• Research Review
• Journal Summary

Title: The value of primordial and primary prevention for cardiovascular disease

Authors: W Weintraub, S Daniels, L Burke, B Franklin, et al

Reference: Circulation 2011; published online 25 July 2011 (open access)
http://bit.ly/q7Vsf5

Summarized by: Jocelyn Sterling, ProCor

Summary: The American Heart Association (AHA) published a paper on the cost-effectiveness and value of primary prevention for CVD, and how changes in systems and interventions can save lives and money.

CVD is related to a large number of health problems in the US
Only 18% of adults follow the three major measures that increase heart health: not smoking, maintaining a healthy body weight, and exercising five times a week. Around 33% of adults do not engage in any vigorous physical activity. One in three adults has high blood pressure, and 36% of them do not have it controlled, while 44% of adults have high cholesterol. At least 65% of type 2 diabetes patients die from heart disease or stroke, and more than 25 million Americans have diagnosed and undiagnosed diabetes, with 37% of the population having pre-diabetes. Nearly one in six children and adolescents are obese.

Solutions require policy change, funding, research, and public support
The AHA believes that policy change is most successful when it uses the environments in which people live, learn, work, and play to make healthier choices and behaviours the standard by default. In terms of funding, if investors can look past the lack of short term cost-savings, major savings in healthcare costs over the long-term would be greater than the cost of investing in programs and interventions. Additionally, more research is needed to clarify and support the effectiveness and sustainability of cost-effective preventive cardiovascular services so that they may be implemented in daily life. Lastly, legislators, public health professionals, and community representatives should support advocacy initiatives and empower locals to adopt a healthy lifestyle of physical activity, nutrition, smoking bans, and affordable healthcare.

Following these guidelines could save lives and reduce costs in the long-term
Community based programs to increase physical activity, improve nutrition, and prevent tobacco use would have a return of investment of almost US$6 for every US$1 spent within five years. For every US$1 spent on workplace wellness programs or on building bike or pedestrian trails, medical costs decrease around US$3 in the first 12 to 18 months. Nearly US$6 billion in heart disease costs could be saved if 10% of Americans began a regular walking program. By reducing the sodium in the food supply to a population intake of 1500 mg/day, more than US$26 billion in health care costs would be saved annually.

A 40% tax-induced cigarette price increase would reduce smoking prevalence by more than 15% by 2025 and would result in a total cost-savings of US$682 billion. Eliminating exposure to second hand smoke through smoke-free air laws in public buildings would save about US$10 billion annually in health care costs.

In addition to financial benefits, people who lower their CVD risk factors may have around 80% fewer heart attacks and strokes than those who do not reduce their risk factors. A 10% decrease in cholesterol levels in the whole population would result in a 30% decrease in heart disease.

An additional fact sheet by the AHA on the value of prevention for CVD is also available: http://bit.ly/pq0Aue