Prevention of cardiovascular disease in high-risk individuals in low-income and middle-income countries: health effects and costs

Lancet. 2007 Dec 15;370(9604):2054-62. doi: 10.1016/S0140-6736(07)61699-7. Epub 2007 Dec 11.


In 2005, a global goal of reducing chronic disease death rates by an additional 2% per year was established. Scaling up coverage of evidence-based interventions to prevent cardiovascular disease in high-risk individuals in low-income and middle-income countries could play a major part in reaching this goal. We aimed to estimate the number of deaths that could be averted and the financial cost of scaling up, above current coverage levels, a multidrug regimen for prevention of cardiovascular disease (a statin, aspirin, and two blood-pressure-lowering medicines) in 23 such countries. Identification of individuals was limited to those already accessing health services, and treatment eligibility was based on the presence of existing cardiovascular disease or absolute risk of cardiovascular disease by use of easily measurable risk factors. Over a 10-year period, scaling up this multidrug regimen could avert 17.9 million deaths from cardiovascular disease (95% uncertainty interval 7.4 million-25.7 million). 56% of deaths averted would be in those younger than 70 years, with more deaths averted in women than in men owing to larger absolute numbers of women at older ages. The 10-year financial cost would be US$47 billion ($33 billion-$61 billion) or an average yearly cost per head of $1.08 ($0.75-1.40), ranging from $0.43 to $0.90 across low-income countries and from $0.54 to $2.93 across middle-income countries. This package could effectively meet three-quarters of the proposed global goal with a moderate increase in health expenditure.

Publication types

  • Review

MeSH terms

  • Adult
  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal / economics
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Antihypertensive Agents / economics
  • Antihypertensive Agents / therapeutic use*
  • Aspirin / economics
  • Aspirin / therapeutic use*
  • Cardiovascular Diseases / economics
  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / prevention & control*
  • Cost-Benefit Analysis / economics*
  • Cost-Benefit Analysis / statistics & numerical data
  • Developed Countries / economics*
  • Developed Countries / statistics & numerical data
  • Developing Countries / economics*
  • Developing Countries / statistics & numerical data
  • Female
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / economics
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Male
  • Middle Aged
  • Risk Factors


  • Anti-Inflammatory Agents, Non-Steroidal
  • Antihypertensive Agents
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Aspirin