45. The Growing Burden of Risk from High Blood Pressure, Cholesterol, and Bodyweight


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Richard Lord, www.rlordphoto.com

Although cardiovascular disease (CVD) is traditionally considered a Western ailment, it has become a leading and growing cause of disability and mortality in developing countries. CVD results from high blood pressure, cholesterol, and bodyweight, among other risk factors, and frequently type 2 diabetes accompanies these conditions. Obesity–related diseases account for 2–8 percent of all health care expenditures in developed countries and signal similar future financial burden for developing countries.

Interventions to address CVD risks can be population–based (lowering risk factors generally) or personal interventions for those at high risk from individual risk factors. Decisions based on the level of single risk factors have no biological justification and are likely to both over– and undertreat. A better strategy is to concentrate on the absolute risk, determined by the interaction of several factors. This strategy, developed in New Zealand, has been widely adopted. It can target individuals with known disease (stroke, myocardial infarction, or angina) or those with no previous cardiovascular disease who are at high risk. The strategy needs to be used in conjunction with population–based interventions to promote healthier lifestyles?such as weight loss, dietary change, and physical activity?as well as pharmacological treatment, particularly with statins to lower cholesterol and blocking agents to reduce hypertension. For those severely overweight, gastric bypass surgery is an alternative but is expensive and risky.

The cost–effectiveness of interventions varies significantly by type and country. For personal interventions, costs include drugs, for which availability of generics is a factor, and diagnostic laboratory testing. Population–based interventions typically are low in cost, but their effectiveness is not as well documented as that of personal interventions. Because it is anticipated that the productive years lost as a result of CVD will nearly double by 2030, treatment would improve the available workforce and yield economic benefits exceeding costs. More research will identify ways to combine treatments and refine the absolute risk–based approach.