CVD Prevention a Savvy Investment as Treatment Costs Soar

Marlene Busko

July 26, 2011

July 25, 2011 (Newark, Delaware) — Public policies for primordial and primary prevention of CVD events are effective and worth the cost, according to an AHA policy statement published online in July 25, 2011 Circulation [1].

"There has been concern that we could not afford prevention," lead author Dr William S Weintraub (Christiana Healthcare Services, Newark, DE) told heartwire . "This is not true. Prevention is most definitely affordable," he said.

This review conducted by the AHA Advocacy Coordinating Committee should provide evidence to facilitate programs and public policies to prevent CVD, he added.

"It is no longer acceptable to simply treat cardiovascular disease and stroke, but in addition we must redouble efforts to not only prevent disease but also prevent the development of risk factors," AHA president Dr Gordon F Tomaselli (Johns Hopkins University, Baltimore, MD) told heartwire . "True healthcare reform will be realized only when we focus attention on disease prevention and not disease management," he emphasized.

Focus on Disease Prevention

Most CVD can be prevented or at least delayed until old age, the authors write. Prevention may be primordial--preventing risk factors before they occur--or primary--modifying existing adverse risk factors to prevent an initial CVD event.

It is no longer acceptable to simply treat cardiovascular disease and stroke, but in addition we must redouble efforts to not only prevent disease but also prevent the development of risk factors.

Whereas pharmacological interventions clearly reduce risk factors and prevent CVD events in clinical trials, there is less evidence about the value of public policies--such as those to reduce salt consumption, eliminate smoking, and encourage physical activity. This is largely because it is more difficult to conduct long-term cost-effectiveness analyses.

To investigate existing evidence about the value of CVD prevention, the AHA commissioned this policy statement, and the team reviewed over 200 papers.

More Bike Paths, Less Salt, More Expensive Cigarettes

Some of the main findings were:

  • Every $1 spent on building biking trails and walking paths would save an estimated nearly $3 in medical expenses.

  • Reducing average individual sodium intake to 1500 mg/day in the US would lead to an estimated 25.6% decrease in blood pressure and healthcare savings of $26.2 billion a year.

  • Increasing tobacco taxes by 40% would reduce smoking prevalence by an estimated 15.2% by 2025, with large gains in life expectancy and quality of life and a total savings of $682 billion.

  • For every $1 spent in wellness programs, companies would save about $3.27 in medical costs and $2.73 in absenteeism costs.

"Individual responsibility is a crucial first step, but environmental and policy changes are the most impactful ways to improve health," Tomaselli said. "[Changing] diet and sedentary behaviors is key," he noted.

Seeking 20% Improvement in Heart Health

By 2020, the AHA aims to "improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%," Tomaselli explained.

Reaching this goal will require individual efforts--from patients and healthcare practitioners--as well as global policy changes.

Some of the authors' recommendations to federal, state, and local policy makers are to:

  • Improve food labeling and implement labeling in restaurant menus.

  • Ensure that schools develop nutrition standards for meals and provide physical activity throughout the school day.

  • Implement workplace wellness programs.

  • Build communities with sidewalks and bike trails.

  • Ensure that smoking-cessation programs are adequately funded.

  • Ensure that neighborhood stores sell affordable fruits and vegetables, especially in poorer areas.

Physicians can play a role in counseling patients about the importance of making healthy lifestyle choices and controlling modifiable risk factors. "Cardiologists and perhaps more importantly primary-care practitioners will have to redouble efforts to emphasize the importance of diet, exercise, smoking cessation, control of blood pressure, glucose, and cholesterol as central to optimizing overall health," Tomaselli said. This is true for patients without heart disease or prior stroke and is as important for people who have already had an MI or stroke.

In addition, physicians need to advocate for changes in public policies that affect healthcare. "It is going to be important for practitioners to advocate for things that make living a healthy lifestyle the easiest and most affordable choice," Tomaselli said. This includes working with politicians and community planners to create safe and hospitable environments for people to be active and continuing to support such enterprises as mandatory physical education in schools.

"What we spend on cardiovascular disease is not sustainable. But we can afford to prevent it," Weintraub said. "Ultimately, we can't afford not to."

Weintraub and Tomaselli report no conflict of interest. Disclosures for the coauthors are listed in the paper.

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