Living Longer in Good Cardiovascular Health: Prevention and Wellness Makes Economic Cents.

Abstract

Article, see p 1693 > The time to repair the roof is when the sun is shining. > > —John F. Kennedy, State of the Union Address, January 11, 1962 Accounting for ≈800 000 deaths per year, not only is cardiovascular disease (CVD) the leading cause of mortality in the United States, but it is also the principal source of healthcare spending.1 Recent conservative estimates suggest that current annual CVD expenditures exceed $300 billion in direct medical expenditures and are expected to rise to >$800 billion by 2030.1 It is no secret that the major proportion of disease and financial burden at stake is related to modifiable lifestyle factors. In 2010, the American Heart Association announced a national goal of upstream cardiovascular health optimization by primordial prevention to counter these impending future challenges.2 This construct included efforts to measure, track and, more important, target ideal states for 4 major behavioral determinants (smoking, body weight, physical activity, and diet) and 3 risk factors (cholesterol, glucose, and blood pressure levels). A recent systematic review indicated that optimal cardiovascular health (CVH) is associated with lower downstream mortality, nonfatal cardiovascular disease, and noncardiovascular disease.3The implications are that preventive interventions favorably influencing these factors, particularly through low-cost lifestyle changes, may be able to produce substantial financial benefits. Reminiscent of the maxim, “an ounce of prevention is worth a pound of cure,” primordial prevention is a sound investment for those financing US healthcare. However, the reality is that μ5% of the entire healthcare spending is reserved for preventive programs.4 Although counterintuitive, market forces consistent with basic behavioral economic principles continue to place less emphasis on prevention and are reluctant to spend resources now to save lives at a later stage. It is critical that we generate and use …