Sunday, August 20, 2006

Cardiovascular disease in the developing world

A fascinating article in the Lancet's most recent issue (many will not be able to access the full-text of the article unless they have access to medical journals). I first became aware of it through It addresses treating cardiovascular disease in developing nations. Many of us are aware of the impact that HIV is having on developing nations. In some countries, it is literally wiping out an entire generation. Most of us, I think, are less aware of the impact cardiovascular disease (like heart attacks, heart failure, and strokes) has on developing nations. I certainly wasn't aware, and I'm a cardiology fellow!

Turns out that most of the global cardiovascular disease burden is in developing nations. This is not just a function of the fact that most people live in developing nations: apparently the number one killer in the developing world (with the exception of sub-Saharan Africa) is cardiovascular disease.

The idea behind this article is that there are cheap drugs that we know help prevent heart trouble. Aspirin. Statins (a class of cholesterol-lowering drugs that includes lovastatin, pravastatin, simvastatin, atorvastatin, rosuvastatin, and others). Ace-inhibitors (these definitely help people who have already had a heart attack--what is less clear is whether these help stave off heart attacks.) Beta-blockers (help people who have had heart attacks).

What is also known is that lowering blood pressure cuts down your risk of a heart attack.

So these investigators took a bunch of people in the developing world at risk of having a heart attack as predicted by the Framingham risk score (developed from a population of people in the 1950s and 1960s from Framingham, MA), gave them cheap generic medications, and compared them to a group of people who did not get medications. Then they waited and counted who had heart problems, and who didn't.

The results are very interesting. You can predict that the people who got treatment did better. What is fascinating, though, is how little money it cost to save lives. For just a dollar a day...

No, seriously.

For just a dollar a day (about $350 a year), treating people who have had a heart attack already will end up saving a year of life. This figure compares very favorably to the cost of treating HIV in the developing world.

And it beats the pants off the cost-effectiveness of therapies delivered in the West. By way of comparison, mammography costs something like $10,000-$20,000 for every year of life saved.


Anonymous Anonymous said...

Hi Nice Blog . I don't really know a lot about cardiovascular system information or art, but that's just my 2 cents. Really great job though, Krudman! Keep up the good work!

7:02 AM  

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