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CMHC PULSE

Cardio Metabolic Health Congress – Official Blog

The Economic Burden of Cardiovascular Disease

Despite the extensive literature and research that indicates the preventability of cardiovascular disease, it remains a primary and leading cause of not only mortality & morbidity, but also a tremendous health care cost and economic burden. A Vital Signs report recently released by the Centers for Disease Control and Prevention cited that in 2016 alone, myocardial infarction, strokes, heart failure, and other largely preventable cardiovascular conditions caused 2.2 million hospitalizations, 415,000 deaths, and $32.7 billion in costs.

The researchers that conducted the findings estimated that “without preventative interventions, approximately 16.3 million events and $173.7 billion in hospitalization costs could occur during 2017–2021.” Moreover, a second Vital Signs report pulled data from the National Health and Nutrition Examination Survey, the National Survey on Drug Use and Health, and the National Health Interview Survey to assess and analyze the pervasiveness and prevalence of critical, key cardiovascular disease risk factors. Researchers found that 54 million adults are smokers, and could likely benefit from smoking cessation interventions. 71 million adults are not engaging in physical activity, and thus more prone to cardiovascular disease. Furthermore, millions of adults are not taking aspirin as recommended; 39 million adults are not managing their cardiovascular disease risk through suggested statin use; and 40 million adults are living with uncontrolled hypertension.

Quoted in an article published in the American College of Cardiology, Janet S. Wright, MD, FACC—executive director of Million Hearts, a national initiative co-led by the CDC and the Centers for Medicare & Medicaid Services, initially designed as a preventive measure to combat one million heart attacks and strokes by the year 2022—”Small changes–the right changes, sustained over time–can produce huge improvements in cardiovascular health.”

The report specifically explains that health care professionals & practitioners, in conjunction with systems and institutions, can focus on various aspects of heart health, including the use of aspirin when appropriate, management of blood pressure, cholesterol control, and smoking cessation. The report further recommends the utilization of a team approach through technological application, coupled with standard process and pooling skills in order to find and treat patients at higher risk for myocardial infarction and stroke. The researchers advocate follow-up care for patients who have previously had a myocardial infarction or stroke, in order to properly recover and therefore reduce future risk of another event. Finally, the report endorses the continuous promotion of physical activity and healthy eating among both patients and employees.

While there are enormous challenges associated with achieving the Million Hearts 2022 goal, and tackling the health and economic burdens of cardiovascular disease, there are ample opportunities to improve the nation’s cardiovascular health. In a related viewpoint recently published in JAMA, Wright and co-authors discuss small steps needed for cardiovascular disease prevention, and focus on the critical need for “individuals and families, health care and public health professionals, and communities to begin doing what works, one small step at a time.”

SOURCES
https://jamanetwork.com/journals/jama/fullarticle/2702070
https://www.cdc.gov/mmwr/volumes/67/wr/mm6735a3.htm
https://www.cdc.gov/mmwr/volumes/67/wr/mm6735a4.htm
https://www.acc.org/latest-in-cardiology/articles/2018/09/06/13/39/new-cdc-reports-spotlight-staggering-number-of-cv-deaths-and-hospitalizations

Sleep Apnea Impact on Cardiometabolic Health

The condition known as sleep apnea, in which a snorer briefly stops breathing, can lead to cardiovascular difficulties—and is often associated with arrhythmia, stroke, high blood pressure, and heart failure. “The evidence is very strong for the relationship between sleep apnea and hypertension and cardiovascular disease generally, so people really need to know that,” said Donna Arnett, PhD, dean and professor of epidemiology at the University of Kentucky College of Public Health in Lexington and former president of the American Heart Association.

While mild sleep apnea is a fairly common problem that affects one in five adults, the most common type is obstructive sleep apnea (OSA), in which weight on the upper chest and neck leads to blockage of the flow of air. OSA is associated with obesity, another major risk factor for stroke and heart disease, and additional clinical research suggests that OSA predisposes people to hypertension and atherosclerosis. Because patients with OSA are often obese, they frequently have an increased prevalence of numerous other cardiovascular risk factors, including type 2 diabetes mellitus.

Moreover, findings recently published in Diabetes Care indicate a bidirectional association between obstructive sleep apnea and diabetes. While previous research has demonstrated a more complex correlation between diabetes and OSA, this is the first study to date that has evaluated the potential relationship between the two disorders. Investigators in the study used data from the Nurses’ Health Study (2002-2012), Nurses’ Health Study II (1995-2003), and Health Professionals Follow-Up Study (1996-2012). At the outset, all participants showed no indications of diabetes, cardiovascular disease, or cancer.

Researchers pinpointed a total of 9,029 diabetes cases during follow-up, and 9,364 OSA cases during follow-up. Findings concluded that OSA is independently associated with an increased risk of diabetes, whereas insulin-treated diabetes is independently associated with a higher risk of OSA: particularly in women. The investigators wrote, “Clinical awareness of this bi-directional association may improve prevention and treatment of both diseases, and vigilant monitoring of one condition among patients with the other is warranted if our findings are confirmed in other studies.”

Hosted in collaboration with the American Academy of Sleep Medicine, our Small Group Workshop at the 13th Annual CMHC titled Don’t Hit the Snooze on Sleep Disorders When it Comes to Cardiometabolic Health will focus on the strong correlation between sleep disorders and adverse cardiometabolic risk: including obesity, hypertension, type 2 diabetes mellitus, and cardiovascular disease. Learn more here.

References
http://care.diabetesjournals.org/content/early/2018/07/30/dc18-0675.long
http://www.heart.org/en/health-topics/consumer-healthcare/sleep-apnea-and-heart-disease-stroke
https://www.uptodate.com/contents/obstructive-sleep-apnea-and-cardiovascular-disease-in-adults