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Yan LD, Rouzier V, Pierre JL, Dade E, Sufra R, Huffman MD, Apollon A, St Preux S, Metz M, Sabwa S, Morisset B, Deschamps M, Pape JW, McNairy ML. Polypill for atherosclerotic cardiovascular disease prevention in Haiti: Eligibility estimates in a low-income country. Front Epidemiol 2022; 2:925464. [PMID: 36816341 PMCID: PMC9937442 DOI: 10.3389/fepid.2022.925464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022]
Abstract
Background Multidrug therapy is a World Health Organization "best buy" for the prevention and control of noncommunicable diseases. CVD polypills, including ≥2 blood pressure medications, and a statin with or without aspirin, are an effective, scalable strategy to close the treatment gap that exists in many low- and middle-income countries, including Haiti. We estimated the number of Haitian adults eligible for an atherosclerotic CVD (ASCVD) polypill, and the number of potentially preventable CVD events if polypills were implemented nationally. Methods We used cross-sectional data from the Haiti CVD Cohort, a population-based cohort of 3,005 adults ≥18 years in Port-au-Prince, to compare two polypill implementation strategies: high-risk primary prevention and secondary prevention. High-risk primary prevention included three scenarios: (a) age ≥40 years, (b) hypertension, or (c) predicted 10-year ASCVD risk ≥7.5%. Secondary prevention eligibility included history of stroke or myocardial infarction. We then used the 2019 Global Burden of Disease database and published polypill trials to estimate preventable CVD events, defined as nonfatal MI, nonfatal stroke, and cardiovascular death over a 5-year timeline. Results Among 2,880 participants, the proportion of eligible adults for primary prevention were: 51.6% for age, 32.5% for hypertension, 19.3% for high ASCVD risk, and 5.8% for secondary prevention. Based on current trends, an estimated 462,509 CVD events (95% CI: 369,089-578,475) would occur among adults ≥40 years in Haiti from 2019-2024. Compared with no polypill therapy, we found 32% or 148,003 CVD events (95% CI: 70,126-248,744) could be prevented by a combined primary and secondary prevention approach in Haiti if polypills were fully implemented over 5 years. Conclusion These modeling estimates underscore the potential magnitude of preventable CVD events in low-income settings like Haiti. Model calibration using observed CVD events, costs, and implementation assumptions are future directions. Clinical trial registration clinicaltrials.gov, identifier: NCT03892265.
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Affiliation(s)
- Lily D. Yan
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
- Center for Global Health, Weill Cornell Medicine, New York, NY, United States
| | - Vanessa Rouzier
- Center for Global Health, Weill Cornell Medicine, New York, NY, United States
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Jean Lookens Pierre
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Eliezer Dade
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Rodney Sufra
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Mark D. Huffman
- Cardiovascular Division and Global Health Center, Department of Medicine, Washington University in St Louis, St Louis, MO, United States
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Alexandra Apollon
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Stephano St Preux
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Miranda Metz
- Center for Global Health, Weill Cornell Medicine, New York, NY, United States
| | - Shalom Sabwa
- Center for Global Health, Weill Cornell Medicine, New York, NY, United States
| | | | - Marie Deschamps
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Jean W. Pape
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Margaret L. McNairy
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
- Center for Global Health, Weill Cornell Medicine, New York, NY, United States
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Kenizou D, Perrin C, Harzallah I, Bresson D, Allimant P, Calcaianu M, Lawson B, Morisset B, Zuily S, Jacquemin L, Kinnel M, Girerd N. Multiple Arterial Thrombosis in a 78-Year-Old Patient: Catastrophic Thrombotic Syndrome in COVID-19. CJC Open 2020; 3:198-200. [PMID: 33024951 PMCID: PMC7529607 DOI: 10.1016/j.cjco.2020.09.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/19/2020] [Indexed: 02/07/2023] Open
Abstract
We describe a patient with coronavirus disease 2019 (COVID-19) and multiple concomitant thromboses occurring on the 9th day of hospital stay. Thromboses were found in distinct zones of the aorta, as well as in the renal, humeral, and pulmonary arteries. The extensive biological workup performed following this catastrophic thrombotic syndrome found no evidence for underlying prothrombotic disease. In light of current evidence regarding endothelium abnormalities related to COVID-19, this extreme case of catastrophic thrombotic syndrome suggests that COVID-19 can induce severe arterial thrombosis following intense endothelial activation.
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Affiliation(s)
- David Kenizou
- Cardiology Department, Mulhouse Region/South of Alsace Hospital, Hôpital E. Muller, Mulhouse, France
- Corresponding author: Dr David Kenizou, Mulhouse Region/South of Alsace Hospital, Hôpital E. Muller, 20 Avenue du Dr Renè Laennec, 68100 Mulhouse, France. Tel.: 03 89 64 70 95.
| | - Clemence Perrin
- Cardiology Department, Mulhouse Region/South of Alsace Hospital, Hôpital E. Muller, Mulhouse, France
| | - Ines Harzallah
- Hematology Department, Mulhouse Region/South of Alsace Hospital, Hôpital E. Muller, Mulhouse, France
| | - Didier Bresson
- Cardiology Department, Mulhouse Region/South of Alsace Hospital, Hôpital E. Muller, Mulhouse, France
| | - Patrick Allimant
- Vascular Surgery Department, Mulhouse Region/South of Alsace Hospital, Hôpital E. Muller, Mulhouse, France
| | - Mihaela Calcaianu
- Cardiology Department, Mulhouse Region/South of Alsace Hospital, Hôpital E. Muller, Mulhouse, France
| | - Bree Lawson
- Cardiology Department, Mulhouse Region/South of Alsace Hospital, Hôpital E. Muller, Mulhouse, France
| | - Béatrice Morisset
- Cardiology Department, Mulhouse Region/South of Alsace Hospital, Hôpital E. Muller, Mulhouse, France
| | | | - Laurent Jacquemin
- Cardiology Department, Mulhouse Region/South of Alsace Hospital, Hôpital E. Muller, Mulhouse, France
| | - Marine Kinnel
- Cardiology Department, Mulhouse Region/South of Alsace Hospital, Hôpital E. Muller, Mulhouse, France
| | - Nicolas Girerd
- CHRU-Nancy, Regional Competence Center For Marfan Syndrome, Vascular Medicine Division, Nancy, France
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