{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T16:14:19Z","timestamp":1759335259343,"version":"3.37.3"},"reference-count":42,"publisher":"Wiley","license":[{"start":{"date-parts":[[2019,1,29]],"date-time":"2019-01-29T00:00:00Z","timestamp":1548720000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100011102","name":"Seventh Framework Programme","doi-asserted-by":"publisher","award":["n223075"],"award-info":[{"award-number":["n223075"]}],"id":[{"id":"10.13039\/100011102","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["n223075"],"award-info":[{"award-number":["n223075"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000384","name":"Higher Education Funding Council for England","doi-asserted-by":"publisher","award":["n223075"],"award-info":[{"award-number":["n223075"]}],"id":[{"id":"10.13039\/501100000384","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Computational and Mathematical Methods in Medicine"],"published-print":{"date-parts":[[2019,1,29]]},"abstract":"<jats:p><jats:italic>Background<\/jats:italic>. 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. <jats:italic>Methods<\/jats:italic>. We developed and validated a Markov model for the Tunisian population aged 35\u201394 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). <jats:italic>Results<\/jats:italic>. 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% (\u221230240 [\u221230580 to \u221229900]) 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. <jats:italic>Conclusions<\/jats:italic>. 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.<\/jats:p>","DOI":"10.1155\/2019\/2123079","type":"journal-article","created":{"date-parts":[[2019,1,29]],"date-time":"2019-01-29T18:36:22Z","timestamp":1548786982000},"page":"1-11","source":"Crossref","is-referenced-by-count":4,"title":["Comparing Strategies to Prevent Stroke and Ischemic Heart Disease in the Tunisian Population: Markov Modeling Approach Using a Comprehensive Sensitivity Analysis Algorithm"],"prefix":"10.1155","volume":"2019","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5206-5736","authenticated-orcid":true,"given":"Olfa","family":"Saidi","sequence":"first","affiliation":[{"name":"Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, 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