The relative impact of inadequate primary and secondary prevention on cardiovascular mortality in the United States

Stroke; a Journal of Cerebral Circulation
Adnan I QureshiAfshin A Divani

Abstract

We developed a model to estimate the costs incurred by ineffective primary and secondary prevention in terms of excess cardiovascular disease (CVD) mortality in a nationally representative sample of the US population. Cox proportional hazards analyses were used to examine the effect of inadequate risk factor control on the incidence of fatal stroke and myocardial infarction (MI) during a follow-up period of 13.4+/-3.6 years after adjusting for differences in age, gender, and ethnicity in a national cohort of 9252 adults who participated in the Second National Health and Nutrition Examination Survey (NHANES) Mortality Follow-up Study. Inadequate risk factor modification was defined by presence of either blood pressure >140/90 mm Hg, serum cholesterol >200 mg/dL, or active cigarette smoking. Using the data from 4115 adults screened in the NHANES 1999 to 2000, population attributable risk (PAR) percent and associated cost incurred (expressed as proportion of total 1-year cost incurred for CVD mortality in year 2001) was estimated. CVD mortality risk increased in a stepwise manner for persons with no previous MI or stroke and > or =2 inadequately controlled risk factors (2x); and previous history of MI and stroke and adequately con...Continue Reading

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