Ignoring Heart Attack, Stroke Risks Costs Billions

Untreated smoking, hypertension, cholesterol has fiscal toll

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HealthDay Reporter

THURSDAY, Sept. 2, 2004 (HealthDayNews) -- The failure of Americans to treat risk factors for heart attack and stroke exacts a fiscal toll as well as a human one.

A new study finds the increase in recurrent and fatal strokes and heart attacks resulting from untreated risk factors, such as hypertension, high cholesterol and smoking, costs society billions of dollars each year.

Ignored risk factors that lead to a first fatal heart attack or stroke has a price tag of more than $13 billion in hospital costs and lost wages yearly in the United States. In addition, second heart attacks and strokes that prove to be fatal cost an additional $13 billion annually, according to the report in the Sept. 2 online edition of Stroke.

"We looked at the financial burden we face in the United States as a consequence of inadequate control of high blood pressure, high cholesterol and smoking," said lead researcher Dr. Adnan I. Qureshi, a professor of neurology and neurosciences from the Zeenat Qureshi Stroke Research Center at the University of Medicine and Dentistry of New Jersey.

Qureshi's team collected data on almost 15,000 subjects who took part in the Second National Health and Nutrition Examination Mortality Follow-up Study from 1976 to 1980 or the National Health and Nutrition Examination Study, 1999 to 2000.

Patients were divided into six groups. The researchers started with those with inadequately controlled risk factors and no history of heart attack or stroke; patients with one inadequately controlled risk factor and no history of heart attack or stroke; and patients with two or more inadequately controlled risk factors and no history of heart attack or stroke.

In addition, they looked at patients with a history of heart attack and stroke, but no inadequately controlled risk factors; patients with a history of heart attack and stroke and one inadequately controlled risk factor; and patients with a history of heart attack and stroke and two or more inadequately controlled risk factors.

During 13 years of follow-up, 565 people died from heart attacks and 126 died from strokes. Qureshi's group calculated the proportion of fatal cardiovascular events that could have been avoided if risk factors for heart attack and stroke had been controlled.

Among patients who had not had a previous heart attack or stroke but had two or more inadequately controlled risk factors, the financial burden to society was $13.2 billion per year, Qureshi said.

"If you look at patients who have had a previous cardiovascular event, and had one inadequately controlled risk factor, the financial loss was $6.2 billion. If there were two or more, the financial loss that's incurred is $7.4 billion."

Having these numbers justifies intensive efforts in monitoring cardiac risk factors and implementing strategies to improve compliance with treatment and to improve screening for risk factors, Qureshi said.

For people who have had a heart attack or stroke, Qureshi suggests medications be subsidized to remove the financial burden from patients and improve compliance. For people who have not had a heart attack or stroke, there should be more efforts to screen patients to identify risk factors, he said.

"Patients have to recognize that if their blood pressure is not controlled, if their cholesterol is high, and they still continue to smoke, there is a price to be paid," Qureshi said. "You are running an almost sixfold increased risk of dying from a cardiovascular event."

"This study documents what has been widely recognized -- that we are doing a pretty poor job of controlling some very basic risk factors," said Dr. Lawrence M. Brass, a professor of neurology, epidemiology and public health from Yale University School of Medicine.

Brass noted that in the United States only 25 percent of patients with high blood pressure have the condition under control. "In a country that spends $1.1 trillion on health care, the fact that we only have a 25 percent success rate in controlling one of the most potent risk factors is shameful," he said. "There is something wrong with a system that does that."

"The cost of not adequately treating blood pressure or cholesterol or smoking is really staggering," Brass added. "People say we can't afford to give everybody the medicines they need; this paper says we can't afford not to."

More information

The American Heart Association can tell you about preventing heart attacks and strokes.

SOURCES: Adnan I. Qureshi, M.D., professor, neurology and neurosciences, Zeenat Qureshi Stroke Research Center, University of Medicine and Dentistry of New Jersey, Newark; Lawrence M. Brass, M.D., professor, neurology, epidemiology and public health, Yale University School of Medicine, New Haven, Conn.; Sept. 2, 2004, Stroke online

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