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PRIMARY PREVENTION OF MYOCARDIAL INFARCTION IN MIDDLE-AGED MALES (15-YEAR FOLLOW-UP): CLINICAL AND ECONOMIC ASPECTS OF THE PROBLEM

https://doi.org/10.20996/1819-6446-2014-10-2-134-146

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Abstract

Aim. To estimate incidence rate of first myocardial infarction (MI) with different outcomes and factors, it is influenced by, depending on the intensity of preventive measures in a population of middle-aged men during 15-year follow-up; to evaluate economic efficiency of primary medical prevention.

Material and methods. Two populations of middle-aged men with a total of 6656 males (3488 men the group of active prevention and 3168 the group of comparison) were followed up over 15 years.

Results. The group of active prevention revealed 22.1% reduced MI incidence rate during 5-year follow-up as compared to the second group, fatal MI incidence rate was 42.4% lower, p<0.05. Mortality rate in new cases of MI was 35.8% in the group of active prevention and 48.5% at routine treatment (p<0.05). The group of active prevention continued to have 17.9% reduced MI incidence rate during the 10-year follow-up as compared to the group of routine management (p>0.05), while patients with clinical signs of ischemic heart disease (IHD) and no history of previous MI kept significant distinctions in first MI incidence rate (41% less in the first group, p<0.05). First MI incidence for the 10-year period was the least at risk factors (RF) absence and twice higher even at single RF presence. Combination of RF caused 4-5 fold increase in risk for MI. Life status of 81.3% of the enrolled men (5410 of 6656) followed over 15 years was received along with the monitoring of prognosis.

Such indices as “life years saved” (LYS) and “quality-adjusted life years saved” (QALYS) for 1000 persons in the active prevention group were 53 and 51 years, respectively during the 5-year follow-up, 147 and 143 years – during the 10-year follow-up. In the long-term actual expenses for 1 LYS were 3.4-fold less than annual gross domestic product (GDP) value, at that charges for primary prevention – 4-fold less, which has been for the first time demonstrated using factual data and not mathematic modeling usually used in scientific literature.

Conclusion. The long-term prospective follow-up has demonstrated that the risk of first MI can be reduced by means of active and systematic prevention. Cost-effectiveness of primary prevention, including the one of MI, has been conclusively showed. The results allowed to validate the reasonability of active multifactorial prevention in the settings of primary healthcare, which makes it possible to define scientific-based recommendations for real practice.

About the Authors

A. M. Kalinina
State Research Center for Preventive Medicine, Moscow
Russian Federation

Anna M. Kalinina – MD, PhD, Professor, Head of Department of Chronic Non-infectious Diseases Primary Prevention



A. V. Kontsevaya
State Research Center for Preventive Medicine, Moscow
Russian Federation
Anna V. Kontsevaya – MD, PhD, leading researcher of Department of Chronic Non-infectious Diseases Primary Prevention


References

1. Mikhaylova YuV, Ivanova A.E, editors. Preventable population mortality in Russia and ways for its reduction. Moscow: RIO TsNIIOZ; 2006. Russian. (Михайлова Ю.В., Иванова А.Е., редакторы. Предотвратимая смертность в России и пути её снижения. Москва: РИО ЦНИИОЗ; 2006.)

2. Sabgayda T.P. Age-specific characteristics of avoidable mortality in Russia. Social Aspects ofHealth (Electronic Scientific journal ISSN2071-5021) 2013; 5(33). Available at: http://vestnik.mednet.ru/content/view/505/30/lang,ru/.Accessed by19.03.2014.Russian (Сабгайда Т.П. Возрастные особенности предотвратимой смертности населения России. Социальные аспекты здоровья населения (ЭлектронныйНаучный журнал ISSN 2071-5021) 2013; 5 (33).Доступно на: http://vestnik.mednet.ru/content/view/505/30/lang,ru/. Дата доступа: 19.03.2014).

3. The Demographic Yearbook of Russia. 2010. Moscow: Rosstat; 2011. Russian (Демографический ежегодник России, 2010. М.: Росстат; 2011)

4. Shalnova S.A., Deev A.D. Russian mortality trends in the early XXI century: official statistics data. Cardiovascular Therapy and Prevention 2011; 10 (6): 5-10. Russian (Шальнова С. А., Деев А. Д. Тенденции смертности в России в начале XXI века (по данным официальной статистики). Кардиоваскулярная Терапия и Профилактика 2011; 10 (6):5-10).

5. Shalnova S.A., Konradi A.O., Karpov Y.A., et al. Cardiovascular mortality in 12 Russian Federation regions – participants of the «Cardiovascular disease epidemiology in Russian Regions» Study. Russian Cardioligy Journal 2012; 97(5): 6-11. Russian (Шальнова С.А., Конради А.О., Карпов Ю.А., и др. Анализ смертности от сердечно-сосудистых заболеваний в 12 регионах Российской Федерации, участвующих в исследовании «Эпидемиология сердечно-сосудистых заболеваний в различных регионах России». Российский Кардиологический Журнал 2012; 97(5):6-11).

6. Ivanova А.Е., Golovenkin S.E., Suldin S.A. Preventable health loss associated with myocardial infarction. Social Aspects of Health (Electronic Scientific journal ISSN2071-5021) 2013; 5(33). Available at: http://vestnik.mednet.ru/content/view/504/30/lang,ru/. Accessed by 19.03.2014. Russian (Иванова А.Е., Головенкин С.Е., Сульдин С.А. Предотвратимость потерь здоровья при инфаркте миокарда. Социальные аспектыздоровья населения (ЭлектронныйНаучный журнал ISSN 2071-5021) 2013; 5(33).Доступно на: http://vestnik.mednet.ru/content/view/504/30/lang,ru/.Дата доступа: 19.03.2014).

7. On approval of the clinical examination of certain adult populations. Order of Ministry of Health of the Russian Federation from 03.12.12 № 1006n. Available at: http://www.rosminzdrav.ru/documents/6553-prikaz-minzdrava-rossii-ot-3-dekabrya-2012-g-1006n. Accessed by 19.03.2014. Russian (Об утверждении порядка проведения диспансеризации определенных групп взрослого населения.ПриказМинистерства здравоохранения Российской Федерации от03.12.2012№1006н. Доступно на: http://www.rosminzdrav.ru/documents/6553-prikaz-minzdrava-rossii-ot-3-dekabrya2012-g-1006n. Дата доступа: 19.03.2014).

8. Kalinina A.M., Yeganyan R.A., Gambaryan M.G., et al. Effective preventive counselling of patients with chronic non-communicable diseases and risk factors: algorithms counselling. Preventive Medicine 2013; 16(4):13-18. Russian (Калинина А.М., Еганян Р.А., Гамбарян М.Г., и др. Эффективное профилактическое консультирование пациентов с хроническими неинфекционными заболеваниями и факторами риска: алгоритмыконсультирования.Профилактическая Медицина 2013; 16(4):13-18.

9. Oganov RG, Kontsevaya AV, Kalinina AM. Economic costs of cardiovascular diseases in the Russian Federation. Cardiovascular Therapy and Prevention 2011; 10 (4):4-9. Russian (Оганов Р. Г., Концевая А. В., Калинина А. М. Экономический ущерб от сердечно-сосудистых заболеваний в Российской Федерации. Кардиоваскулярная Терапия и Профилактика 2011; 10 (4):4-9).

10. ShroufiA., Chowdhury R.,Anchala R. et al. Cost effective interventions forthe prevention of cardiovascular disease in low and middle income countries: a systematic review. BMC Public Health 2013; 13:285.

11. Goetzel R.Z., Ozminkowski R.J. TheHealth and Cost Benefits of Work SiteHealth-Promotion Programs. Annual Review of Public Health 2008;29: 303-23.

12. Kalinina A.M. Scientific Evidence prevention of cardiovascular diseases in public health practice. Cardiovascular Therapy and Prevention 2010;9(1):14-20. Russian (Калинина А.М. Научные доказательные факты профилактики сердечно-сосудистых заболеваний в практическом здравоохранении. Кардиоваскулярная Терапия и Профилактика 2010;9(1):14-20).

13. Kalinina A.M., Chazova L.V. Influence of the multifactorial cardiovascular diseases prevention on the life prognosis. Therapeutic Archive 1998;70(3):8-12. (Калинина А.М., Чазова Л.В. Влияние многофакторной профилактики сердечно-сосудистых заболеваний на прогнозжизни. Терапевтический Архив 1998;70(3):8-12).

14. World Health Organization Regional Office for Europe: Myocardial Infarction Community Registers. Public Health in Europe No 5. Copenhagen: WHO; 1976.

15. Kalinina AM, Kontsevaya AV, Deev AD. Long-term cost-effectiveness of prevention programs multifactorial cardiovascular disease in primary care. Cardiovascular Therapy and Prevention 2013; 12 (1):606. (Калинина А.М., Концевая А.В.,Деев А.Д.Долгосрочная экономическая эффективность программы многофакторной профилактики сердечно-сосудистых заболеваний в первичной медико-санитарной помощи. Кардиоваскулярная Терапия и Профилактика 2013;12(1):60-6)

16. Goetzel R.Z., Ozminkowski R.J. TheHealth and Cost Benefits of Work SiteHealth-Promotion Programs. Annual Review of Public Health 2008;29: 303-23.

17. Lindenbraten AL. Resources require thrift. Social insurance in 2010, (6) :22-6. Russian (Линденбратен А.Л. Ресурсы требуют бережливости. Социальное страхование 2010;(6):22-6).

18. Caro J, Klittich W, McGuire A, et al, for the West of Scotland Coronary Prevention Study Group. The West of Scotland coronary prevention study: economic benefit analysis of primary preventionwith pravastatin. BMJ 1997; 315: 1577-82.


For citation:


Kalinina A.M., Kontsevaya A.V. PRIMARY PREVENTION OF MYOCARDIAL INFARCTION IN MIDDLE-AGED MALES (15-YEAR FOLLOW-UP): CLINICAL AND ECONOMIC ASPECTS OF THE PROBLEM. Rational Pharmacotherapy in Cardiology. 2014;10(2):134-146. https://doi.org/10.20996/1819-6446-2014-10-2-134-146

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