Workplace Prevention Cuts Prevalence of Smoking, Hypertension, and Metabolic Syndrome

August 29, 2012

August 29, 2012 (Munich, Germany) — Preliminary data from a work fitness program suggests that prevention strategies might be more effective if they target individuals in the workplace rather than the doctor's office. The program, started in 2005, reduced the rates of smoking, improved blood pressure control, reduced the incidence of metabolic syndrome, and improved the 10-year predicted risk of cardiovascular disease, according to researchers.

"The workplace is the ideal setting for primary and secondary prevention, because there we can get access to all patients at risk," said Dr Johannes Scholl (Prevention First, Ruedesheim, Germany) during a presentation closing out the European Society of Cardiology 2012 Congress. "Close cooperation between respective departments of occupational medicine and specialist prevention clinics is the basis for good compliance and success."

For Scholl, the workplace is better suited for primary and secondary prevention, as many younger patients, including those with undetected hypertension and elevated cholesterol levels, are not frequent users of primary-care physicians. As a result, many of their cardiovascular risk factors go untreated.

Fit in Life, Fit on the Job

Initiated in 2004 and known as the "Fit in Life, Fit on the Job" program, Boehringer Ingelheim employees in Germany were enrolled through the department of occupational medicine. During their index visit, physical examinations and family-history assessments were performed, and all biometric data recorded. Two weeks later, employees went to the Prevention First clinic for a more complete assessment, including baseline carotid intima-media thickness (IMT) measurements, fitness testing to maximal exhaustion, and a full cardiovascular risk assessment. After these examinations, individuals were shown their 10-year and longer-term risk of cardiovascular disease and prescribed comprehensive nutritional and exercise recommendations.

"Unlike many other companies, not only executives came to the health checkups, but it was a program for all employees 40 years or older," said Scholl.

Based on data from 312 men and 223 women included in the program, mean age 50 years old, more than half of patients had high blood pressure and approximately one-third had metabolic syndrome. The mean body-mass index in men was 27 and 25.6 in women.

The results showed that after a mean follow-up of 3.4 years, the number of male and female smokers declined by 39% and 17.5%, respectively. At baseline, 28.6% of men and 38.2% of women had their blood pressure under control, but these numbers increased significantly--up to 42.8% in men and 54.2% in women--when individuals participated in the workplace prevention program. The prevalence of metabolic syndrome declined 34% in women and 44% in men during the follow-up period, a reduction that would translate into a large reduction in the prevalence of diabetes, according to the investigators. Approximately 25% of men and women had an improvement in their 10-year risk of cardiovascular disease as assessed by the Framingham risk score.

For Scholl, one of the strengths of the program was the inclusion of all employees, not just executives. The executives led the charge with testimonials and encouraged all of Boehringer to participate, however.

One of the downsides of presenting such preliminary data is that researchers are currently unaware of the economic benefits of the program. For example, it is unknown whether getting employees healthier and more active reduces absenteeism or improves productivity, an important bottom-line factor that will determine the long-term continuance of the program. Scholl said the researchers are planning on performing such economic analysis when more than 3000 patients have at least one follow-up visit.

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