Favorable Cardiovascular Health, Compression of Morbidity, and Healthcare Costs

Abstract

Background We examined the association of cardiovascular (CV) health at younger ages with the proportion of life lived free of morbidity, the cumulative burden of morbidity, and average healthcare costs at older ages. Methods The Chicago Heart Association (CHA) study is a longitudinal cohort of employed men and women aged 18–74 years at baseline examination in 1967–1973. Baseline measurements included blood pressure, cholesterol, diabetes, BMI and smoking. Individuals were classified into one of four strata of CV health: favorable levels of all factors, 0 factors high but 1+ elevated, 1 high, and ≥2 high risk factors. Linked Medicare and National Death Index data from 1984–2010 were used to determine morbidity in older age. An individual’s all-cause morbidity score and CV morbidity score were calculated from ICD-9 codes for each year of follow-up. Results We included 25,804 participants who became 65 years of age or older by 2010, representing 65% of all original CHA participants (43% female, 90% White, mean age 44 at baseline); 6% had favorable levels of all factors, 19% had 1+ risk factors at elevated levels, 40% had 1 high risk factor and 35% had 2+ high risk factors. Favorable CV health at younger ages extended survival by almost 4 years and postponed the onset of all-cause and CV morbidity by 4·5 and 7 years, respectively, resulting in compression of morbidity in both absolute and relative terms. This translated to lower cumulative and annual healthcare costs for those in favorable CV health (p<0.001) during Medicare eligibility. Conclusions Individuals in favorable CV health in early middle age live a longer, healthier life free of all types of morbidity. These findings provide strong support for prevention efforts earlier in life aimed at preserving cardiovascular health and reducing the burden of disease in older ages.

Defining Optimal Brain Health in Adults: A Presidential Advisory From the American Heart Association/American Stroke Association

“…Overall, those CHA cohort members who had a favorable health profile in midlife had prolonged survival by ≈4 years and postponed onset of all-cause and cardiovascular mortality of 7 years. 173 In addition, all morbidities were reduced, compression of morbidity was observed both absolutely and relatively, and there were lower cumulative and annual healthcare costs during the Medicare-eligibility life span in older ages for those with favorable cardiovascular health profiles in midlife. 173 Although cognition was not the primary focus of this publication, several other study results support the belief that favorable cardiovascular health earlier in life leads to maintenance of cognitive vitality.…”

The association of employment status with ideal cardiovascular health factors and behaviors among Hispanic/Latino adults: Findings from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

“…A growing body of prospective studies have demonstrated that the presence of ideal CVH metrics at younger age is associated with lower risk of all-cause mortality [ 5 ], lowest rate of functional disability [ 6 ], and reduced health costs [ 7 , 8 ] at older age. Findings from the Hispanic Community Healthy Study/Study of Latinos (HCHS/SOL) showed that the proportion of Hispanics/Latinos with ideal CVH is low (less than 1% have all 7 ideal metrics) and varies by sex with females having more favorable profiles than males [ 9 ].…”

Agreement of PROCAM and SCORE to assess cardiovascular risk in two different low risk European populations

“…Poorly performing calibration factors (low sensitivity for atherosclerosis and outcome) will unnecessarily delay timely preventive interventions, for instance with statins. This will lead to a substantial increase in long-term morbidity and all-cause mortality as has recently been shown for the principle of compression of morbidity in the Chicago area (Allen et al, 2017). An important difference between AGLA/PROCAM and SCORE is the outcome variable estimate, which is myocardial infarction for AGLA/PROCAM (CHD) and which is myocardial infarction, stroke and coronary revascularisation for SCORE (CVD).…”