Comparing Strategies for Lipid Lowering in Argentina: An Analysis from the CVD Policy Model-Argentina

Hypertension and Dyslipidaemia in Argentina: Patient Journey Stages

Cardiovascular disease (CVD) leads to one-third of all deaths in Argentina. To implement patient-centric strategies for reducing CVD burden, available data on hypertension and hypercholesterolemia patients at different stages of their journey: awareness, screening, diagnosis, treatment, adherence, and control were analysed. A semi-systematic review in peer-reviewed databases (EMBASE and MEDLINE) and unstructured sources such as Google Scholar, Argentine Ministry of Health, and World Health Organization websites was conducted till 06.07.2021 for hypertension and dyslipidemia. English articles published in 2010-2021, depicting patient journey data for hypertension or hypercholesterolemia of the nationally representative adult population of Argentina were included. Thesis abstracts, letters to the editor, editorials, and case studies were excluded. No limits were used for unstructured sources. Weighted or simple means were estimated for patient journey stages. Out of 296 and 1257 articles retrieved for hypertension and hypercholesterolemia, respectively, five articles were retained for each of the conditions. The estimates for hypertension and hypercholesterolemia, respectively, were 46.6% and 30.7% for prevalence, 61.6% and 37.3% for awareness, 97.5% and ≥80% for screening, 64.1% and 28.9% for diagnosis, and 49.7% and 36.6% for treatment, and 19.9% and 20% for overall control. Adherence data were not available for hypercholesterolemia, while the same for hypertension was 50.4%. Various determinants are responsible for low adherence such as patient-level barriers, physician-related barriers, and health system-related issues. The review reveals that hypertension and hypercholesterolemia are poorly controlled in Argentina. Although further studies with more accurate data are needed to confirm these results, they should alert the medical community and the public health institutions to take urgent corrective actions.

Impacto sanitario de la prohibición total de publicidades de tabaco en argentina

Health impact of the total ban on advertising of tobacco productsThe objective was to estimate the health impact of the total ban on advertising of tobacco products in terms of avoided cardiovascular events in those over 35 years of age in Argentina.The Cardiovascular Disease Policy Model (CVDPM) was used, which is a Markov simulation model used to represent and project mortality and morbidity due to cardiovascular disease (CVD) in the population aged 35 or over. It constitutes a demographic-epidemiological model, which represents the population between 35 and 95 years of age and uses a logistic regression model based on the Framingham equation to estimate the annual incidence of cardiovascular disease. We assumed that implementing a complete ban on the advertising of tobacco products would lead to a 9% reduction in tobacco consumption.The complete ban on advertising could prevent 15,164 deaths over a period of 10 years, of which 2610 would be the result of coronary heart disease and 747 due to stroke. These reductions would mean an annual decrease of 0.46% of total deaths, 0.60% of deaths from coronary heart disease and 0.33% in deaths from stroke. In addition, during the same period, it would avoid 6630 acute myocardial infarctions and 2851 strokes (reductions of 1.35% and 0.40%, respectively).We hope that these findings might contribute to the strengthening of sanitary tobacco control policies in Argentina based on the remarkable benefits of banning the advertising of tobacco products in full and in line with current global recommendations.

The Cost-Effectiveness of Hyperlipidemia Medication in Low- and Middle-Income Countries: A Review

Hyperlipidemia is a risk factor for cardiovascular disease - the leading cause of death globally. Increased understanding of the cost-effectiveness of hyperlipidemia treatment in low- and middle-income countries can guide approaches to hyperlipidemia management in resource-limited environments. We conducted a systematic review of the evidence on the cost-effectiveness of hyperlipidemia medication treatment in low- and middle-income countries using studies published between January 2010 and April 2020. We abstracted study details, including study design, treatment setting, intervention type, health metrics, costs standardized to constant 2019 US dollars, and cost-effectiveness measures including average and incremental cost-effectiveness ratios. Comparisons across studies suggested that treatment via polypill is generally more cost-effective than statin-only therapy, and that primary prevention is more cost-effective than secondary prevention. Treating hyperlipidemia at a threshold of 5.7 mmol/l comes at a higher cost per disability-adjusted life-years averted than at a threshold of 6.2 mmol/l. Most pharmacological treatment strategies for hyperlipidemia were found to be cost-effective in most of the examined low- and middle-income countries.