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American Heart Association (AHA): Epidemiology and Prevention - Lifestyle and Cardiometabolic Health 2015 Scientific Sessions (EPI/LIFESTYLE)
Midlife blood pressure patterns predict CVD, mortality risk
BALTIMORE – Distinct patterns of blood pressure changes in midlife are associated with varying degrees of risk for cardiovascular disease and death, according to a multisite study.
These patterns of change contributed to risk for both CVD and mortality, separate from the known association of absolute elevation of systolic blood pressure with CVD and death. Natalia Petruski-Ivleva of the University of North Carolina, Chapel Hill, and colleagues identified SBP patterns emerging from the biracial, multisite Atherosclerosis Risk in Communities (ARIC) study and presented the results at the American Heart Association Epidemiology and Prevention, Lifestyle and Cardiometabolic Health 2015 Scientific Sessions.
The study included 9,882 patients from the ARIC population who had recorded BPs at four study visits between 1987 and 1998, and whose outcomes were tracked over the period from 1987 to 2011. Median follow-up after the last study visit was 13.2 years. Participants were grouped by patterns of change in SBP over time using a latent class growth model; this analytic model allowed for the discovery of similar groups of cases within the data.
Results were adjusted for age and demographic characteristics, as well as for self-reported hypertension medication use. In addition to all-cause mortality, outcomes included coronary heart disease, heart failure, and stroke.
In all, six distinct patterns emerged of change in SBP over the study visit period, with three groups having SBPs consistently below the threshold of 140 mm Hg, and three other groups showing varying patterns of elevation. About 84% of participants fell into one of the three groups that showed parallel patterns of SBP change, with pressures slowly rising over time, but never exceeding 140 mm Hg. The remainder of participants were grouped into three other patterns. One showed a steep increase over time from an initial SBP just under 140 mm Hg to a final reading just over 160 mm Hg; a second showed high and sustained SBPs of more than 160 mm Hg at all study visits. Finally, some participants had initially elevated SBPs that fell to the normal range by the end of the study.
Overall, analysis showed a gradient of risk, with lower SBP associated with lower risk of CVD and death. This was true even for those participants in the first three groups, whose SBPs stayed below 140 mm Hg throughout. Notably, the pattern of steep increase of already elevated SBP, as well as that of sustained elevated blood pressures, were both associated with the highest all-cause mortality. Reducing SBP to less than 140 mm Hg was not associated with reduced risk of CHD in the final group.
The three higher-risk groups were more likely to be obese, black, on hypertension medication, and have diabetes. They were also older on average than participants with the three nonelevated patterns.
These patterns of change, said Ms. Petruski-Ivleva, “contribute varying amounts of risk of CVD and mortality in addition to the risk imparted by the absolute SBP level.” Though the clinical significance of these patterns of blood pressure change needs more examination, she said that the results underscore the cumulative impact of elevated SBP through midlife.
BALTIMORE – Distinct patterns of blood pressure changes in midlife are associated with varying degrees of risk for cardiovascular disease and death, according to a multisite study.
These patterns of change contributed to risk for both CVD and mortality, separate from the known association of absolute elevation of systolic blood pressure with CVD and death. Natalia Petruski-Ivleva of the University of North Carolina, Chapel Hill, and colleagues identified SBP patterns emerging from the biracial, multisite Atherosclerosis Risk in Communities (ARIC) study and presented the results at the American Heart Association Epidemiology and Prevention, Lifestyle and Cardiometabolic Health 2015 Scientific Sessions.
The study included 9,882 patients from the ARIC population who had recorded BPs at four study visits between 1987 and 1998, and whose outcomes were tracked over the period from 1987 to 2011. Median follow-up after the last study visit was 13.2 years. Participants were grouped by patterns of change in SBP over time using a latent class growth model; this analytic model allowed for the discovery of similar groups of cases within the data.
Results were adjusted for age and demographic characteristics, as well as for self-reported hypertension medication use. In addition to all-cause mortality, outcomes included coronary heart disease, heart failure, and stroke.
In all, six distinct patterns emerged of change in SBP over the study visit period, with three groups having SBPs consistently below the threshold of 140 mm Hg, and three other groups showing varying patterns of elevation. About 84% of participants fell into one of the three groups that showed parallel patterns of SBP change, with pressures slowly rising over time, but never exceeding 140 mm Hg. The remainder of participants were grouped into three other patterns. One showed a steep increase over time from an initial SBP just under 140 mm Hg to a final reading just over 160 mm Hg; a second showed high and sustained SBPs of more than 160 mm Hg at all study visits. Finally, some participants had initially elevated SBPs that fell to the normal range by the end of the study.
Overall, analysis showed a gradient of risk, with lower SBP associated with lower risk of CVD and death. This was true even for those participants in the first three groups, whose SBPs stayed below 140 mm Hg throughout. Notably, the pattern of steep increase of already elevated SBP, as well as that of sustained elevated blood pressures, were both associated with the highest all-cause mortality. Reducing SBP to less than 140 mm Hg was not associated with reduced risk of CHD in the final group.
The three higher-risk groups were more likely to be obese, black, on hypertension medication, and have diabetes. They were also older on average than participants with the three nonelevated patterns.
These patterns of change, said Ms. Petruski-Ivleva, “contribute varying amounts of risk of CVD and mortality in addition to the risk imparted by the absolute SBP level.” Though the clinical significance of these patterns of blood pressure change needs more examination, she said that the results underscore the cumulative impact of elevated SBP through midlife.
BALTIMORE – Distinct patterns of blood pressure changes in midlife are associated with varying degrees of risk for cardiovascular disease and death, according to a multisite study.
These patterns of change contributed to risk for both CVD and mortality, separate from the known association of absolute elevation of systolic blood pressure with CVD and death. Natalia Petruski-Ivleva of the University of North Carolina, Chapel Hill, and colleagues identified SBP patterns emerging from the biracial, multisite Atherosclerosis Risk in Communities (ARIC) study and presented the results at the American Heart Association Epidemiology and Prevention, Lifestyle and Cardiometabolic Health 2015 Scientific Sessions.
The study included 9,882 patients from the ARIC population who had recorded BPs at four study visits between 1987 and 1998, and whose outcomes were tracked over the period from 1987 to 2011. Median follow-up after the last study visit was 13.2 years. Participants were grouped by patterns of change in SBP over time using a latent class growth model; this analytic model allowed for the discovery of similar groups of cases within the data.
Results were adjusted for age and demographic characteristics, as well as for self-reported hypertension medication use. In addition to all-cause mortality, outcomes included coronary heart disease, heart failure, and stroke.
In all, six distinct patterns emerged of change in SBP over the study visit period, with three groups having SBPs consistently below the threshold of 140 mm Hg, and three other groups showing varying patterns of elevation. About 84% of participants fell into one of the three groups that showed parallel patterns of SBP change, with pressures slowly rising over time, but never exceeding 140 mm Hg. The remainder of participants were grouped into three other patterns. One showed a steep increase over time from an initial SBP just under 140 mm Hg to a final reading just over 160 mm Hg; a second showed high and sustained SBPs of more than 160 mm Hg at all study visits. Finally, some participants had initially elevated SBPs that fell to the normal range by the end of the study.
Overall, analysis showed a gradient of risk, with lower SBP associated with lower risk of CVD and death. This was true even for those participants in the first three groups, whose SBPs stayed below 140 mm Hg throughout. Notably, the pattern of steep increase of already elevated SBP, as well as that of sustained elevated blood pressures, were both associated with the highest all-cause mortality. Reducing SBP to less than 140 mm Hg was not associated with reduced risk of CHD in the final group.
The three higher-risk groups were more likely to be obese, black, on hypertension medication, and have diabetes. They were also older on average than participants with the three nonelevated patterns.
These patterns of change, said Ms. Petruski-Ivleva, “contribute varying amounts of risk of CVD and mortality in addition to the risk imparted by the absolute SBP level.” Though the clinical significance of these patterns of blood pressure change needs more examination, she said that the results underscore the cumulative impact of elevated SBP through midlife.
AT AHA EPI/LIFESTYLE 2015
Key clinical point: Systolic blood pressures at midlife fall into patterns associated with varying degrees of CVD risk.
Major finding: Lower SBP was associated with lower risk of CVD and death, and a pattern of steep increase of already elevated SBP was associated with higher all-cause mortality.
Data source: Analysis of longitudinal change in SBP of nearly 10,000 participants in the multiracial, multisite ARIC study.
Disclosures: ARIC is supported by the National Heart, Lung, and Blood Institute. No authors reported financial disclosures.
Statins for all eligible under new guidelines could save lives
BALTIMORE – If all Americans eligible for statins under new American College of Cardiology/American Heart Association guidelines actually took them, thousands of deaths per year from cardiovascular disease might be prevented but at a cost of increased incidence of diabetes and myopathy.
The 2013 ACC/AHA guidelines expand criteria for the use of statins for primary prevention of CVD to more Americans (Circulation 2015;131:A05). Compliance with those guidelines would save 7,930 lives per year that would have been lost to CVD, according to Quanhe Yang, Ph.D., of the Centers for Disease Control and Prevention’s Division for Heart Disease and Stroke Prevention, and colleagues from the CDC and Emory University, Atlanta. Dr. Yang presented the findings at the American Heart Association Epidemiology and Prevention, Lifestyle and Cardiometabolic Health 2015 Scientific Sessions.
Statins are now indicated for primary prevention of CVD for anyone with an LDL cholesterol level greater than or equal to 190 mg/dL, for individuals aged 40-75 years with diabetes, and for those aged 40-75 years with LDL cholesterol greater than or equal to 70 mg/dL but less than 190 mg/dL who have at least a 7.5% estimated 10-year risk of developing atherosclerotic CVD. This means that an additional 24.2 million Americans are now eligible for statins but are not taking one, according to Dr. Yang and coinvestigators. However, “no study has assessed the potential impact of statin therapy under the new guidelines,” said Dr. Yang.
In order to obtain treatment group-specific atherosclerotic CVD, investigators first estimated hazard ratios for each treatment group by sex from the National Health and Nutrition Examination Survey III (NHANES III)–linked Mortality files. These hazard ratios were then applied to data from NHANES 2005-2010, the 2010 Multiple Cause of Death file, and the 2010 U.S. census to obtain age/race/sex-specific atherosclerotic CVD for each treatment group.
Applying the per-group hazard ratios, Dr. Yang and colleagues calculated that an annual 7,930 atherosclerotic CVD deaths would be prevented with full statin compliance, a reduction of 12.6%. However, modeling predicted an additional 16,400 additional cases of diabetes caused by statin use, he cautioned. More cases of myopathy would also occur, though the estimated number depends on whether the rate is derived from randomized, controlled trials (RCTs) or from population-based reports of myopathy. If the RCT data are used, just 1,510 excess cases of myopathy would be seen, in contrast to the 36,100 cases predicted by population-based data.
The study could model deaths caused by CVD only and not the reduction in disease burden of CVD that would result if all of the additional 24.2 million Americans took a statin, Dr Yang noted. Other limitations of the study included the lack of agreement in incidence of myopathy between RCTs and population-based studies, as well as the likelihood that the risk of diabetes increases with age and higher statin dose – effects not accounted for in the study.
Questioning after the talk focused on sex-specific differences in statin takers. For example, statin-associated diabetes is more common in women than men, another effect not accounted for in the study’s modeling, noted an audience member. Additionally, given that women have been underrepresented in clinical trials in general and in those for CVD in particular, some modeling assumptions in the present study may also lack full generalizability to women at risk for CVD.
BALTIMORE – If all Americans eligible for statins under new American College of Cardiology/American Heart Association guidelines actually took them, thousands of deaths per year from cardiovascular disease might be prevented but at a cost of increased incidence of diabetes and myopathy.
The 2013 ACC/AHA guidelines expand criteria for the use of statins for primary prevention of CVD to more Americans (Circulation 2015;131:A05). Compliance with those guidelines would save 7,930 lives per year that would have been lost to CVD, according to Quanhe Yang, Ph.D., of the Centers for Disease Control and Prevention’s Division for Heart Disease and Stroke Prevention, and colleagues from the CDC and Emory University, Atlanta. Dr. Yang presented the findings at the American Heart Association Epidemiology and Prevention, Lifestyle and Cardiometabolic Health 2015 Scientific Sessions.
Statins are now indicated for primary prevention of CVD for anyone with an LDL cholesterol level greater than or equal to 190 mg/dL, for individuals aged 40-75 years with diabetes, and for those aged 40-75 years with LDL cholesterol greater than or equal to 70 mg/dL but less than 190 mg/dL who have at least a 7.5% estimated 10-year risk of developing atherosclerotic CVD. This means that an additional 24.2 million Americans are now eligible for statins but are not taking one, according to Dr. Yang and coinvestigators. However, “no study has assessed the potential impact of statin therapy under the new guidelines,” said Dr. Yang.
In order to obtain treatment group-specific atherosclerotic CVD, investigators first estimated hazard ratios for each treatment group by sex from the National Health and Nutrition Examination Survey III (NHANES III)–linked Mortality files. These hazard ratios were then applied to data from NHANES 2005-2010, the 2010 Multiple Cause of Death file, and the 2010 U.S. census to obtain age/race/sex-specific atherosclerotic CVD for each treatment group.
Applying the per-group hazard ratios, Dr. Yang and colleagues calculated that an annual 7,930 atherosclerotic CVD deaths would be prevented with full statin compliance, a reduction of 12.6%. However, modeling predicted an additional 16,400 additional cases of diabetes caused by statin use, he cautioned. More cases of myopathy would also occur, though the estimated number depends on whether the rate is derived from randomized, controlled trials (RCTs) or from population-based reports of myopathy. If the RCT data are used, just 1,510 excess cases of myopathy would be seen, in contrast to the 36,100 cases predicted by population-based data.
The study could model deaths caused by CVD only and not the reduction in disease burden of CVD that would result if all of the additional 24.2 million Americans took a statin, Dr Yang noted. Other limitations of the study included the lack of agreement in incidence of myopathy between RCTs and population-based studies, as well as the likelihood that the risk of diabetes increases with age and higher statin dose – effects not accounted for in the study.
Questioning after the talk focused on sex-specific differences in statin takers. For example, statin-associated diabetes is more common in women than men, another effect not accounted for in the study’s modeling, noted an audience member. Additionally, given that women have been underrepresented in clinical trials in general and in those for CVD in particular, some modeling assumptions in the present study may also lack full generalizability to women at risk for CVD.
BALTIMORE – If all Americans eligible for statins under new American College of Cardiology/American Heart Association guidelines actually took them, thousands of deaths per year from cardiovascular disease might be prevented but at a cost of increased incidence of diabetes and myopathy.
The 2013 ACC/AHA guidelines expand criteria for the use of statins for primary prevention of CVD to more Americans (Circulation 2015;131:A05). Compliance with those guidelines would save 7,930 lives per year that would have been lost to CVD, according to Quanhe Yang, Ph.D., of the Centers for Disease Control and Prevention’s Division for Heart Disease and Stroke Prevention, and colleagues from the CDC and Emory University, Atlanta. Dr. Yang presented the findings at the American Heart Association Epidemiology and Prevention, Lifestyle and Cardiometabolic Health 2015 Scientific Sessions.
Statins are now indicated for primary prevention of CVD for anyone with an LDL cholesterol level greater than or equal to 190 mg/dL, for individuals aged 40-75 years with diabetes, and for those aged 40-75 years with LDL cholesterol greater than or equal to 70 mg/dL but less than 190 mg/dL who have at least a 7.5% estimated 10-year risk of developing atherosclerotic CVD. This means that an additional 24.2 million Americans are now eligible for statins but are not taking one, according to Dr. Yang and coinvestigators. However, “no study has assessed the potential impact of statin therapy under the new guidelines,” said Dr. Yang.
In order to obtain treatment group-specific atherosclerotic CVD, investigators first estimated hazard ratios for each treatment group by sex from the National Health and Nutrition Examination Survey III (NHANES III)–linked Mortality files. These hazard ratios were then applied to data from NHANES 2005-2010, the 2010 Multiple Cause of Death file, and the 2010 U.S. census to obtain age/race/sex-specific atherosclerotic CVD for each treatment group.
Applying the per-group hazard ratios, Dr. Yang and colleagues calculated that an annual 7,930 atherosclerotic CVD deaths would be prevented with full statin compliance, a reduction of 12.6%. However, modeling predicted an additional 16,400 additional cases of diabetes caused by statin use, he cautioned. More cases of myopathy would also occur, though the estimated number depends on whether the rate is derived from randomized, controlled trials (RCTs) or from population-based reports of myopathy. If the RCT data are used, just 1,510 excess cases of myopathy would be seen, in contrast to the 36,100 cases predicted by population-based data.
The study could model deaths caused by CVD only and not the reduction in disease burden of CVD that would result if all of the additional 24.2 million Americans took a statin, Dr Yang noted. Other limitations of the study included the lack of agreement in incidence of myopathy between RCTs and population-based studies, as well as the likelihood that the risk of diabetes increases with age and higher statin dose – effects not accounted for in the study.
Questioning after the talk focused on sex-specific differences in statin takers. For example, statin-associated diabetes is more common in women than men, another effect not accounted for in the study’s modeling, noted an audience member. Additionally, given that women have been underrepresented in clinical trials in general and in those for CVD in particular, some modeling assumptions in the present study may also lack full generalizability to women at risk for CVD.
AT AHA EPI/LIFESTYLE 2015MEETING
Key clinical point: New statin guidelines, if followed, could save lives but increase cases of myopathy and diabetes.
Major finding: Up to 12.6% of current deaths from CVD could be prevented if all guideline-eligible Americans took statins; saving of these lives would come at the cost of excess cases of diabetes and myopathy.
Data source: Analysis of U.S. census data and data from the NHANES study, together with meta-analysis of RCTs, used to model outcomes for 100% guideline-eligible statin use.
Disclosures: No authors reported financial disclosures.
Fitter veterans have 35% lower health care costs
BALTIMORE – Higher levels of fitness were associated with markedly reduced overall health care costs for a large group of service veterans, with annualized age-adjusted costs over a third lower when compared with the least-fit quartile.
Fitness was a stronger predictor of overall costs than any other variable assessed in the Veterans Exercise Testing Study (VETS), Dr. Jonathan Myers of the VA Palo Alto Health Care System and Stanford (Calif.) University reported at the American Heart Association Epidemiology and Prevention, Lifestyle and Cardiometabolic Health 2015 Scientific Sessions.
“Fitness,” Dr. Myers noted, “is a powerful predictor of risk, but few data exist that have associated health costs with objective measures of fitness.” To address this gap in the literature, Dr. Myers and his colleagues captured maximal exercise test results from the VETS cohort and capitalized on the availability of cost data from the VA Allocation Resource Center for VETS participants.
The 9,945 study participants, all of whom had clinical indications for maximal exercise testing, were almost entirely male (98%), with a mean age of 58 years. The population had a mean body mass index of 29.0 kg/m2, just under the cutoff for obesity. Nearly half (43%) had a history of cardiovascular disease, 27% had hypertension, 19% had diabetes, and only 1% had heart failure. Mean follow-up time was 10.7 years.
Participants’ results on maximal exercise testing were expressed as a percentage of the age-predicted peak metabolic equivalents (METS) achieved and stratified into quartiles of <60%, 60%-80%, 80%-100%, and >100% of age-expected peak METs. Multiple regression techniques were used to assess the contribution of exercise test results and clinical characteristics to overall health care costs.
The investigators also examined costs in a variety of ways: total aggregated cost over the study period, cost per patient per study year, and median annualized cost. For all analyses, a highly significant correlation (P <.0001) existed between level of fitness and health care costs. Each additional MET achieved on exercise testing, the investigators calculated, saved $1,592.
Health care costs generally maintained the inverse relationship with fitness across the gradient from most to least fit. Median age-adjusted annualized costs from most- to least-fit quartile, for example, were $10,600, $11,900, $11,300, and $12,600.
Study limitations included the study’s overwhelmingly male makeup, though Dr. Myers noted that there would be no reason to expect different results in women. Additionally, investigators could only obtain data for overall costs, without a breakdown of inpatient vs. outpatient expenditures. In analysis, models were not fully adjusted for comorbidities, either at baseline or during the study course.
In response to a question from the audience about the relative benefits of statin use when compared with enhanced physical fitness, Dr. Myers responded, “It’s been shown that fitness trumps statins for outcomes in the VA data.”
The results presented in this study “provide objective economic-based evidence for employers, health care professionals, and professional organizations to promote physical activity” not only as a means of enhancing well-being, but as a common-sense way to hold down health care costs, Dr. Myers concluded.
The study was funded by the Veterans Affairs Health Care System. No authors reported financial disclosures.
BALTIMORE – Higher levels of fitness were associated with markedly reduced overall health care costs for a large group of service veterans, with annualized age-adjusted costs over a third lower when compared with the least-fit quartile.
Fitness was a stronger predictor of overall costs than any other variable assessed in the Veterans Exercise Testing Study (VETS), Dr. Jonathan Myers of the VA Palo Alto Health Care System and Stanford (Calif.) University reported at the American Heart Association Epidemiology and Prevention, Lifestyle and Cardiometabolic Health 2015 Scientific Sessions.
“Fitness,” Dr. Myers noted, “is a powerful predictor of risk, but few data exist that have associated health costs with objective measures of fitness.” To address this gap in the literature, Dr. Myers and his colleagues captured maximal exercise test results from the VETS cohort and capitalized on the availability of cost data from the VA Allocation Resource Center for VETS participants.
The 9,945 study participants, all of whom had clinical indications for maximal exercise testing, were almost entirely male (98%), with a mean age of 58 years. The population had a mean body mass index of 29.0 kg/m2, just under the cutoff for obesity. Nearly half (43%) had a history of cardiovascular disease, 27% had hypertension, 19% had diabetes, and only 1% had heart failure. Mean follow-up time was 10.7 years.
Participants’ results on maximal exercise testing were expressed as a percentage of the age-predicted peak metabolic equivalents (METS) achieved and stratified into quartiles of <60%, 60%-80%, 80%-100%, and >100% of age-expected peak METs. Multiple regression techniques were used to assess the contribution of exercise test results and clinical characteristics to overall health care costs.
The investigators also examined costs in a variety of ways: total aggregated cost over the study period, cost per patient per study year, and median annualized cost. For all analyses, a highly significant correlation (P <.0001) existed between level of fitness and health care costs. Each additional MET achieved on exercise testing, the investigators calculated, saved $1,592.
Health care costs generally maintained the inverse relationship with fitness across the gradient from most to least fit. Median age-adjusted annualized costs from most- to least-fit quartile, for example, were $10,600, $11,900, $11,300, and $12,600.
Study limitations included the study’s overwhelmingly male makeup, though Dr. Myers noted that there would be no reason to expect different results in women. Additionally, investigators could only obtain data for overall costs, without a breakdown of inpatient vs. outpatient expenditures. In analysis, models were not fully adjusted for comorbidities, either at baseline or during the study course.
In response to a question from the audience about the relative benefits of statin use when compared with enhanced physical fitness, Dr. Myers responded, “It’s been shown that fitness trumps statins for outcomes in the VA data.”
The results presented in this study “provide objective economic-based evidence for employers, health care professionals, and professional organizations to promote physical activity” not only as a means of enhancing well-being, but as a common-sense way to hold down health care costs, Dr. Myers concluded.
The study was funded by the Veterans Affairs Health Care System. No authors reported financial disclosures.
BALTIMORE – Higher levels of fitness were associated with markedly reduced overall health care costs for a large group of service veterans, with annualized age-adjusted costs over a third lower when compared with the least-fit quartile.
Fitness was a stronger predictor of overall costs than any other variable assessed in the Veterans Exercise Testing Study (VETS), Dr. Jonathan Myers of the VA Palo Alto Health Care System and Stanford (Calif.) University reported at the American Heart Association Epidemiology and Prevention, Lifestyle and Cardiometabolic Health 2015 Scientific Sessions.
“Fitness,” Dr. Myers noted, “is a powerful predictor of risk, but few data exist that have associated health costs with objective measures of fitness.” To address this gap in the literature, Dr. Myers and his colleagues captured maximal exercise test results from the VETS cohort and capitalized on the availability of cost data from the VA Allocation Resource Center for VETS participants.
The 9,945 study participants, all of whom had clinical indications for maximal exercise testing, were almost entirely male (98%), with a mean age of 58 years. The population had a mean body mass index of 29.0 kg/m2, just under the cutoff for obesity. Nearly half (43%) had a history of cardiovascular disease, 27% had hypertension, 19% had diabetes, and only 1% had heart failure. Mean follow-up time was 10.7 years.
Participants’ results on maximal exercise testing were expressed as a percentage of the age-predicted peak metabolic equivalents (METS) achieved and stratified into quartiles of <60%, 60%-80%, 80%-100%, and >100% of age-expected peak METs. Multiple regression techniques were used to assess the contribution of exercise test results and clinical characteristics to overall health care costs.
The investigators also examined costs in a variety of ways: total aggregated cost over the study period, cost per patient per study year, and median annualized cost. For all analyses, a highly significant correlation (P <.0001) existed between level of fitness and health care costs. Each additional MET achieved on exercise testing, the investigators calculated, saved $1,592.
Health care costs generally maintained the inverse relationship with fitness across the gradient from most to least fit. Median age-adjusted annualized costs from most- to least-fit quartile, for example, were $10,600, $11,900, $11,300, and $12,600.
Study limitations included the study’s overwhelmingly male makeup, though Dr. Myers noted that there would be no reason to expect different results in women. Additionally, investigators could only obtain data for overall costs, without a breakdown of inpatient vs. outpatient expenditures. In analysis, models were not fully adjusted for comorbidities, either at baseline or during the study course.
In response to a question from the audience about the relative benefits of statin use when compared with enhanced physical fitness, Dr. Myers responded, “It’s been shown that fitness trumps statins for outcomes in the VA data.”
The results presented in this study “provide objective economic-based evidence for employers, health care professionals, and professional organizations to promote physical activity” not only as a means of enhancing well-being, but as a common-sense way to hold down health care costs, Dr. Myers concluded.
The study was funded by the Veterans Affairs Health Care System. No authors reported financial disclosures.
AT AHA EPI/LIFESTYLE 2015
Key clinical point: Health care costs are significantly lower for the most-fit service veterans.
Major finding: Health care costs for the most-fit quartile of a group of veterans were 35% lower than for the least-fit quartile, and fitness was a stronger predictor of cost than any other clinical variable.
Data source: Nearly 10,000 veterans enrolled in an ongoing prospective study were undergoing clinically indicated maximal exercise testing at two VA hospitals, with costs assessed in 2005 and 2012.
Disclosures: The study was funded by the Veterans Affairs Health Care System. No authors reported financial disclosures.
