Article

Cardiovascular disease (CVD) prevention is commonly focused on
providing individuals at high predicted CVD risk with preventive medication.
Whereas CVD risk increases rapidly with age, current risk-based selection of
individuals mainly targets the elderly. However, the lifelong (preventable)
consequences of CVD events may be larger in younger individuals. The purpose of
this paper is to investigate if health benefits from preventive treatment may
increase when the selection strategy is further optimised. Methods Data from
three Dutch cohorts were combined ( n = 47469, men:women 1:1.92) and classified
into subgroups based on age and gender. The Framingham global risk score was used
to estimate 10-year CVD risk. The associated lifelong burden of CVD events
according to this 10-year CVD risk was expressed as quality-adjusted life years
lost. Based on this approach, the additional health benefits from preventive
treatment, reducing this 10-year CVD risk, from selecting individuals based on
their expected CVD burden rather than their expected CVD risk were estimated.
These benefits were expressed as quality-adjusted life years gained over
lifetime. Results When using the current selection strategy (10% risk threshold),
32% of the individuals were selected for preventive treatment. When the same
proportion was selected based on burden, more younger and fewer older individuals
would receive treatment. Across all individuals, the gain in quality-adjusted
life years was 217 between the two strategies, over a 10-year time horizon. In
addition, when combining the strategies 5% extra eligible individuals were
selected resulting in a gain of 628 quality-adjusted life years. Conclusion
Improvement of the selection approach of individuals can help to reduce further
the CVD burden. Selecting individuals for preventive treatment based on their
expected CVD burden will provide more younger and fewer older individuals with
treatment, and will reduce the overall CVD burden.

Langue : ANGLAIS