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Risk Factors, Medicare Costs Linked

October 15, 1998

People with a low risk of heart disease in middle age need far less hospital care when they get old, according to a study published today in the New England Journal of Medicine.

The greater the number of heart disease risk factors in middle age, the higher the Medicare spending on hospital services an average of 23 years later, according to the study by Northwestern University Medical School researchers.

The risk factors for heart disease are high blood pressure, high cholesterol, smoking, a previous heart attack, diabetes or an abnormal heartbeat.

The study found that women at low risk for heart disease in middle age cost Medicare less than half as much as women with at least one risk factor. Men with no risk factors cost Medicare one-third less than men with at least one risk factor.

Most of the Medicare savings were associated with the three risk factors that can be prevented or controlled: smoking, high cholesterol and high blood pressure.

Controlling blood pressure and cholesterol and getting people to quit smoking are ``key not only to mitigating the epidemic of coronary heart disease ... but also to containing health care expenditures and possibly improving the quality of life in the later years,″ the researchers concluded.

In an accompanying editorial, Rutgers University researcher Louise Russell said the study does not prove that reducing heart disease risks will lower overall health care costs because the researchers did not look at the cost of prevention: prescription drugs that control cholesterol and blood pressure, and kick-the-habit programs.

However, Dr. Valentin Fuster, president of the American Heart Association, said other studies have shown that drugs and other lifestyle changes that control cholesterol or blood pressure are cheap compared with the cost of even one heart attack.

Fuster said the study’s findings are important because the population is aging rapidly and the Medicare system faces an unprecedented burden. The heart association helped pay for the study.

The Northwestern researchers, led by Dr. Martha Daviglus, looked at 7,039 men and 6,757 women. All were evaluated for heart disease risk factors from 1967 to 1973, when they were age 40 to 64. The researchers then looked at Medicare spending for each person from 1984 to 1994.