The evidence supporting intervention in chronic diseases

December 04, 2007

Data from low, middle, and high income countries shows that tobacco control, salt reduction, and the use of multidrug regimens for patients with high-risk cardiovascular disease confirms these measures are cost effective and should be scaled up. These are the conclusions of Dr Thomas Gaziano, Brigham & Women's Hospital, Harvard Program for Health Division Science, Boston, MA, USA, and colleagues, author of this second paper in The Lancet's Chronic Diseases Series.

The authors also say that further assessment to determine the best national policies to achieve reductions in consumption of saturated and trans fat -- chemically hydrogenated plant oils -- could eventually lead to substantial reductions in cardiovascular disease. Changes in personal behaviour, health systems, and policy decisions are also analysed for their cost effectiveness.

One of the earliest and most cited community interventions is the North Karelia project, which began in Finland in 1972. The programme involved health education, screening, hypertension control, and treatment. In the first five years coronary heart disease mortality fell by 2.9% per year versus a 1% decline in the rest of Finland. Policy changes such as one in Poland in the early 1990s can also lead to significant health improvements. The Polish government reduced subsidies on animal fats (lard, butter) which led to a switch to polyunsaturated oils such as rapeseed and soyabean. Coronary heart disease mortality dropped by more than 25% between 1991 and 2002, an increase which could not be explained by increased fruit consumption or decreases in smoking.

The authors say that weight loss of between 5% and 10% and also minimal adherence to physical activity recommendations (expending 4200kJ per week in exercise) lead to health gains, in the case of minimal exercise this can be a 20%-30% reduction in risk of all cause mortality.

In low- and middle-income countries, cost-effectiveness of the intervention of salt reduction as a result of public education are quite favourable, ranging from being cost saving to US$200 per disability life year (DALY) averted; tobacco interventions have similar results, with measures such as increased pricing/taxation coming in at US$100 per DALY averted. Analyses from the Disease Control Priorities Project also show that replacing 2% of energy from trans fats with polyunsaturated fat can reduced coronary heart disease by 7-8%. If changes such as this are facilitated through voluntary action by industry or by regulation (eg. the banning of trans fats in New York restaurants), the US Food and Drug Administration believes this can be achieved for less than $0.50 per head. The authors say: "With this cost and the conservative estimate of an 8% reduction in coronary heart disease, the intervention is highly cost effective at $25-75 per DALY averted across the developing world. Assuming the greater reduction of 40% in coronary heart disease, the intervention is cost saving."

The authors conclude: "There is clear evidence that many interventions are cost effective. The Commission on Macroeconomics and Health has proposed a standard of three times gross national income (GNI) per head per DALY averted as being cost-effective. The World Bank estimates that GNI per head in 2006 was, on average, $650 for low-income countries and $3051 for middle-income countries. Tobacco interventions, salt reductions, and multidrug strategies to treat individuals with high-risk cardiovascular disease have acceptable cost-effectiveness ratios for low-income and middle-income countries on the basis of this criterion. If scale-up is feasible for many nations, then it would be reasonable to pursue these options immediately to achieve the projected goals of reducing rates of chronic disease by an additional 2% per year."
This paper associated with this release can be found at


Related Cardiovascular Disease Articles from Brightsurf:

Changes by income level in cardiovascular disease in US
Researchers examined changes in how common cardiovascular disease was in the highest-income earners compared with the rest of the population in the United States between 1999 and 2016.

Fighting cardiovascular disease with acne drug
Researchers from the European Molecular Biology Laboratory (EMBL) in Heidelberg and Stanford University have found the cause of dilated cardiomyopathy - a leading cause of heart failure - and identified a potential treatment for it: a drug already used to treat acne.

A talk with your GP may prevent cardiovascular disease
Having a general practitioner (GP) who is trained in motivational interviewing may reduce your risk of getting cardiovascular disease.

Dilemma of COVID-19, aging and cardiovascular disease
Whether individuals should continue to take angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in the context of coronavirus disease 2019 (COVID-19) is discussed in this article.

Air pollution linked to dementia and cardiovascular disease
People continuously exposed to air pollution are at increased risk of dementia, especially if they also suffer from cardiovascular diseases, according to a study at Karolinska Institutet in Sweden published in the journal JAMA Neurology.

New insights into the effect of aging on cardiovascular disease
Aging adults are more likely to have - and die from - cardiovascular disease than their younger counterparts.

Premature death from cardiovascular disease
National data were used to examine changes from 2000 to 2015 in premature death (ages 25 to 64) from cardiovascular disease in the United States.

Ultrasound: The potential power for cardiovascular disease therapy
In the current issue of Cardiovascular Innovations and Applications volume 4, issue 2, pp.

Despite the ACA, millions of Americans with cardiovascular disease still can't get care
Cardiovascular disease (CVD) is the leading cause of death for Americans, yet millions with CVD or cardiovascular risk factors (CVRF) still can't access the care they need, even years after the implementation of the Affordable Care Act (ACA).

Excess weight and body fat cause cardiovascular disease
In the first Mendelian randomization study to look at this, researchers have found evidence that excess weight and body fat cause a range of heart and blood vessel diseases (rather than just being associated with it).

Read More: Cardiovascular Disease News and Cardiovascular Disease Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to