Preventing cardiovascular disease among Canadians: what are the potential benefits of treating hypertension or dyslipidemia?
BACKGROUND
Treatments for hypertension and dyslipidemia to prevent the development of cardiovascular disease compete for the same finite number of health care dollars. Therefore, the potential benefits of treating Canadians without cardiovascular disease or diabetes who would currently be targeted by the national treatment guidelines were estimated and compared.


METHODS
Canadian Heart Health Surveys data were used to estimate the number of Canadians requiring intervention. The Cardiovascular Life Expectancy Model, a previously validated Markov model, was used to calculate the increased life expectancy and decreased morbidity associated with treating risk factors to target.


RESULTS
Among 8.44 million adults 40 to 74 years of age without cardiovascular disease or diabetes, it was estimated that approximately 2.33 million would require treatment for dyslipidemia and 2.34 million for hypertension. The estimated Framingham 10-year coronary risk averaged 12.4% versus 9.6%, respectively. Treating dyslipidemia was associated with an average increased life expectancy of 1.67 years and 1.81 years of life free of cardiovascular disease. Treating hypertension was expected to increase life expectancy by 0.94 years and years of life free of cardiovascular disease by 1.29 years. The population benefits associated with treating dyslipidemia or hypertension would be 2.5 million and 1.4 million person years of life saved, respectively. Overall, the person years of treatment required to save one year of life was estimated to average 20 years for dyslipidemia therapy and 38 years for hypertension.


CONCLUSIONS
The potential benefits associated with treating hypertension or dyslipidemia to prevent cardiovascular disease are substantial. However, compared with hypertension guidelines, dyslipidemia guidelines target higher-risk patients. Accordingly, given the relative efficacy of each treatment, the forecasted benefits associated with treating dyslipidemia are substantially greater than those associated with hypertension therapy.
Grover
Steven A
SA
Centre for the Analysis of Cost-Effective Care, Division of General Internal Medicine, The Montreal General Hospital, Montreal, Canada. steven.grover@mcgill.ca
Coupal
Louis
L
Kaouache
Mohammed
M
Lowensteyn
Ilka
I
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002170:Canada / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000191:economics / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D050171:Dyslipidemias / Q000191:economics* / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D017048:Health Care Costs; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000191:economics* / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011314:Preventive Health Services / Q000191:economics*; D017678:Sex Distribution