The relative influence of secondary versus primary prevention using the National Cholesterol Education Program Adult Treatment Panel II guidelines
Key result
NCEP primary prevention yields ~50% less benefit than secondary prevention despite double the treatment years.
Key Points
- To project the population-wide impact of full implementation of the National Cholesterol Education Program Adult Treatment Panel II guidelines on coronary heart disease morbidity and mortality from 2000 to 2020.
- Utilized a calibrated, validated computer simulation model of the United States population aged 35 to 84 years.
- Projected coronary heart disease morbidity, mortality, and overall mortality under varying assumptions of guideline implementation from 2000 to 2020.
- Secondary prevention produced a 3- to 12-fold higher increase in quality-adjusted years of life per year of treatment than primary prevention.
- Primary prevention yielded approximately half the epidemiologic benefits of secondary prevention while requiring nearly twice as many person-years of treatment.
- Achieving equivalent population-wide benefits via primary prevention required a nearly sixfold increase in treated persons, whereas an 11 mg/dl (8%) universal reduction in low-density lipoprotein cholesterol in individuals without coronary heart disease matched all primary prevention benefits.
PICO
P
Population
Simulation of the U.S. population aged 35 to 84 years to estimate the potential for NCEP guidelines to reduce coronary heart disease morbidity and mortality from 2000 to 2020.
E
Exposure / Comparator
NCEP ATP II guidelines for primary vs secondary prevention
O
Primary Outcome
Coronary heart disease morbidity and mortality and overall mortality
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Many people have assumed that lowering cholesterol levels before the onset of heart disease would have a powerful effect as a primary prevention tool. Our results show that secondary prevention, or lowering cholesterol levels after being diagnosed with heart disease, has an even greater impact.”
Implication
Simulation study reveals secondary prevention yields substantially greater cardiovascular mortality reductions than targeted primary prevention in US adults, highlighting the priority of secondary...
Abstract
OBJECTIVES: This study was undertaken to project the population-wide effect of full implementation of the Adult Treatment Panel (ATP) II guidelines of the National Cholesterol Education Program (NCEP). BACKGROUND: The ATP II has proposed guidelines for cholesterol reduction, but the long-term epidemiologic influence of its components has not been fully examined. METHODS: We used a calibrated, validated simulation of the U.S. population, aged 35 to 84 years to estimate the potential for the NCEP guidelines, under varying assumptions, to reduce coronary heart disease morbidity and mortality and overall mortality from the years 2000 to 2020. RESULTS: Primary prevention would yield only about half of the benefits of secondary prevention despite requiring nearly twice as many person-years of treatment. The projected increase in quality-adjusted years of life per year of treatment for secondary prevention was 3- to 12-fold higher than for primary prevention. To yield population-wide epidemiologic benefits equivalent to NCEP recommendations for secondary prevention, primary prevention would require a nearly sixfold increase in the number of persons treated compared with NCEP recommendations. All benefits of universal success of the NCEP primary prevention "screen and treat" guidelines could be achieved by a 11 mg/dl (8%) population-wide reduction in low-density lipoprotein cholesterol levels among persons without preexisting coronary heart disease. CONCLUSIONS: The NCEP guidelines for targeted primary prevention can be a useful component of a rational public health strategy, but only as a complement to the more appealing strategies of secondary prevention and "across-the-board" programs to lower all cholesterol levels.
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Cite This Study
Goldman et al. (1999) studied Coronary heart disease. NCEP ATP II guidelines for primary vs secondary prevention was evaluated on Coronary heart disease morbidity and mortality and overall mortality. Primary prevention using NCEP guidelines would yield only about half the benefits of secondary prevention despite requiring nearly twice as many person-years of treatment.