Prevention Activities Increase Lifespan Of US Adults
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.
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-a-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.