How reps and care givers can improve heart disease morbidity and mortality as well as improving better health outcomes.
We all know that high cholesterol is a risk factor for heart disease, but do we know the details important to share with our customers and prospects to galvanize them into action to test before treating? Many clinicians rely on newer statin and non-statin medications to reduce lipid levels and reduce heart disease risks. But the treatment program cannot be initiated without the data, especially lipid testing information. As consultants to our clinical customers, getting the facts in place should lead to a healthier patient base and better cardiac health outcomes. Not to mention more lab business for you.
While death rates from heart disease have dropped significantly (more than 68%) from 1969 to 2014 based on the Centers for Disease Control and Prevention (CDC) data, heart disease remains on the CDC’s list of the five leading preventable causes of death. Importantly, that data was published in 2017 and pre-dates the current COVID-19 pandemic which has resulted in a decline in physician office visits, reduced levels of treatment for chronic diseases and also the emergence of COVID cardiac co-morbidities. As a result, while we have made progress, we have a long way to go. As you will learn, both where we live and how we live are substantially influential in your risk of heart disease and how often the physicians you call on are likely to encounter elevated cholesterol and increased risk of heart disease. Let’s look at some facts and see where they lead us.
Cholesterol facts
We now know that some forms of cholesterol are healthy (HDL in particular) and some (LDL and LP(a)) lead to increased rick of atherosclerosis and heart disease. The lower density cholesterol particles take up more space in the arteries and consequently reduce blood flow, which can lead to a heart attack, acute coronary insufficiency or ischemic heart disease. But, did you know that cholesterol is actually produced by the body as well as being available in certain foods? It’s true. Cholesterol is produced by the liver as the precursor for steroid hormones including estrogen and testosterone. As a result, cholesterol is vital for life and comes in a surprising variety of particle sizes and types. LP(a) and LDL elevations are most closely related to increased risk of heart disease, heart attack and death.
Health risk factors for heart disease
Unfortunately, this list goes well beyond managing the patient’s cholesterol, LDL, HDL and triglyceride levels. On the bright side, we have made pretty good strides in reducing the impact of many of these risk factors. In 1969, 42.4% of all U.S. adults smoked tobacco products. In 2018 the rate had dropped by 13.7%. Sedentary lifestyle is another risk factor and according to the CDC it increases with age and is inversely related to socioeconomic status; poorer patients tend to be more sedentary. It is 54.8% among adults from 18 to 34, but over 61.9% for adults over 65. High blood pressure is also a risk factor and the CDC estimates that only 25% of all adults diagnosed with high blood pressure have it controlled. Thirty seven million Americans have blood pressure of 140/90 or greater. Elevated cholesterol is an acknowledged risk factor and nearly 94 million Americans have cholesterol levels over 200 (high) and 28 million have cholesterol levels above 240 (very high). Obesity is an issue. The CDC classified over 42% of all Americans as obese in 2018. The CDC reports 37 million Americans as diabetic and 96 million as pre-diabetic. Obesity and diabetes are also factors, as is increasing age.
How are statins and non-statin treatment for high cholesterol helping?
With death rates from heart disease dropping as significantly as noted above, a lot of things are going well. Reductions in smoking are making a difference, but obesity, increased incidence of diabetes and a generally sedentary population are counterbalancing the positive factors and preventing death rates from heart disease from dropping more rapidly.
Statins have clearly changed the ability to lower cholesterol and LDL in particular, in spite of the unhealthy lifestyle choices many Americans continue to embrace. Forty-seven million Americans currently take statins, and an estimated 87 million Americans could benefit from the use of statins or non-statin lipid lowering medications. This is a profound change since statins were introduced in the United States in 1987 and a significant contributor to better heart disease outcome statistics. In 1980, the rate of elevated LDL was reported as 59%; by 2010 it had dropped to 23%. New medications that impact reabsorption of cholesterol from the intestines are now being combined with statins to create a two-pronged approach to lowering lipid levels.
I expect these decreases in LDL levels to continue somewhat irrespective of lifestyle choices. But, the fact remains today, as it did when the National Institute of Health observed in 1985 that “you need to know your numbers”. Therefore, the need to test for lipids, as well as diabetes markers continues to be critical to diagnose patients requiring treatment. It is your responsibility as consultants to our physicians and other care givers to continue to promote this message. Some recent learnings point out why this is important. This is especially true with the availability of simple, accurate waived systems to measure lipids, glucose and hemoglobin A1C. You have a range of powerful solutions for customers performing just a few patients with risk factors for heart disease daily to large practices where over 100 candidate patients are seen daily. You and your key suppliers can customize a solution to meet the needs of any sized practice.
Patient facts that influence risk
Not enough information yet? Well, try a couple of newer facts: the CDC describes why heart disease remains on its list of the five leading causes or preventable death. It is more problematic in rural communities and communities of 10,000 to 49,000 and it also impacts lower income communities disproportionately from wealthier ones. As a result, many Americans remain at risk for preventable heart disease. Do you know how your community stacks up? Also, we now know that a COVID infection creates an additional risk of myocarditis and multiorgan inflammatory syndrome. This creates a new risk group. Finally, during the social distancing phase of the COVID pandemic, many patients put chronic disease management on the back burner. It’s time to discuss how we and the care givers we call on every day can improve heart disease morbidity and mortality as well as improving better health outcomes. Lipid and diabetes testing are gateways to diagnosis, and the right steps needed to initiate or modify a patient treatment program. Spread the news.