title: Comparing Strategies for Lipid Lowering in Argentina: An Analysis from the CVD Policy Model-Argentina.
abstract: BACKGROUND
  In Argentina, the national guidelines for lipid control emphasize the use of relatively inexpensive low- or moderate-potency statins by patients at high risk (>20 %) of a cardiovascular event. The objective of this study was to compare the impact and costs of the current national CVD prevention guidelines with regard to morbidity and mortality in Argentina with the impact and costs of three strategies that incorporate high-potency statins.
  
  
  METHODS
  We used the CVD Policy Model-Argentina to model the proposed interventions. This model is a national-scale, state-transition (Markov) computer simulation model of the CVD incidence, prevalence, mortality, and costs in adults 35-84 years of age. We modeled three scenarios: scenario 1 lowers the risk threshold for treatment to >10 % according the Framingham Risk Score (FRS); scenario 2 intensifies statin potency under current treatment thresholds; and scenario 3 combines both scenarios by lowering the treatment threshold to ≥10 % FRS and intensifying statin potency.
  
  
  RESULTS
  Scenario 1 would translate into 1400 fewer MIs and 500 fewer CHD deaths every year, a 3 % and 2 % reduction, respectively. Scenario 2 would lead to 2000 fewer MIs and 1000 fewer CHD deaths every year. Scenario 3 would result in the greatest reduction in MIs and CHD deaths, with 3400 fewer MIs and 1400 fewer CHD deaths every year, which translates to a 7 % and 6 % reduction, respectively. All scenarios were cost-effective if the cost of a high-potency statin pill was under US$0.25.
  
  
  CONCLUSIONS
  Incorporating those individuals with greater than 10 % cardiovascular risk and the use of high-potency statins into Argentina's national lipid guidelines could result in fewer CHD deaths and events at a reasonable cost.
authors.affiliation: Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina. jkonfino@gmail.com.
authors.forename: Jonatan
authors.initials: J
authors.lastname: Konfino
authors.affiliation: Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina.|Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Alicia
authors.initials: A
authors.lastname: Fernandez
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Joanne
authors.initials: J
authors.lastname: Penko
authors.affiliation: University of California San Diego School of Medicine, La Jolla, CA, USA.
authors.forename: Antoinette
authors.initials: A
authors.lastname: Mason
authors.affiliation: Instituto de Investigaciones Económicas, Facultad de Cs. Económicas, Universidad Nacional de Salta, Salta, Argentina.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Martinez
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Coxson
authors.affiliation: Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: David
authors.initials: D
authors.lastname: Heller
authors.affiliation: Division of General Internal Medicine, Columbia University Medical Center, New York, NY, USA.|New York College of Physicians and Surgeons, Columbia University, New York, NY, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Moran
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bibbins-Domingo
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California San Francisco, San Francisco, CA, USA.|Office of the Director, National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Eliseo J
authors.initials: EJ
authors.lastname: Pérez-Stable
authors.affiliation: Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina.|Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.|University of California San Diego School of Medicine, La Jolla, CA, USA.|Instituto de Investigaciones Económicas, Facultad de Cs. Económicas, Universidad Nacional de Salta, Salta, Argentina.|Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.|Division of General Internal Medicine, Columbia University Medical Center, New York, NY, USA.|New York College of Physicians and Surgeons, Columbia University, New York, NY, USA.|Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California San Francisco, San Francisco, CA, USA.|Office of the Director, National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA.|Hospital de Clinicas, University of Buenos Aires, Buenos Aires, Argentina.
authors.forename: Raul
authors.initials: R
authors.lastname: Mejía
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001118:Argentina / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000097:blood* / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D003362:Cost-Benefit Analysis / Q000379:methods; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards; D011322:Primary Prevention / Q000191:economics / Q000379:methods; D012307:Risk Factors
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Argentina; cardiovascular disease; coronary heart disease; hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor; prevention; statin