Smoking, high blood pressure and high cholesterol have taken a substantial toll on the American wallet

Sep 2 2004

Smoking, high blood pressure and high cholesterol have taken a substantial toll on the American wallet.

When these cardiovascular risk factors led to a fatal heart attack or stroke in people who had not had a previous heart attack or stroke, it cost more than $13 billion in hospitalization and lost wages annually. When these uncontrolled risk factors lead to a recurrent heart attack or stroke that was fatal, it cost another $13 billion per year, according to research published in Stroke: Journal of the American Heart Association.

Overall, the American Heart Association estimates that direct and indirect costs of stroke is $53.6 billion a year.

“The large financial cost incurred by inadequate primary or secondary prevention justifies intensive efforts directed towards detection and treatment of cardiovascular risk factors,” said Adnan I. Qureshi, M.D., the study’s lead author and professor of neurology and neurosciences at the Zeenat Qureshi Stroke Research Center at University of Medicine and Dentistry of New Jersey in Newark.

Qureshi and colleagues developed a computer model that estimated the financial impact of uncontrolled risk factors on deaths from heart attack and stroke.

Researchers reviewed data from two federal health surveys that included nearly 15,000 Americans: the Second National Health and Nutrition Examination (NHANES II) Mortality Follow-up Study (1976 to 1980) and NHANES 1999-2000. They focused on risk factors such as high blood pressure, (higher than 140/90 mmHg), high total cholesterol (higher than 200 mg/dL) and current cigarette smoking in six categories of people:

1. those with no inadequately controlled risk factors and no previous history of heart attack or stroke;
2. one inadequately controlled risk factor and no previous history of heart attack or stroke;
3. two or more inadequately controlled risk factors and no previous history of heart attack or stroke;
4. a previous history of heart attack and stroke, but no inadequately controlled risk factors;
5. a previous history of heart attack and stroke and one inadequately controlled risk factor; and
6. a previous history of heart attack and stroke and two or more inadequately controlled risk factors.

There were 691 cardiovascular deaths (565 from heart attack and 126 from stroke) during an average follow-up of more than 13 years. Researchers calculated the proportion of fatal cardiovascular diseases among those surveyed that could have been avoided if the risk factors had been sufficiently controlled.

They estimated that 14 percent of cardiovascular deaths are related to inadequate control of multiple risk factors in people without previous heart attack or stroke.

Qureshi said that first heart attacks or strokes in people with no history of heart disease who had two or more uncontrolled risk factors costs the United States about $13.2 billion in acute hospitalizations and lost productivity due to premature death for one year. The cost of failed secondary prevention is roughly the same: $13.6 billion, which includes $6.2 billion for death in people with a history of heart disease and one uncontrolled risk factor and $7.4 billion for people with previous heart attack or stroke who had two or more uncontrolled risk factors.

“In addition, people with no history of heart attack or stroke are twice as likely to die of cardiovascular disease if they have two or more uncontrolled risk factors, which puts them close to the same risk for death from cardiovascular disease as people with a history of heart attack or stroke,” Qureshi said.

“For people with a history of heart disease or stroke, the risk of dying from cardiovascular disease increases to 4.3 times normal risk if they have even one uncontrolled risk factor, and it goes up to almost six times greater when they have two or more uncontrolled risk factors," Qureshi said. “The study highlights the large financial losses incurred because of inadequate control of cardiovascular risk factors in the Unites States and points to the need for a more rigorous, aggressive approach to risk factor control.”

Co-authors are M. Fareed K. Suri, M.D.; Jawad F. Kirmani, M.D.; and Afshin A. Divani, Ph.D.