A health investigation details what measures could lower the mortality rate of cardiovascular diseases and shows that preventing these diseases is cheaper than treating them when they have already occurred.
Cardiovascular diseases such as heart attack and cerebrovascular accident (CVA) are the leading cause of death in Argentina: they represent 34.2 percent of deaths in our country and 12,6 percent of disabilities. A study published in BMC Public Health, an internationally recognized scientific journal, reveals that a high percentage of these deaths could be avoided. This study, carried out by the Argentine doctor and president of the Institute of Clinical and Health Effectiveness (IECS), Dr. Adolfo Rubinstein, details what measures can be taken to reduce deaths caused by cardiovascular diseases by between 10 and 20 percent, as well as to reduce the frequency of risk factors for these diseases, which are: high blood pressure, high cholesterol , diabetes, obesity, smoking, sedentary lifestyle and unhealthy diets.
The first measure described in the analytical model published by BMC consists of lowering the salt intake of the population through a modification in the bread production process so that it has one less gram of salt for every 100 of bread. “The daily consumption of salt in Argentina is 12 grams per capita, of which 3,4 gr. They come from bread. Various local experiences have shown that the amount of salt in bread can be reduced without it being noticeable in the taste of the product,” the study states. According to the study, reducing 15 percent of salt in the average Argentine diet (which would result from reducing 1g of salt for every 100g in bread) in 10 years would save 60.000 lives.
“With an intervention as simple as that, the number of deaths and lives with disabilities would decrease by at least 1 percent. This number seems small, but when we think that this means that in 10 years 60.000 lives can be saved (victims of heart attacks and strokes), we become aware that this is a measure with an enormous population impact,” says Rubinstein. The specialist, who directs the Center of Excellence in Cardiovascular Health for the Southern Cone (CESCAS), explains: “One of the risk factors for suffering a stroke is having high blood pressure and half of the Argentine population does not know that they are hypertensive. (you don't know you have high blood pressure) or you know it but it is not controlled (medicated for this purpose). Precisely for this reason, if we manage to lower the pressure of the entire population (even in sectors that register 'normal' levels of pressure) through this change in bread production, the benefit would be enormous."
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1- Source: Statistics Directorate of the National Ministry of Health (DEIS). 2005.
2- This model was created based on the first National Risk Factors survey carried out by the National Ministry of Health in 2005.
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The second measure proposed by this health model consists of providing a 4-drug pharmacological treatment to people over 35 years of age with high cardiovascular risk. These are 4 inexpensive drugs to normalize blood pressure and lower blood cholesterol: a diuretic, an antihypertensive, a statin and 1 aspirin (which is a cardiovascular protector). As described in the research published by BMC Public Health, “this intervention would mean reducing more than 10.000 heart attacks and strokes per year.”
PREVENTION IS CHEAPER THAN CURE
The study analyzes the economic impact of cardiovascular diseases and concludes that both reducing the amount of salt in the composition of bread and pharmacological treatment are cost-saving measures, since they allow the health system to save money. This means that the money currently allocated to treating people with cardiovascular diseases is much more than what would be required to prevent the onset of these diseases.
The president of the IECS details other measures that would also help reduce the current mortality rate from cardiovascular diseases. They are:
1-Implement a media campaign that promotes smoking cessation. With 4 television spots, 6 radio spots and graphic campaigns in the media, this intervention would reduce the adult population that smokes in Argentina, which currently represents 30 percent, by 7 percent.
2- Provide pharmacological treatment to lower blood pressure to less than 140/90mmHg. This measure (aimed at people over 35 years of age with high blood pressure who currently do not receive any treatment) would reduce cardiovascular diseases and heart attacks by 8 percent.
3- Provide treatment to lower cholesterol to less than 240 mg/dl. This measure (aimed at those over 35 years of age who have high cholesterol and do not receive any treatment) would reduce 8 percent of heart diseases and strokes registered in our country.
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3- Source: National Survey of Risk Factors of the Ministry of Health of the Nation. 2005.
It should be noted that the model developed by Dr. Rubinstein analyzes the potential impact of a pilot experience that the Ministry of Health of the Nation is promoting in some cities of the country and which consists of raising awareness and training bakers to reduce 1 gram of salt in bread making. If this pilot experience led to voluntary agreements between the Government and the industry (through the Chamber of Bakers) so that the change in bread production is carried out throughout the country, the mortality rate from cardiovascular diseases would decrease significantly.