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Cardiovascular System --- Cardiovascular Diseases

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Background Cardiovascular disease (CVD) has for decades been the most common cause of death in Norway and most other Western countries. Several groups of drugs have shown in clinical trials to prevent CVD. In this report, we have evaluated the cost-effectiveness of these drugs. Methods Based on a model of the progression of CVD from healthy to death, we explored which drugs that might be cost-effective. Analyses were conducted both compared to no treatment and between different drugs. Analyses were conducted on different risk levels and in different age groups for both men and women. We also performed probabilistic sensitivity analyses. Our analyses were accompanied by a systematic review of other economic evaluations of preventive strategies against CVD. Results Calcium channel blockers, thiazides, beta blockers, aspirin and statins were all cost-effective compared to no treatment for all groups of men and women in age groups between 40 and 69. The life year gains for each of the drugs varied between 3 and 17 months. Calcium channel blockers and thiazides were the most cost-effective combination of two antihypertensive drugs. In the base case analyses, the combination of calcium channel blockers, thiazides and ACE-inhibitors was the most cost-effective combination of three drugs. The sensitivity analyses indicate considerable uncertainty related to the question of which was the most cost-effective of the antihypertensive drugs. Whether treatment was cost-effective compared to no treatment was concerned with less uncertainty. Our systematic review of other economic evaluations showed considerable discrepancies between analyses of prevention strategies against CVD. Discussion The results of this study indicate that statins, several antihypertensives and aspirin are cost-effective in all analysed groups between 40 and 69 years old. It is worthwhile noting, however, that the model is built on numerous assumptions, and this introduces considerable uncertainty with respect to optimal choice of therapies.

Cardiovascular diseases.

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1. Many interventions to quit smoking, increase physical activity, reduce weight and improve diet can reduce risk factors for cardiovascular disease. The interventions seem to produce only small effects, if any, and there is a lack of evidence regarding effects on morbidity and mortality. A small or moderate effect may be important, though, both for the individual but particularly at population level. 2. Several interventions support smoking cessation: mass media campaigns targeted at young people and adults, advice from health professionals both in primary care and hospitals, self help programs, group therapy, telephone advice, interventions in the workplace, nicotine replacement, bupropion and varenicline. 3. Mass media campaigns aimed at adult established smokers seemed to have similar effects regardless of age, gender, ethnicity or education. 4. Biomedical risk assessments and hypnosis are unlikely to help smokers to quit. 5. We can not draw conclusions on the effects on smoking rates of training of health professionals, school-based or family-based programs, acupuncture, physical activity, interventions for preventing tobacco sales to minors or relapse prevention. 6. Physical activity interventions moderately improve self-reported physical activity and cardio-respiratory fitness, and help achieving a predetermined activity level. 7. Exercise for overweight and type 2 diabetes supports weight reduction and reduces cardiovascular disease risk factors even if no weight is lost. 8. Calorie restricted diets in overweight hypertensive persons can give modest weight loss and blood pressure decreases. 9. Weight loss strategies in prediabetes may reduce weight and diabetes incidence. 10. Dietary advice, advice to reduce or modify fat intake and reduce intake of salt may have a small, but important effect on cardiovascular risk factors. 11. There are no high quality data on the efficacy of the dietary treatment of type 2 diabetes or familial hypercholesterolaemia. 12. An organized system of regular review may reduce blood pressure. 13. We have not assessed cost effectiveness of the interventions. 14. We need more evidence on effects of interventions to reduce social inequalities in risk for and incidence of cardiovascular disease. 15. We need evidence from studies of high quality and longer follow-up measuring morbidity and mortality, for several of the interventions that we have assessed.

Cardiovascular agents.

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Cardiovascular system --- Lymphatics --- Cardiovascular Diseases. --- Lymphatic Diseases. --- Diseases --- Cardiovascular Diseases

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Cet ouvrage est destiné en priorité aux étudiants en médecine et en sciences et de façon plus générale à, tous ceux qui s'intéressent à la physiologie. Particulièrement exhaustif, il explique la physiologie cardiovasculaire depuis la notion de charge dans la circulation du sang, les principales lois de l'hémodynamique jusqu'à la régulation de la pression artérielle et la physiologie cardio-vasculaire de l'exercice musculaire en passant par l'étude précise de la pompe cardiaque, de l'activité électrique cardiaque cellulaire et globale ou encore des sources d'énergie du muscle cardiaque. Cette troisième édition, entièrement revue, comporte en outre un nouveau chapitre consacré à la ± Génétique des troubles du rythme . Deux modèles de compréhension, l'un concernant l'activité mécanique cardiovasculaire et l'autre la genèse des électrocardiogrammes, viennent étayer cet ouvrage. Une iconographie très complète, enrichie par trois planches couleurs, illustre les textes déjà très didactiques. La première édition de cet ouvrage a été accueillie très favorablement par les spécialistes de physiologie cardiovasculaire, par exemple ± Il s'agit incontestablement d'un ouvrage de physiopathologie remarquable et d'une haute tenue scientifique... Professeur Jean Lequime, Président d'honneur de la Société internationale de cardiologie ± Excellent livre sur la physiologie cardiovasculaire... J'ai beaucoup apprécié la clarté avec laquelle des sujets Ies plus complexes sont traités. Cet ouvrage rendra, j'en suis persuadé, service à de nombreux étudiants et spécialistes qui souhaitent pénétrer dans l'intimité du système cardiocirculatoire. Professeur Robert Haîat, Président de la Société française de cardiologie ± La très grande clarté de l'exposé va faciliter la tâche des étudiants et va aussi aider les chercheurs et les professeurs qui veulent comprendre certains chapitres de la physiologie en dehors de leur spécialisation.

Cardiovascular system --- Cardiovascular Physiology --- Appareil cardiovasculaire --- Physiology --- Physiologie --- Cardiovascular Physiological Phenomena --- Cardiovascular Physiological Phenomena.