Comparing strategies to prevent stroke and ischemic heart disease in the Tunisian population: Markov modeling approach using a comprehensive sensitivity analysis algorithm (Q2632260)

Summary: \textit {Background}. Mathematical models offer the potential to analyze and compare the effectiveness of very different interventions to prevent future cardiovascular disease. We developed a comprehensive Markov model to assess the impact of three interventions to reduce ischemic heart diseases (IHD) and stroke deaths: (i) improved medical treatments in acute phase, (ii) secondary prevention by increasing the uptake of statins, (iii) primary prevention using health promotion to reduce dietary salt consumption. \textit{Methods}. We developed and validated a Markov model for the Tunisian population aged 35--94 years old over a 20-year time horizon. We compared the impact of specific treatments for stroke, lifestyle, and primary prevention on both IHD and stroke deaths. We then undertook extensive sensitivity analyses using both a probabilistic multivariate approach and simple linear regression (metamodeling). \textit{Results}. The model forecast a dramatic mortality rise, with 111,134 IHD and stroke deaths (95\% CI 106567 to 115048) predicted in 2025 in Tunisia. The salt reduction offered the potentially most powerful preventive intervention that might reduce IHD and stroke deaths by \(27\% (-30240 [-30580\text{ to }-29900])\) compared with 1\% for medical strategies and 3\% for secondary prevention. The metamodeling highlighted that the initial development of a minor stroke substantially increased the subsequent probability of a fatal stroke or IHD death. \textit{Conclusions}. The primary prevention of cardiovascular disease via a reduction in dietary salt consumption appeared much more effective than secondary or tertiary prevention approaches. Our simple but comprehensive model offers a potentially attractive methodological approach that might now be extended and replicated in other contexts and populations.