Value of Primordial and Primary Prevention for Cardiovascular Disease

TLDR

Atherosclerosis begins in youth and can cause fatal and nonfatal cardiovascular events, but primordial and primary prevention can largely avert these outcomes, though evaluating their value is challenging due to long time horizons and the enormous $450 billion–$1 trillion annual cost burden. The study examines whether primordial and primary prevention interventions provide value relative to their costs. Clinical trials confirm that pharmacologic risk‑factor treatment prevents events, and although evidence for policy and lifestyle interventions is less definitive, cost‑effectiveness analyses indicate they are likely cost‑effective or cost‑saving, and overall prevention yields substantial societal value.

Abstract

The process of atherosclerosis may begin in youth and continue for decades, leading to both nonfatal and fatal cardiovascular events, including myocardial infarction, stroke, and sudden death. With primordial and primary prevention, cardiovascular disease is largely preventable. Clinical trial evidence has shown convincingly that pharmacological treatment of risk factors can prevent events. The data are less definitive but also highly suggestive that appropriate public policy and lifestyle interventions aimed at eliminating tobacco use, limiting salt consumption, encouraging physical exercise, and improving diet can prevent events. There has been concern about whether efforts aimed at primordial and primary prevention provide value (ie, whether such interventions are worth what we pay for them). Although questions about the value of therapeutics for acute disease may be addressed by cost-effectiveness analysis, the long time frames involved in evaluating preventive interventions make cost-effectiveness analysis difficult and necessarily flawed. Nonetheless, cost-effectiveness analyses reviewed in this policy statement largely suggest that public policy, community efforts, and pharmacological intervention are all likely to be cost-effective and often cost saving compared with common benchmarks. The high direct medical care and indirect costs of cardiovascular disease—approaching $450 billion a year in 2010 and projected to rise to over $1 trillion a year by 2030—make this a critical medical and societal issue. Prevention of cardiovascular disease will also provide great value in developing a healthier, more productive society.