Health reform must include prevention

It has become clear that any changes in the health care system proposed by the Clinton administration will, at best, attempt to slow the rate of increase of health care costs and not in any way curtail them. The concept of prevention is not addressed.

We have so focused on acute and complex care that the simple, expedient measures which many times could prevent advanced problems are overlooked.

For example, the current vogue in cardiology is electrophysiology and the use of an automatic implantable cardiovertor/defibrillator to prevent sudden death. These devices are most often used for individuals with advanced coronary artery disease, often in conjunction with coronary artery bypass grafts. Implantation of one of these new devices costs more than $130,000.

In addition, the most commonly prescribed thrombolytic drug, tissue plasminogen activator (tPA), at $2,300 a dose for 500,000 individuals for whom the therapy is appropriate (more than $1 billion) is a hefty price tag by any calculation.

Contrast hospitalization and thrombolytic therapy with the efforts that result in risk reduction. We know that a 1% reduction in cholesterol results in a 2% reduction in the risk of having a heart attack. A 10% reduction in cholesterol, an attainable goal, would result in a 20% reduction in the incidence of heart attacks. Based on the numbers of 1.5 million heart attacks in the United States annually, that would mean 300,000 fewer heart attacks.

Preventive considerations

A study in the New England Journal of Medicine (May 21, 1992) looked at the impact on cardiac risk of lifestyle modification. An individual who stops smoking has a 70% less likelihood of having a heart attack. An individual who exercises regularly has a 45% reduction in that risk. There is a similar benefit to weight reduction. A 15% reduction in cholesterol would offer another 30% reduction in the risk of heart disease. Similarly, an 8 to 10 mm Hg (mercury) drop in blood pressure would afford a 25% risk reduction.

The Cardiovascular Risk Reduction Center's studies show that preventive care through lifestyle modification is an effective way to address the health care cost crisis. The Center recently completed a corporate health pilot program at Stratus Computer Inc. in Marlboro, Mass. Twenty high-risk employees volunteered to participate in a study to reduce their cardiovascular risk. At a screening in January 1992, the employees data showed that they were at very high risk for cardiovascular disease, and two employees were diabetic.

After four months of working closely with these individuals, they were re-screened in June 1992. Fifteen of the 20 participants had made major changes in their cardiovascular risk. They showed an average weight loss of 11 pounds, a drop in blood pressure of 8 mm systolic and 6 mm diastolic, a drop in total cholesterol of 13% without a drop in their HDL cholesterol, resulting in a significant improvement in the cholesterol/HDL ratio. One of the two diabetics normalized his blood sugar. Applying current statistical standards, they reduced their risk of a cardiovascular event by more than 50%. And, perhaps even more importantly, when re-screened eight months later without any further intervention, they maintained and, in some cases, even improved their risk level.

Corporations, and the nation, could significantly reduce their health care costs by working in partnership with in-depth risk reduction programs.

COPYRIGHT 1993 A Thomson Healthcare Company
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