***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background In Africa hypertension is common and stroke is increasing . Detection , treatment and control of high blood pressure ( BP ) is limited . BP can be lowered by reducing salt intake . In Africa salt is added to the food by the consumer , as processed food is rare . A population -wide approach with programmes based on health education and promotion is thus possible . Methods We carried out a community-based cluster r and omised trial of health promotion in 1,013 participants from 12 villages ( 628 women , 481 rural dwellers ) ; mean age 55 years to reduce salt intake and BP .  Average BP was 125/74 mmHg and urinary sodium ( UNa ) 101 mmol/day . A health promotion intervention was provided over 6 months to all villages . Assessment s were made at 3 and 6 months . Primary end-points were urinary sodium excretion and BP levels . Results There was a significant positive relationship between salt intake and both systolic ( 2.17 mmHg [ 95 % CI 0.44 to 3.91 ] per 50 mmol of UNa per day , p < 0.001 ) and diastolic BP ( 1.10 mmHg [ 0.08 to 1.94 ] , p < 0.001 ) at baseline . At six months the intervention group showed a reduction in systolic ( 2.54 mmHg [ -1.45 to 6.54 ] ) and diastolic ( 3.95 mmHg [ 0.78 to 7.11 ] , p = 0.015 ) BP when compared to control . There was no significant change in UNa . Smaller villages showed greater reductions in UNa than larger villages ( p = 0.042 ) . Irrespective of r and omisation , there was a consistent and significant relationship between change in UNa and change in systolic BP , when adjusted for confounders . A difference in 24-hour UNa of 50 mmol was associated with a lower systolic BP of 2.12 mmHg ( 1.03 to 3.21 ) at 3 months and 1.34 mmHg ( 0.08 to 2.60 ) at 6 months ( both p < 0.001 ) . Conclusion In West Africa the lower the salt intake , the lower the BP . It would appear that a reduction in the average salt intake in the whole community may lead to a small but significant reduction in population systolic BP AIMS To evaluate whether a structured community pharmacy-based smoking cessation programme ( the PAS model ) would give rise to a higher smoking cessation rate compared with ad hoc advice from pharmacists . DESIGN A r and omized controlled trial comparing a structured intervention with usual care . SETTING One hundred pharmacists working in community pharmacies in N. Irel and and 24 in London took part in the study and were each asked to enroll 12 smokers ; 44 % of pharmacists who were trained managed to recruit one or more smokers during the recruitment period of approximately 1 year . PARTICIPANTS A total of 484 smokers were enrolled by the pharmacists and individually r and omized into the PAS intervention group ( N = 265 ) or the control group ( N = 219 ) . INTERVENTION The PAS intervention involved a structured counselling programme , an information leaflet and a follow-up weekly for the first 4 weeks then monthly as needed . MEASUREMENTS The primary outcome measure of this study was self-reported smoking cessation for 12 months with cotinine validation at the 12-month follow-up . FINDINGS Of smokers in the PAS group , 14.3 % ( 38 ) were abstinent up to 12 months compared with 2.7 % ( 6 ) in the control group ( p < 0.001 for the difference ) . CONCLUSION The community pharmacy-based PAS smoking cessation service can be an effective method of helping people stop smoking when delivered by pharmacists willing to adopt this approach The main aim of the trial was to determine whether drug treatment of mild hypertension ( phase V diastolic pressure 90 - 109 mm Hg ) reduced the rates of stroke , of death due to hypertension , and of  coronary events  in men and women aged 35 - 64 years . Subsidiary aims were : to compare the course of blood pressure in two groups , one taking bendrofluazide and one taking propranolol , and to compare the incidence of suspected adverse reactions to these two drugs . The study was single blind and based almost entirely in general practice s ; 17 354 patients were recruited , and 85 572 patient years of observation have accrued . Patients were r and omly allocated at entry to take bendrofluazide or propranolol or placebo tablets . The primary results were as follows . The stroke rate was reduced on active treatment : 60 strokes occurred in the treated group and 109 in the placebo group , giving rates of 1.4 and 2.6 per 1000 patient years of observation respectively ( p less than 0.01 on sequential analysis ) . Treatment made no difference , however , to the overall rates of coronary events : 222 events occurred on active treatment and 234 in the placebo group ( 5.2 and 5.5 per 1000 patient years respectively ) . The incidence of all cardiovascular events was reduced on active treatment : 286 events occurred in the treated group and 352 in the placebo group , giving rates of 6.7 and 8.2 per 1000 patient years respectively ( p less than 0.05 on sequential analysis ) . For mortality from all causes treatment made no difference to the rates . There were 248 deaths in the treated group and 253 in the placebo group ( rates 5.8 and 5.9 per 1000 patient years respectively ) . Several post hoc analyses of subgroup results were also performed but they require very cautious interpretation . The all cause mortality was reduced in men on active treatment ( 157 deaths versus 181 in the placebo group ; 7.1 and 8.2 per 1000 patient years respectively ) but increased in women on active treatment ( 91 deaths versus 72 ; 4.4 and 3.5 per 1000 patient years respectively ) . The difference between the sexes in their response to treatment was significant ( p = 0.05 ) . Comparison of the two active drugs showed that the reduction in stroke rate on bendrofluazide was greater than that on propranolol ( p = 0.002 ) . The stroke rate was reduced in both smokers and non-smokers taking bendrofluazide but only in non-smokers taking propranolol . This difference between the responses to the two drugs was significant ( p = 0.03 ) . ( ABSTRACT TRUNCATED AT 400 WORDS The Dietary Approaches to Stop Hypertension multicenter trial examined the impact of dietary patterns on blood pressure in 459 adults with blood pressure < 160 mm Hg systolic and 80 to 95 mm Hg diastolic . After a 3-week run-in period on a control diet low in fruits , vegetables , and dairy products , and with a fat content typical for Americans , participants were r and omized for 8 weeks to either the control diet , a diet rich in fruits and vegetables , or a combination diet that emphasized fruits , vegetables , and low-fat dairy products . Body weight and sodium intake were held constant , and physical activity did not change during the intervention . Baseline mean + /- st and ard deviation systolic and diastolic blood pressures were 131.3 + /- 10.8 mm Hg and 84.7 + /- 4.7 mm Hg , respectively . Relative to the control diet , the combination diet reduced blood pressure by 5.5 mm Hg and diastolic blood pressure by 3.0 mm Hg ( P < .001 ) . For those on the fruits and vegetables diet , blood pressure reductions relative to control were 2.8 mm Hg systolic ( P < .001 ) and 1.1 mm Hg diastolic ( P < .07 ) . In 133 participants with hypertension , the combination diet produced a net blood pressure reduction of 11.4 and 5.5 mm Hg systolic and diastolic , respectively ( P < .001 ) . In participants without hypertension ( n = 326 ) , the corresponding blood pressure reductions were 3.5 mm Hg systolic ( P < .001 ) and 2.1 mm Hg diastolic ( P < .003 ) . In other subgroup analyses , minorities showed relatively larger reductions in blood pressure than nonminorities ( P < .001 ) . We conclude that the dietary pattern reflected in the combination diet can substantially reduce blood pressure , and , accordingly , provides an additional lifestyle approach to preventing and treating hypertension Background The Lescol Intervention Prevention Study ( LIPS ) showed substantial gains in health outcomes from statins following PCI . That study was a r and omized double-blind placebo-controlled trial undertaken in 77 centres , predominantly in Europe , of patients with moderate hypercholesterolemia who had undergone their first PCI . The evidence on cost-effectiveness has been established for the UK , USA and the Netherl and s , but due to different health system cost structures , the results may not be applicable to other European countries . The aim of this study was to estimate the cost-effectiveness of fluvastatin used following first PCI in Hungary . Material s and methods A deterministic Markov model was used to estimate the incremental costs per quality -adjusted life year gained , with cost data drawn from the Hungarian National Health Insurance Fund . Effectiveness data on fluvastatin was derived directly from LIPS and utility weights from previous studies on heart disease . Sensitivity analyses were conducted around key parameters and analyses were conducted for subgroups identified in LIPS . Results Treatment with fluvastatin  cost an additional € 1,704 and result ed in an additional 0.107 QALYs per patient discounted over 10-years compared with controls . The incremental cost per quality -adjusted life year gained was € 15,910 . The key determinants of cost-effectiveness were the effectiveness of fluvastatin , utility weights , cost of fluvastatin , and the time horizon evaluated .  Fluvastatin was substantially more cost-effective in patients with diabetes , renal disease , multi-vessel disease or LDL-cholesterol > 3.4 mmol/l . Conclusions Fluvastatin is an economically efficient pharmaceutical for reducing heart disease in Hungary and other European countries in patients following PCI Abstract Objectives : To estimate the long-term impact of treatment with perindopril on costs and health effects in patients with stable coronary artery disease in Pol and . Methods : The cost-effectiveness analysis was based on data from a r and omized double-blind , placebo-controlled trial . A decision-tree analysis was employed , including Monte Carlo and bootstrapping techniques . This study was a sub- study of the EUROPA ( European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease ) trial ( n = 12 218 ; mean follow-up 4.2 years ) . Re source use was based on data from Polish EUROPA study patients ( n = 1251 ) , while effectiveness was based on the whole EUROPA study . The health gain  of perindopril in life-years was based on overall EUROPA study results , and the adapted Polish life expectancy of patients not dying during the trial . Costs were calculated in new Polish zloty ( PLN ) , year 2003 values ; € 1 = PLN4.053 . Only direct healthcare costs related to cardiovascular events and medication use were studied . Results : When observed mortality was combined with life expectancy beyond the end of the study , perindopril use showed a gain in life expectancy of 0.182 lifeyears ( SD ± 0.129 ) at a cost of PLN1983 ( SD ± 103 ) with discounting of 5 % per annum on costs and no discounting on effects . This result ed in an incremental cost-effectiveness ratio ( ICER ) of PLN10 896 per life-year gained . The probability that the ICER  for perindopril was below the threshold of PLN60 000 was 88 % . The overall results were insensitive to discount rates for costs and life-years . Conclusions : Perindopril leads to a reduction in the risk of coronary events among patients with stable heart disease . When the expected improvement in life expectancy is combined with associated medical costs , there is a high probability that perindopril is cost effective , given the threshold of PLN60 000 per life-year gained BACKGROUND Lowering the blood cholesterol level may reduce the risk of coronary heart disease . This double-blind study was design ed to determine whether the administration of pravastatin to men with hypercholesterolemia and no history of myocardial infa rct ion reduced the combined incidence of nonfatal myocardial infa rct ion and death from coronary heart disease . METHODS We r and omly assigned 6595 men , 45 to 64 years of age , with a mean ( + /- SD ) plasma cholesterol level of 272 + /- 23 mg per deciliter ( 7.0 + /- 0.6 mmol per liter ) to receive pravastatin ( 40 mg each evening ) or placebo .  The average follow-up period was 4.9 years . Medical records , electrocardiographic recordings , and the national death registry were used to determine the clinical end points . RESULTS Pravastatin lowered plasma cholesterol levels by 20 percent and low-density-lipoprotein cholesterol levels by 26 percent , whereas there was no change with 
    Output:
    
Results From 9731 search results we found 16 studies , which presented economic outcomes  for interventions to prevent cardiovascular disease in low and middle income setting s , with most of these reporting positive cost effectiveness results .When the same interventions were evaluated across setting s , within and between papers , the likelihood of an intervention being judged cost effective was generally lower in regions with lowest gross national income .
While population based interventions were in most cases more cost effective , cost effectiveness estimates for individual pharmacological interventions were overall based upon a stronger evidence base .
Conclusions While more studies of cardiovascular preventive interventions are needed in low and mid income setting s , the available high-level of evidence supports a wide range of interventions for the prevention of cardiovascular disease as being cost effective across all world regions