BACKGROUND: To estimate the impact of population-wide and high-risk blood pressure-lowering strategies on cardiovascular disease (CVD) incidence in China. DESIGN: A modelling study based on a community cohort of 30 362 men and women aged 35-74 years in urban Shanghai, China, 3.3% of whom have existing CVD. METHODS: We modelled three blood pressure-lowering strategies: population-wide salt reduction, or antihypertensive drug treatment (following Chinese guidelines) for two subpopulations with either high blood pressure (>/=150/95 mmHg), or high baseline-predicted CVD risk (>/=10% in 10 years based on a multivariate risk model). Avoidable CVD events were estimated by applying a range of relative risk reductions in CVD, 5-7.5% for population-wide salt reduction and 20-25% for drug treatment derived from meta-analyses. Drug compliance was assumed to be 50%. RESULTS: Population-wide salt reduction would avoid 240-362 events per 100 000 population over 10 years. Drug treatment for the 14.1% of people with raised blood pressure could avoid 217-273 events, whereas treating the 14.2% of people with predicted 10-year CVD risk over 10% would avoid 310-385 events. Of the prevented events, 70-80% would occur in over 60 years and almost a third of the events were predicted to occur among the 3.3% of people with prevalent CVD. CONCLUSION: Population-wide and high-risk blood pressure-lowering strategies would have a similar impact on CVD incidence in urban China. The expected epidemic of CVD could be reduced by highly targeted drug treatment while more sustainable population-wide strategies are put in place.
BACKGROUND: To estimate the impact of population-wide and high-risk blood pressure-lowering strategies on cardiovascular disease (CVD) incidence in China. DESIGN: A modelling study based on a community cohort of 30 362 men and women aged 35-74 years in urban Shanghai, China, 3.3% of whom have existing CVD. METHODS: We modelled three blood pressure-lowering strategies: population-wide salt reduction, or antihypertensive drug treatment (following Chinese guidelines) for two subpopulations with either high blood pressure (>/=150/95 mmHg), or high baseline-predicted CVD risk (>/=10% in 10 years based on a multivariate risk model). Avoidable CVD events were estimated by applying a range of relative risk reductions in CVD, 5-7.5% for population-wide salt reduction and 20-25% for drug treatment derived from meta-analyses. Drug compliance was assumed to be 50%. RESULTS: Population-wide salt reduction would avoid 240-362 events per 100 000 population over 10 years. Drug treatment for the 14.1% of people with raised blood pressure could avoid 217-273 events, whereas treating the 14.2% of people with predicted 10-year CVD risk over 10% would avoid 310-385 events. Of the prevented events, 70-80% would occur in over 60 years and almost a third of the events were predicted to occur among the 3.3% of people with prevalent CVD. CONCLUSION: Population-wide and high-risk blood pressure-lowering strategies would have a similar impact on CVD incidence in urban China. The expected epidemic of CVD could be reduced by highly targeted drug treatment while more sustainable population-wide strategies are put in place.
Authors: Luisa V Giles; Prabjit Barn; Nino Künzli; Isabelle Romieu; Murray A Mittleman; Stephan van Eeden; Ryan Allen; Chris Carlsten; Dave Stieb; Curtis Noonan; Audrey Smargiassi; Joel D Kaufman; Shakoor Hajat; Tom Kosatsky; Michael Brauer Journal: Environ Health Perspect Date: 2010-08-20 Impact factor: 9.031