Australian-designed model for heart attack, stroke prevention

Monash University researchers have developed a novel health economic model to inform different health interventions and treatment plans for people at risk of heart attack and stroke.

Dr Jedidiah Morton, Co-lead author and Research Fellow at the Centre for Medicine Use and Safety (CMUS) within the Monash Institute of Pharmaceutical Sciences (MIPS), claimed this is the first health economic model to incorporate the long-term cumulative effect of risk factors potentially leading to heart attack or stroke.

“Many health economic models for cardiovascular diseases, including heart attack and stroke, are based on randomised clinical trials; however, because they don’t incorporate the cumulative effect of changes in risk factors over time, they may underestimate the benefit of therapies as the time horizon of the studies increases,” Morton said.

“Our new model will complement evidence from clinical trials because it can also provide estimates of economic costs and benefits of different health interventions relative to an individual’s various risk factors spanning over several decades.”

The model looks at the impact of multiple ‘modifiable risks’ in individuals aged between 30 and 84, including low-density lipoprotein-cholesterol (‘bad’ cholesterol), lipoprotein (a), high blood pressure, smoking and diabetes.

Professor Zanfina Ademi, co-lead and senior author also from CMUS, said the model has potential in public health and clinical decision-making when a clinical trial for the intervention simulated is not possible or practical.

“For most long-term studies on the primary prevention of CVD, clinical trials are too costly and limited to pursue. This is where epidemiological modelling using the next best evidence from Mendelian Randomisation plays an important role,” Ademi said.

“We believe that this model will appropriately capture all costs and value health outcomes of existing and new health interventions and this approach will identify at-risk individuals early when we take into consideration the cumulative impact of modifiable risk factors, and as such has the potential to save many lives and provide efficient access to prevention.”

Ademi said scaling the model up to be implemented at population level would require a systemic change in thinking about prevention.

“If we were to think of modifying risk factors for CVD in the same way we think about clean drinking water, seatbelts and vaccination, for example, it could be a game changer for CVD outcomes in millions of people around the world.”

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