Back to Basics: Preventing Heart Disease

Marilyn W. Edmunds, PhD, CRNP


January 03, 2011

Cost-Effective Prevention of Coronary Heart Disease

Ashen D
J Nurse Practitioners. 2010;6:754-764

Article Summary

Healthcare designed to prevent future illness and minimize progression of chronic illness are powerful means to improve quality of life, minimize mortality, and lower healthcare costs. Coronary heart disease (CHD) is the number 1 killer of both men and women in the United States.

Prevention of CHD involves early identification and management of risk factors through assessment and treatment. The goal in CHD prevention research is to find interventions with the largest relative risk reduction, the smallest number needed to treat, and the lowest cost per quality-adjusted life year saved.

Evidence-based treatment strategies have been shown to cost-effectively minimize CHD risk and reduce morbidity and mortality. Approaches that encompass the lifespan and reach into the workplace, schools, churches, and homes can make small changes in risk factors across an entire population and are important areas for improving CHD preventive care. Public health policies are also necessary to support implementation of preventive programs.


In this article, Ashen adopts a narrow focus on interventions to prevent CHD. Rather than focusing on everything that might be done, assessment and treatment strategies are considered from a cost-effective standpoint, and primary care strategies are viewed from a societal, rather than an individual, point of view. This is a unique contribution to the primary care literature.

Costs associated with coronary heart disease have continued to escalate. In the case of CHD and diabetes mellitus -- which contribute and potentiate each other -- these cost increase are also byproducts of the growing obesity epidemic. Ways must be found to return to a focus on wellness along with good nutrition and exercise, but these are not new conclusions.

I have just returned to the United States after living for several years in China. As I stepped off the airplane in a large US airport I was overwhelmed by the number of overweight and obese individuals -- some of them morbidly obese --walking past me in the airport. I attended a professional conference of nurse practitioners (NPs) and encountered many NP colleagues who were grossly overweight. I heard them discussing their diabetes and CHD and other health problems they were having. I also noticed that one of the contestants on the TV program The Biggest Loser is a NP. Of course, NPs are not the only healthcare providers who need to slim down.

The problems that the United States faces in establishing healthcare strategies and trying to resolve these chronic diseases is staggering but more imperative every day. The solution must begin with us. As healthcare providers, we must be the role models as well as the educators, but how effective can we be in counseling patients to lose weight if we are clearly not following our own advice?


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