterol concentration, and bodyweight), and either legislation or voluntary agreements on salt content to ensure appropriate labelling and decreases in the salt content of processed foods. Personal interventions included the detection and treatment of people with high concentrations of cholesterol, treatment of individuals with high systolic blood pressure, treatment of both high blood pressure and high cholesterol, and treatment of individuals based on their absolute risk of a cardiovascular event in the next 10 years.
The investigators evaluated the epidemiological differences of cardiovascular risk across 14 regions of the world and sought to prioritise personal and non-personal interventions for each region. The main study finding was the potential for both personal and non-personal interventions to have substantial effects in both developed and less-developed settings. The investigators comment how non-personal health interventions--including government action to reduce the salt content of processed foods--are cost-effective ways to limit cardiovascular disease and could avert over 21 million DALYs per year worldwide. Combination treatment with blood pressure and cholesterol-lowering agents and with aspirin for individuals whose risk of a cardiovascular event over the next 10 years is above 35% was also judged to be cost-effective; this could further reduce the impact of cardiovascular disease by 63 million DALYs per year worldwide. In all regions this was more cost-effective than traditional blood-pressure lowering or cholesterol-lowering treatment strategies.
Christopher Murray comments: "Our findings challenge the perception that strategies to prevent cardiovascular disease should strictly be the concern of the very wealthy. Implied in these results is a further frameshift in thinking about priorities and public-health strategies for less developed regions."
Contact: J Liden, WHO Communications, World Health Organization, 1211, Geneva 27, Switzerland;
T) 41-22-791-3982;
F) 41-22-791-4881;
E) Lidenj@who.int
Journal
The Lancet