More risk factors
for heart disease increase Medicare cost
November 9, 2003
ORLANDO, FL (AHA)
Preventing heart disease risk factors in younger adults could be
a money-saving investment for the federal Medicare program,
researchers reported in two studies presented at the American
Heart Association’s Scientific Sessions 2003.
The studies found that people who had cardiovascular risk
factors identified during middle age had increasing Medicare
costs after age 65 and during the last year of their life. Most
previous studies have assessed health care costs in the years
immediately after risk assessment.
“Even if they live far longer, people who enter middle age
with lower heart disease risk factors cost Medicare less money,”
said lead author of one study Kiang Liu, Ph.D., professor of
preventive medicine at the Feinberg School of Medicine at
Northwestern University in Chicago.
Liu’s study found that Medicare spent an average $18,604 to
treat cardiovascular disease in men over age 65 who had none of
the six major controllable risk factors when screened at middle
age. Costs for men with three or more risk factors in middle
age were more than twice as high: $38,044. Those with one to
two risk factors had intermediate costs – $28,483 for those with
one risk factor and $28,632 for those with two. All costs were
adjusted to year 2000 levels and for participants’ baseline age,
education and body-mass index. Drug costs not covered by
Medicare were not included.
Women without any risk factors earlier in life cost Medicare
an average $11,711 to treat cardiovascular disease from age 65
until death. Those with one risk factor cost $19,171; those
with two cost $24,048; and those with three or more cost
$38,059, the researchers reported.
In the two studies, investigators analyzed the Medicare costs
before death among people who had been screened for heart
disease risk factors when they were much younger.
Liu’s study analyzed inpatient and outpatient Medicare costs
in 1,246 men and 775 women who enrolled in Medicare from age 65
and died between 1984–2000. Each had participated in the
Chicago Heart Association Detection Project, a study of more
than 40,000 blue- and white-collar workers. In 1967-73, when
the participants were 35 to 52 years old, they had been screened
for high blood pressure, high cholesterol, cigarette smoking,
abnormal electrocardiograms and a history of diabetes or
previous heart attack.
“There were large variations in costs among individuals, but
there was a significant relationship between more risk factors
and higher costs to treat cardiovascular disease,” Liu said.
There also was a trend toward greater expenditures for all
types of illnesses in those with more risk factors, the
researchers reported. Total Medicare costs for all illness
between age 65 and death were $75,111 for men with no risk
factors, and $105,083 in men with three or more. In women, the
trend was less striking: total costs for those with no risk
factors were $97,123, compared with $101,731 for those with
three or more risk factors.
“Medicare costs strongly relate to middle-age risk factors.
People need to pay attention to health when they are middle-aged
or younger – by the time they are older it could be too late.
And if the government and the medical field want to reduce
expenses, they should pay attention to prevention,” Liu said.
In a companion study, Medicare costs in the last – and
usually a person’s most expensive – year of life were analyzed
in 6,250 participants (2,598 women) in the Chicago Heart
Association study. When initially screened, they were between
ages 33 and 64; deaths occurred between ages 66 and 96.
Among men, average Medicare charges for all illness in the
last year of life were $36,414 for those without heart disease
risk factors (i.e., low-risk, at the earlier screening),
compared with $50,639 for those with three or more risk
factors. Costs to treat cardiovascular disease alone were
$8,675 in the low-risk men vs. $20,103 for those with three or
more risk factors. The trends were similar in women, with total
charges of $36,911 ($7,396 for cardiovascular disease) in
low-risk women and $41,769 ($13,721 for cardiovascular disease)
in those with three or more risk factors.
“Having no cardiovascular risk factors earlier in life can
result in lower costs for medical care in the last year of
life,” said lead author Martha L. Daviglus, M.D., Ph.D.,
associate professor of medicine (geriatrics) and preventive
medicine at Feinberg School of Medicine.
“This is evidence that being healthier in middle age makes
you more likely to have a better health status and better
quality of life until very near the end. Instead of dying of an
expensive and debilitating chronic illness, those who are
healthier earlier in life maintain better health until near the
time of death,” Daviglus said.
Co-authors for Liu’s study are Daviglus; LiJing Yan, Ph.D.;
Daniel B. Garside, B.S.; Philip Greenland, M.D.; Larry M.
Manheim, Ph.D.; Alan R. Dyer, Ph.D.; and Jeremiah Stamler, M.D.
Co-authors for Daviglus’ included those researchers plus Renwei
Wang, M.D. and Amber Pirzada, M.D.
The National Heart, Lung, and Blood Institute funded the