Implementation of prevention strategies may lower burden of CVD

An increase in preventive activities could lead to fewer events but also increased costs.

The implementation of prevention strategies for cardiovascular disease may have a dramatic effect on event rates for cardiovascular disease, according to results of a special report copublished in Circulation and Diabetes Care.

Researchers with the American Diabetes Association, American Heart Association, American Cancer Society and Archimedes, Inc., designed and conducted an analysis that included data from 13 separate simulated clinical trials. Eleven of these were designed to examine specific prevention activities and the remaining two were designed to evaluate the effect of combinations of the prevention activities.

Among the guideline-driven prevention strategies evaluated were introduction of aspirin to high-risk patients, the lowering of LDL to recommended target levels, the lowering of blood pressure, cessation from smoking and reduction in weight.

Patients were drawn from the National Health and Nutrition Examination Survey population. Each simulated trial included a sample of 50,000 patients, which was later scaled to represent the approximately 200 million adults in the United States as of 2005. The simulated trials were each conducted for 30 years.

The researchers calculated outcomes based on the maximum potential of prevention for CVD at 100% compliance and performance level and again at a feasible compliance and performance level.

Prevention benefits

Approximately 156 million adults (78%) met indications for at least one preventive activity.

The researchers estimated that if every adult received the preventive treatments they were indicated for, myocardial infarctions could be reduced from approximately 43 million during 30 years to approximately 16 million (>60%). Strokes could also be reduced by 30%; from approximately 33 million during 30 years to approximately 23 million. The complete adoption of the preventive strategies would increase life expectancy by an average of 1.3 years and would yield a higher quality of life, according to the report.

The financial costs associated with the implementation of such preventive activities and programs at the national level are substantial, according to the researchers. Even if implemented at feasible levels, the financial burden on the health care system and on the individual would be increased.

“As they are currently delivered, almost all of the prevention activities are expensive,” the researchers wrote. “If applied fully, using current protocols and the reference assumptions about costs, they would increase health care costs by approximately $8.5 trillion over 30 years, or $283 billion per year, or approximately $1,700 per person per year. The only cost-saving activity is smoking cessation.” – by Eric Raible

Circulation. 2008;doi:10.1161/CIRCULATIONAHA.108.190186.

It is true that seen strictly from a financial point of view, current costs of prevention would require additional outlay of money. However, the savings in terms of lessened human misery, suffering and familial distress would be enormous. One cannot apply a dollar value to these latter savings. I agree we need to come up with strategies to reduce the costs associated with preventive strategies. The quality of life improvement costs are not totally unreasonable compared with other medical interventions that we do on a routine basis; heart transplantation is an example. The question becomes whether the U.S. population is willing to spend more money to prevent MIs and strokes.

– Joseph S. Alpert, MD

Professor of Medicine, Chair of the Department of Medicine,
University of Arizona Health Sciences Center, Tucson, Ariz.