Re: Government’s plans for universal health checks for people aged 40-75
In the next 20 years, more than 40% of the US population is expected to have some form of cardiovascular disease, and this will triple the total direct medical costs of caring for hypertension, coronary heart disease, heart failure, stroke, and other forms of cardiovascular disease from the current $273 billion to more than $800 billion, according to a new policy statement from the American Heart Association (AHA) [1].
In addition, the AHA estimates that the prevalence of cardiovascular disease will increase by approximately 10% over the next 20 years given no changes to prevention and treatment trends.
At present, cardiovascular disease is the leading cause of death in the US and accounts for 17% of overall healthcare expenditures. In the past, the medical costs of cardiovascular disease increased at an average annual rate of 6%, and this growth in costs has been associated with an increase in life expectancy. That said, there are "many opportunities to further improve cardiovascular health while controlling costs," according to the AHA.
By 2030, the prevalence of cardiovascular disease is expected to increase 9.9%, with the prevalence of heart failure and stroke increasing approximately 25%. Total direct costs will increase to $818 billion by 2030, according to the AHA estimates, and the total indirect cost to the US in terms of lost productivity is close to $275 billion [1,2].
Hypertension has the greatest projected medical cost, in part because of the aging population, although the increase in prevalence and cost is not explained fully by age. Rising obesity rates are also contributing to the increasing rates of hypertension. The AHA notes that the downstream medical costs of high blood pressure--including its impact on cardiovascular disease and stroke--approximately double the cost of hypertension, making it a "particularly valuable target to modify the future total costs of cardiovascular disease."'
Data from the Coronary Artery Risk Development in Young Adults (CARDIA) study [3] suggest that cardiovascular disease prevention should begin earlier in life. In CARDIA, risk-factor levels in individuals younger than 30 years old were predictive of subclinical atherosclerosis 15 years later. The data, they write, also show that modest improvements in risk factors earlier in life have a larger impact than more substantial reductions later in life.
Of 58 million deaths globally, 60% were attributed to chronic diseases in 2004 (4). Deaths from chronic diseases are projected to increase dramatically between now and 2030 (5).
Considering all risk factors trends together, the forecast for cardiovascular disease burden in low-income and middle income countries over the next few decades comprises a population emergency that will cost tens of millions of preventable deaths, unless rapid actions are taken by governments and health care systems worldwide. In the long term, the most effective strategic approach is through a population level risk factors control (6).
However, a recent analysis of 23 low income and middle income countries indicated that the capacity of these countries to effectively deal with existing and projected burden of non communicable disease is limited (7). The decision by the United General Assembly to convene a “high level meeting on the prevention and control of non-communicable disease worldwide” in September 2011 provides a unique opportunity to elevate chronic diseases to the global political agenda.
More evidence-based effective policy should be applied in the prevention, early detection, and management of cardiovascular disease risk factors. Through a combination of improved prevention of risk factors and treatment of established risk factors, the dire projection of the health and economic impact of cardiovascular disease can be diminished. [1-3].
On the basis of the available data the American College of Cardiology Foundation and American Heart Association have stated in their guidelines that screening is of limited value in individuals at low risk (10 year Framingham risk scoring <10%). However, in individuals at intermediate risk (10 year Framingham risk scoring 10-20%) the finding of coronary calcium scoring of 400 or higher would increase the risk to that noted with diabetes or peripheral disease, altering clinical-decision making. Individuals with a high 10 year Framingham risk score (> 20%) should be treated aggressively according to the current National Cholesterol Education Program (NCEP) III guidelines and do not require additional testing (8,9).
An evidence-based preventative programme based on scientific international guidelines is essential to identify asymptomatic individuals at the highest risk requiring preventive lipid lowering medication or blood pressure treatment. Treating people at high risk of cardiovascular disease with aspirin, a statin, and two blood pressure lowering drugs is highly cost effective and would save about as many premature deaths as the population strategies (11).
Cardiovascular disease is largely preventable through training an adequate workforce, using clinical practice guidelines to improve care, improving management of population risk factors.
Rapid Response:
Re: Government’s plans for universal health checks for people aged 40-75
In the next 20 years, more than 40% of the US population is expected to have some form of cardiovascular disease, and this will triple the total direct medical costs of caring for hypertension, coronary heart disease, heart failure, stroke, and other forms of cardiovascular disease from the current $273 billion to more than $800 billion, according to a new policy statement from the American Heart Association (AHA) [1].
In addition, the AHA estimates that the prevalence of cardiovascular disease will increase by approximately 10% over the next 20 years given no changes to prevention and treatment trends.
At present, cardiovascular disease is the leading cause of death in the US and accounts for 17% of overall healthcare expenditures. In the past, the medical costs of cardiovascular disease increased at an average annual rate of 6%, and this growth in costs has been associated with an increase in life expectancy. That said, there are "many opportunities to further improve cardiovascular health while controlling costs," according to the AHA.
By 2030, the prevalence of cardiovascular disease is expected to increase 9.9%, with the prevalence of heart failure and stroke increasing approximately 25%. Total direct costs will increase to $818 billion by 2030, according to the AHA estimates, and the total indirect cost to the US in terms of lost productivity is close to $275 billion [1,2].
Hypertension has the greatest projected medical cost, in part because of the aging population, although the increase in prevalence and cost is not explained fully by age. Rising obesity rates are also contributing to the increasing rates of hypertension. The AHA notes that the downstream medical costs of high blood pressure--including its impact on cardiovascular disease and stroke--approximately double the cost of hypertension, making it a "particularly valuable target to modify the future total costs of cardiovascular disease."'
Data from the Coronary Artery Risk Development in Young Adults (CARDIA) study [3] suggest that cardiovascular disease prevention should begin earlier in life. In CARDIA, risk-factor levels in individuals younger than 30 years old were predictive of subclinical atherosclerosis 15 years later. The data, they write, also show that modest improvements in risk factors earlier in life have a larger impact than more substantial reductions later in life.
Of 58 million deaths globally, 60% were attributed to chronic diseases in 2004 (4). Deaths from chronic diseases are projected to increase dramatically between now and 2030 (5).
Considering all risk factors trends together, the forecast for cardiovascular disease burden in low-income and middle income countries over the next few decades comprises a population emergency that will cost tens of millions of preventable deaths, unless rapid actions are taken by governments and health care systems worldwide. In the long term, the most effective strategic approach is through a population level risk factors control (6).
However, a recent analysis of 23 low income and middle income countries indicated that the capacity of these countries to effectively deal with existing and projected burden of non communicable disease is limited (7). The decision by the United General Assembly to convene a “high level meeting on the prevention and control of non-communicable disease worldwide” in September 2011 provides a unique opportunity to elevate chronic diseases to the global political agenda.
More evidence-based effective policy should be applied in the prevention, early detection, and management of cardiovascular disease risk factors. Through a combination of improved prevention of risk factors and treatment of established risk factors, the dire projection of the health and economic impact of cardiovascular disease can be diminished. [1-3].
On the basis of the available data the American College of Cardiology Foundation and American Heart Association have stated in their guidelines that screening is of limited value in individuals at low risk (10 year Framingham risk scoring <10%). However, in individuals at intermediate risk (10 year Framingham risk scoring 10-20%) the finding of coronary calcium scoring of 400 or higher would increase the risk to that noted with diabetes or peripheral disease, altering clinical-decision making. Individuals with a high 10 year Framingham risk score (> 20%) should be treated aggressively according to the current National Cholesterol Education Program (NCEP) III guidelines and do not require additional testing (8,9).
An evidence-based preventative programme based on scientific international guidelines is essential to identify asymptomatic individuals at the highest risk requiring preventive lipid lowering medication or blood pressure treatment. Treating people at high risk of cardiovascular disease with aspirin, a statin, and two blood pressure lowering drugs is highly cost effective and would save about as many premature deaths as the population strategies (11).
Cardiovascular disease is largely preventable through training an adequate workforce, using clinical practice guidelines to improve care, improving management of population risk factors.
1. Heidenreich PA, Trogdon JG, Khavjou MA et al on behalf of the American Heart Association. Forecasting the future of cardiovascular disease in the United States- A policy statement from the American Heart Association. Circulation 2011; 123:
2. Michael O'Riordan. Cost of Cardiovascular Disease to Triple by 2030. Heartwire © 2011 Medscape, LLC
3. Ogunyankin KO, Liu K, Lloyd-Jones DM, Colangelo LA, Gardin JM. Reference values of right ventricular end-diastolic area defined by ethnicity and gender in a young adult population: the CARDIA study. Echocardiography. 2011 Feb;28(2):142-9. Epub 2011 Jan 7.
4. WHO. Global infobase. https://apps.who.it/infobase/mortality aspx
5. Mothers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. Plo S Med 2006; 3: e442
6. Anand SS, Yusuf S. Stemming the global tsunami of CVD. The Lancet 2011; 337: 529-532
7. Alwan A, Maclean DR, Riley LM et al. Monitoring and surveillance of chronic non-communicable disease: progress and capacity in high burden countries. The Lancet 2010; 376: 1861-1868
8. Greenland P, Bonow RO, Brundage BH et al. ACCF/AHA expert consensus document on coronary artery calcium scoring. Circulation 2007; 115: 402-426
9. Third report on the NCEP Expert Panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 3143-421
10. Writing Committee Members: ACCF/AHA Task Force Members. 2010 ACCF/AHA Guideline for assessment of cardiovascular risk in asymptomatic adults: Executive summary: A report of the American college of cardiology foundation/American heart association task force on practice guidelines. J Am Coll Cardiol 2010; 56 (25): 2182-2199
11. Shiffman J, Smith S. Generation of political priority for global health initiatives: a framework and case study of maternal mortality. The Lancet 2007; 370: 1370-79
Competing interests: No competing interests