Crude estimates of effects on cardiovascular events of different levels of use of proven secondary preventive treatments




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Crude estimates of effects on cardiovascular events of different levels of use of proven secondary preventive treatments



Assumptions


  • 20 million individuals in Europe with existing vascular disease and eligible for secondary preventive therapy with aspirin, blood pressure lowering and cholesterol lowering

  • Risk of cardiovascular event among individuals requiring secondary prevention is 25% over 10 years




  • Low-dose aspirin decreases relative risk of cardiovascular disease by 20%

  • Blood pressure lowering therapy decreases relative risk of cardiovascular disease by 25%

  • Cholesterol lowering therapy decreases relative risk of cardiovascular disease by 25%

  • Combined effects of three treatment modalities results in 55% relative risk reduction (1-(1*0.80*0.75*0.75))

  • Combined effects of two treatment modalities (aspirin and one other) results in 40% relative risk reduction (1-(1*0.80*0.75))

  • Effects of one treatment modality (aspirin alone) results in 20% relative risk reduction (1-(1*0.80))

  • Treatment at levels reported in EUROAPSIRE (say aspirin in most, cholesterol lowering in two thirds and blood pressure lowering in two-thirds) results in 43% relative risk reduction (1-(1-(0.80*0.9))*(1-(0.75*0.66))*(1-(0.75*0.66)))

  • Treatment at levels more plausible on the basis of EUROAPSIRE (say aspirin in four fifths, cholesterol lowering in half and blood pressure lowering in half) results in 36% relative risk reduction (1-(1-(0.80*0.8))*(1-(0.75*0.50))*(1-(0.75*0.50)))


Expected numbers of events


Total number of events over 10 years if no treatment (20,000,000*0.25) =5,000,000

Expected number of events per annum =500,000




Estimated effects of secondary preventive treatments on cardiovascular events


Expected number of events each two years if:

  • Full use of three preventive therapies = 1,000,000*(1-0.55)=450,000

  • Full use of two preventive therapies = 1,000,000*(1-0.60)=600,000

  • Full use of one preventive therapy = 1,000,000*(1-0.20)=800,000

Expected number of events each 2 years with Europe-wide levels of treatment comparable to those observed in EUROAPSIRE:



  • Partial use of three preventive therapies = 1,000,000*(1-0.43)=570,000

Expected number of events each 2 years with Europe-wide levels of treatment that are perhaps more plausible:



  • Plausible use of three preventive therapies = 1,000,000*(1-0.36)=640,000

Numbers of potentially avoidable events caused by incomplete treatment each 2 years in Europe:



  • If Europe-wide treatment at EUROSAPIRE levels (570,000-450,000) = 120,000

  • If Europe-wide treatment at more plausible levels (640,000-450,000) = 190,000


29 September 2004


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