CHICAGO --- Lower cardiovascular disease risk in middle age not only improves health in older age and extends lifespan -- it is also better for the nation's fiscal well-being.
A study by Northwestern University Medical School researchers found significantly lower Medicare health costs in older people who had no heart disease risk factors, such as high cholesterol and blood pressure levels and cigarette smoking, during young adulthood and middle age.
In an article in the Oct. 15 New England Journal of Medicine, the group reported that total annual Medicare charges for men at low cardiovascular disease risk were about 30 percent lower, or $1,600 less per year ($3,200 vs. $4,800), than those for men not at low risk. The total annual Medicare charges for women at low risk were 50 percent lower, or $1,800 less per year ($1,800 vs. $3,600), than those for women not at low risk.
Persons classified as being at low risk for cardiovascular disease had a serum cholesterol of less than 200; blood pressure of 120 systolic/80 diastolic or lower; no current smoking; a normal electrocardiogram; and no history of diabetes or heart attack.
Medicare is the largest single source of health care spending in the United States. As the population ages, the issue of expenditures for health care under Medicare has become increasingly important. Results of the Northwestern study indicate that preventing the major cardiovascular disease risk factors before or during middle age may dramatically reduce future Medicare costs.
"These findings imply improved quality of life -- the prolongation of independent and productive living, with a decreased burden on family and society," said Martha L. Daviglus, M.D., assistant professor of medicine at the Medical School, who was lead author on the study.
The Northwestern researchers studied data on over 7,000 middle-aged men and 6,800 women surveyed from 1967 to 1973 as part of the Chicago Heart Association Detection Project in Industry, who survived to be eligible for Medicare coverage for at least two years. Health Care Financing Administration (HCFA) charges for services to Medicare beneficiaries were used to estimate average annual health care costs (adjusted for age and inflation) for all conditions, cardiovascular conditions and cancer. Costs were compared over an 11-year period for men and women with favorable risk factors vs. those with unfavorable risk factors at the beginning of the survey.
Serum cholesterol level, systolic and diastolic blood pressure and cigarette smoking were selected as factors not only because of their substantial influence on risk, but also because of the high prevalence of these traits in the adult population and the fact that they can be prevented and controlled -- with a great effect on risk, longevity and health care costs.
Based on the HCFA data on costs of inpatient and outpatient services, average annual Medicare charges for cardiovascular care and for all care were significantly lower for both low-risk men and women than for those with one or more risk factors. The charges attributable to cancer as the primary diagnosis were also lower for the men and women at low risk than for those not at low risk. Additionally, as the number of major risk factors increased, there was a significant graded increase in charges for care related to cardiovascular diseases and all causes.
While there was no significant difference in rate of use of services between those at low risk and those not at low risk, average number of hospital days per year was lower for the low-risk group, possibly because they had less severe illness, different types of illness, fewer medical problems or fewer hospital-related complications than their higher-risk counterparts.
Daviglus said the results of the study underscore the soundness of a national health policy that emphasizes primary prevention and control of all three major risk factors for cardiovascular disease -- adverse cholesterol levels, adverse blood pressure and cigarette smoking. Such a strategy, she said, would not only control the epidemic of coronary heart disease and related conditions, but also contain health care costs and improve quality of life in later years.
Daviglus's co-researchers on the study were Jeremiah Stamler, M.D., emeritus professor of preventive medicine; Kiang Liu, professor of preventive medicine; Philip Greenland, M.D., the Harry W. Dingman Professor and chair of preventive medicine; Alan R. Dyer, professor of preventive medicine; Daniel B. Garside, research programming manager, preventive medicine; Larry M. Manheim, research professor, Institute for Health Services Research and Policy Studies, Northwestern University; Lynn P. Lowe, research assistant professor, preventive medicine; Miriam Rodin, M.D., assistant professor of medicine; and James Lubitz, Office of Research and Demonstrations, Health Care Financing Administration, Baltimore, Md.
This research was supported by grants from the American Heart Association and its Chicago and Illinois affiliates, the Illinois Regional Medical Program, the National Heart, Lung, and Blood Institute, the Chicago Health Research Foundation and private donors.