This Article Full Text Full Text (PDF) All Versions of this Article: 35/10/2346    most recent 01.STR.0000141417.66620.09v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Qureshi, A. I. Articles by Divani, A. A. Search for Related Content PubMed PubMed Citation Articles by Qureshi, A. I. Articles by Divani, A. A. Related Collections Lipids Cerebrovascular disease/stroke Clinical Studies Acute myocardial infarction

(Stroke. 2004;35:2346.)
© 2004 American Heart Association, Inc.

Original Contributions

The Relative Impact of Inadequate Primary and Secondary Prevention on Cardiovascular Mortality in the United States

From the Zeenat Qureshi Stroke Research Center (A.I.Q., J.F.K., A.A.D.), Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, Newark, NJ; and the Department of Neurology (M.F.K.S.), Case Western Reserve University, Cleveland, Ohio.

Correspondence to Dr Adnan I. Qureshi, Neurological Institute of New Jersey, 90 Bergen Street, DOC-8100, University of Medicine and Dentistry of New Jersey, Newark, NJ 07103-2425. E-mail aiqureshi{at}hotmail.com

Background and Purpose— 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.

Methods— 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.

Results— CVD mortality risk increased in a stepwise manner for persons with no previous MI or stroke and 2 inadequately controlled risk factors (2x); and previous history of MI and stroke and adequately controlled risk factors (2.6x), 1 inadequately controlled risk factor (4.3x), and 2 inadequately controlled risk factors (5.7x). The PAR was 14% (estimated cost incurred $13.2 billion) among persons with 2 inadequately controlled risk factors without previous MI or stroke (estimated 17% of total US population). Among persons with previous MI or stroke, the PAR was 7% (cost incurred $6.2 billion) and 8% (cost incurred $7.4 billion) for 1 inadequately controlled risk factor and 2 inadequately controlled risk factors, respectively. An excess of cost of $13.6 billion was spent on 4% of the total population (persons with inadequate secondary prevention).

Conclusions— The model demonstrates the differential risk of mortality from inadequately controlled cardiovascular risk factors in primary and secondary prevention settings. The large financial cost incurred by inadequate primary and secondary prevention justifies intensive efforts directed toward detection and treatment of cardiovascular risk factors.

Key Words: cigarette smoking • hypercholesterolemia • hypertension • mortality • primary prevention • secondary prevention

This article has been cited by other articles:

				A. I. Qureshi, M. F. K. Suri, J. Zhou, and A. A. Divani African American women have poor long-term survival following ischemic stroke. Neurology, November 14, 2006; 67(9): 1623 - 1629. [Abstract] [Full Text] [PDF]

				L. B. Goldstein and G. J. Hankey Advances in Primary Stroke Prevention Stroke, February 1, 2006; 37(2): 317 - 319. [Full Text] [PDF]

				A. Zalewski and C. Macphee Role of Lipoprotein-Associated Phospholipase A2 in Atherosclerosis: Biology, Epidemiology, and Possible Therapeutic Target Arterioscler Thromb Vasc Biol, May 1, 2005; 25(5): 923 - 931. [Abstract] [Full Text] [PDF]

				D. B. Matchar and A. G. Rudd Health Policy and Outcomes Research 2004 Stroke, February 1, 2005; 36(2): 225 - 227. [Full Text] [PDF]