Saidi, Olfa, O'Flaherty, Martin 
ORCID: 0000-0001-8944-4131, Zoghlami, Nada, Malouche, Dhafer, Capewell, Simon ORCID: 0000-0003-3960-8999, Critchley, Julia A, Bandosz, Piotr ORCID: 0000-0002-6395-6216, Ben Romdhane, Habiba and Guzman Castillo, Maria
(2019)
Comparing Strategies to Prevent Stroke and Ischemic Heart Disease in the Tunisian Population: Markov Modeling Approach Using a Comprehensive Sensitivity Analysis Algorithm.
COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE, 2019.
2123079-.
Abstract
<h4>Background</h4>Mathematical models offer the potential to analyze and compare the effectiveness of very different interventions to prevent future cardiovascular disease. We developed a comprehensive Markov model to assess the impact of three interventions to reduce ischemic heart diseases (IHD) and stroke deaths: (i) improved medical treatments in acute phase, (ii) secondary prevention by increasing the uptake of statins, (iii) primary prevention using health promotion to reduce dietary salt consumption.<h4>Methods</h4>We developed and validated a Markov model for the Tunisian population aged 35-94 years old over a 20-year time horizon. We compared the impact of specific treatments for stroke, lifestyle, and primary prevention on both IHD and stroke deaths. We then undertook extensive sensitivity analyses using both a probabilistic multivariate approach and simple linear regression (metamodeling).<h4>Results</h4>The model forecast a dramatic mortality rise, with 111,134 IHD and stroke deaths (95% CI 106567 to 115048) predicted in 2025 in Tunisia. The salt reduction offered the potentially most powerful preventive intervention that might reduce IHD and stroke deaths by 27% (-30240 [-30580 to -29900]) compared with 1% for medical strategies and 3% for secondary prevention. The metamodeling highlighted that the initial development of a minor stroke substantially increased the subsequent probability of a fatal stroke or IHD death.<h4>Conclusions</h4>The primary prevention of cardiovascular disease via a reduction in dietary salt consumption appeared much more effective than secondary or tertiary prevention approaches. Our simple but comprehensive model offers a potentially attractive methodological approach that might now be extended and replicated in other contexts and populations.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Humans, Myocardial Ischemia, Sodium Chloride, Dietary, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Multivariate Analysis, Linear Models, Probability, Markov Chains, Primary Prevention, Algorithms, Models, Theoretical, Computer Simulation, Software, Adult, Aged, Aged, 80 and over, Middle Aged, Health Promotion, Tunisia, Female, Male, Stroke, Secondary Prevention |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 26 Mar 2019 16:44 |
| Last Modified: | 19 Jan 2023 00:56 |
| DOI: | 10.1155/2019/2123079 |
| Open Access URL: | https://doi.org/10.1155/2019/2123079 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3035007 |
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