OBJECTIVES: Cardiovascular disease (CVD) is the primary cause of mortality globally, costing the EU economy more than €200 billion annually. Whilst medical guidelines for the secondary prevention of CVD recommend thresholds for risk factor treatment, there is insufficient achievement of therapeutic goals. We targeted a literature gap to estimate lifetime benefits achievable via optimization of secondary preventive treatment of atherosclerotic CVD (ASCVD) patients, providing an estimation of anticipated benefits in population health (country level).

METHODS: The simulation exercise used an existing analytical framework and the SMART-REACH survival model. A literature review identified CVD risk factors and ASCVD prevalence in EU4, Denmark, Poland, and the UK. A multivariable regression, which modelled treatment scenarios, was developed, giving baseline (risk free) event-free survival at 1-year. The model was replicated to generate coefficients for all risk-factors – 1-year survival estimates were based on all the risk factor inputs.

RESULTS: Increasing ‘treatment coverage’ of hypertension and hyperlipidaemia from 43% to 70% and quitting smoking in the ASCVD population could lead to 38,288 life years gained per year across 7 countries. Broken down as: hypertension: 20, 215.1, 338.9, 352.7, 132.5, 161.7 and 225.7; hyperlipidaemia: 174.3, 1901.1, 2955.2, 2035.8, 1157.6, 713 and 717.4; smoking cessation: 424.6, 3916.7, 7193.7, 6421.3, 2821.2, 2362.5 and 4047.9 in Denmark, France, Germany, Italy, Poland, Spain and the UK. Enhancing diabetes treatment coverage could save an additional 56,066 years. In all countries, the combined effect of treatment (hypertension, hyperlipidaemia & diabetes) saves more life-years than quitting smoking, highlighting the importance of identifying and treating patients with hypertension, high cholesterol and diabetes.

CONCLUSIONS: This unique approach develops estimates that can feed into strategies for research and policy for secondary prevention of CVD in Europe given the thousands of annual life years that could be accrued and the impact on quality-adjusted life expectancy, productivity and other dimensions of value.