Prevention Activities Could Increase Lifespan Of U.S. Adults

Main Category: Cardiovascular / Cardiology
Also Included In: Diabetes
Article Date: 08 Jul 2008 - 4:00 PDT

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Aggressive use of nationally recommended clinical prevention activities, such as smoking cessation programs, controlling pre-diabetes or lowering cholesterol, could increase life expectancy for U.S. adults by reducing cardiovascular disease (CVD), according to a joint report of three major national healthcare organizations.

"The Impact of Prevention on Reducing the Burden of Cardiovascular Disease" is published online today, and will appear in the July 29 issue of Circulation: Journal of the American Heart Association and the August issue of Diabetes Care. The study was conducted by researchers from the American Heart Association, the American Diabetes Association and the American Cancer Society.

Using a sophisticated mathematical model called Archimedes, senior scientists from the organizations evaluated the impact of 11 widely recognized, tailored clinical preventive services for reducing cardiovascular disease, such as smoking cessation, preventive aspirin therapy, cholesterol-lowering medications and weight reduction. A similar analysis is being conducted that includes preventive measures for cancer.

The scientists found that using these CVD clinical preventive measures to their fullest potential could add about 220 million life-years over the next 30 years, or an average of 1.3 years of life expectancy for each adult in the United States. About 78 percent of U.S. adults ages 20 to 80 are candidates for at least one of these clinical prevention activities, and the report notes a number of ways prevention could bring benefits.

There are large gaps in the application of prevention, thus large opportunities to reduce morbidity and mortality from CVD.

If every individual achieved 100 percent adherence with all the clinical prevention activities for which they are candidates, then heart attacks would decrease about 63 percent and strokes about 31 percent in the next three decades.

Since it is unrealistic to expect that these clinical prevention activities will be 100 percent effective in all cases, the authors assessed their impact using more "feasible" success levels that have actually been achieved in clinical practice. Under those conditions, heart attacks would drop by 36 percent and strokes by 20 percent in the same period.

"The American Cancer Society, the American Diabetes Association, and the American Heart Association have joined forces to look at clinical prevention and its impact because, although we represent different health conditions, the same prevention strategies that can significantly reduce the risk of cardiovascular diseases, including heart disease and stroke, also could reduce the risk of diabetes and cancer," said Rose Marie Robertson, M.D., chief science officer of the American Heart Association and co-author of the report.

"However, our current healthcare system is not optimally designed to promote health or prevent illness," Robertson said. "The lesson from these findings is that we need a system in which we can apply these interventions in a way that is efficient and cost effective. The benefits are too important to be ignored. A healthier, more productive society is good for us all."

"People with diabetes are among those who would benefit the most from these prevention strategies," said Richard Kahn, Ph.D., chief scientific and medical officer of the American Diabetes Association and co-author of the report. "Of the specific clinical prevention activities, the greatest benefits to the U.S. population in terms of reducing cardiovascular disease come from providing aspirin to high-risk individuals, controlling pre-diabetes, weight reduction in obese individuals, lowering blood pressure in people with diabetes, and lowering LDL cholesterol in people with existing coronary artery disease (CAD)."

"If you have diabetes, you need to know that you are at high risk for having a heart attack or stroke, so taking action to prevent diabetes and its complications -which include heart attack and stroke - is very important," Kahn said. "This report spotlights how great an impact we can make in this population simply by employing common clinical prevention strategies."

The report is the first of two joint reports that will focus on cardiovascular disease, which is the overall leading cause of death for people in the U.S. and for people with diabetes. Future reports will broaden the focus to look at the impact of these same strategies along with primary prevention strategies and cancer screening, on reducing the risk of morbidity and mortality from cardiovascular disease, diabetes and cancer.

"This research has important implications for the work our three organizations are doing to broaden access to care, including preventive services, and to promote the role of prevention in the national debate on healthcare reform.," said Otis W. Brawley, M.D., chief medical officer of the American Cancer Society. "We expect that these impressive findings will only grow stronger when we're able to show the additional impact on reducing the risk of developing and dying from cancer."

As part of their analysis, the authors also modeled the impact of these clinical prevention strategies on direct medical costs based on an assumption that current patterns of delivery and treatment remain the same over the next 30 years. The 11 activities varied widely in terms of their impact on CVD health outcomes and their overall cost. The results suggest that some clinical strategies are "better buys" than others in terms of cost effectiveness vis-à-vis other prevention strategies for CVD employed routinely by the current system.

The authors also note that these clinical prevention activities could be achieved at a lower cost by developing less expensive interventions. Moreover, the analysis didn't include important savings from reductions in nonmedical costs, which could be considerable, but are much more difficult to estimate. These could include reducing the human and financial burden of caregiving for family members or for society, and increasing the productive working lifespan of individuals.

Co-authors are: Robert Smith, Ph.D., of the American Cancer Society and David Eddy, M.D., Ph.D. of Archimedes, Inc. Individual author disclosures can be found on the manuscript.

The American Heart Association receives funding primarily from individuals. In addition, foundations and corporations - including pharmaceutical, device manufacturers and other companies - make donations and fund specific American Heart Association/American Stroke Association programs and events. Revenues from pharmaceutical and device corporations are disclosed at http://www.americanheart.org/corporatefunding.

American Heart Association

Founded in 1924, the American Heart Association is the nation's oldest and largest voluntary health organization dedicated to building healthier lives, free of heart disease and stroke. These diseases, America's No. 1 and No. 3 killers, and all other cardiovascular diseases claim nearly 870,000 lives a year. In fiscal year 2006-07 the association invested more than $554 million in research, professional and public education, advocacy and community service programs to help all Americans live longer, healthier lives. To learn more, call 1-800-AHA-USA1 or visit http://www.americanheart.org.

American Diabetes Association

The American Diabetes Association is the nation's premier voluntary health organization supporting diabetes research, information and advocacy. Founded in 1940, the Association's mission is to prevent and cure diabetes and to improve the lives of all people affected by diabetes. The Association's commitment to research is reflected through its scientific meetings; education and provider recognition programs; and its Research Foundation and Nationwide Research Program, which fund breakthrough studies looking into the cure, prevention, and treatment of diabetes and its complications. Visit the American Diabetes Association at http://www.diabetes.org or call 1-800-DIABETES (1-800-342-2383).

American Cancer Society

The American Cancer Society is dedicated to eliminating cancer as a major health problem by saving lives, diminishing suffering and preventing cancer through research, education, advocacy and service. Founded in 1913 and with national headquarters in Atlanta, the Society has 13 regional Divisions and local offices in 3,400 communities, involving millions of volunteers across the United States. For more information anytime, call toll free 1-800-ACS-2345 or visit http://www.cancer.org.

American Diabetes Association