Modelling The Burden Of Cardiovascular Disease In Turkey And The Impact Of Reducing Modifiable Risk Factors

OBJECTIVES: This study aims to estimate the current and future burden of cardiovascular diseases (CVD) in Turkey, and quantify the impact of reducing modifiable risk factors. METHODS: A burden of disease model was used to forecast the burden of CVD in Turkey, and estimate the impact of reducing modifiable risk factors (tobacco use, hypertension, type 2 diabetes, obesity and physical inactivity) in the general Turkish population, in accordance with World Health Organization (WHO) targets. Another model estimated the impact of reducing LDL-cholesterol through increased access to effective treatment for two high risk populations: heterozygous familial hypercholesterolemia (HeFH) and secondary prevention (SP), with a focus on patients with LDL-cholesterol >100 mg/dL. Inputs for the models included disease and risk factor prevalence, population forecast, CVD event rates, and treatment effectiveness, primarily derived from published literature. Direct costs to the public health care system and indirect costs from lost productivity due to premature mortality, hospitalizations, and early retirement were included, although the cost of programs and pharmacological interventions to reduce risk factors was not considered. RESULTS: The prevalence of CVD is projected to increase to 5.4 million adults by 2035, while the economic burden, including both direct and indirect costs, would increase to US$5.7 billion. The value of reducing modifiable risk factors (except LDL-cholesterol) is estimated at US$9.2 billion over the forecast period. Reducing the prevalence of uncontrolled LDL-cholesterol through increased access to evolocumab could lead to savings of up to US$691.3 million for HeFH patients and up to US$8.1 billion for high-risk SP patients over the forecast period. CONCLUSIONS: The burden of CVD is significant and growing. Efforts to achieve WHO risk factor targets and further lower LDL-cholesterol through increased access to effective treatment for high-risk patients are projected to greatly reduce the clinical, economic, and humanistic burden of cardiovascular disease in Turkey.