Tag Archives: Cardiovascular disease

Getting your teeth into health care

Posted by on October 27, 2013 Comments Off on Getting your teeth into health care

We all know the reasons for going to the dentist regularly:

  1. Early detection (cavities, gum disease, oral cancer, bruxism)
  2. Checking existing fillings for structural weakness or peripheral decay
  3. Review of oral health practices

These are dental reasons, but there are other reasons as well.

The relationship between dental health and other medical health is not a new concept, with studies going back to the 1980’s. For example, the statistical relationship between heart attacks and poor dental health was noted in a 1989 Finnish study.

Managed care organizations have a strong financial incentive to lower health care costs. Healthier members have lower medical costs, so improving the health of members is an attractive alternative to cutting benefits in order to lower costs.

Aetna has been a leader in “Dental-Medical Integration” (DMI) as an approach to that end.

A study in 2006 found significant relationships between treatment for gum disease ( a proxy for having gum disease) and higher medical costs for cardiovascular, cerebrovascular, and diabetic conditions, heart, stroke, and diabetes, respectively.

In 2009, Aetna reported considerable success in getting dental care for at risk members:

In 2008, nearly 67,000 medically at-risk members sought dental care after being enrolled in Aetna’s Dental Medical Integration program. At-risk members are identified as those with diabetes, heart disease and pregnant women who have not seen a dentist in 12 months or more.

A 2011 University of Pennsylvania study in collaboration with Cigna Dental established lower medical costs two years after periodontal (gum) treatment:

2011_UPa_Dental

Earlier this month Aetna reported:

  • Lowered their medical claim costs by an average of 17 percent
  • Improved diabetes control by 45 percent
  • Used 42 percent less major and basic dental services
  • Required 3.5 percent fewer hospital admissions year-over-year compared to a 5.4 percent increase for non-members

With the caveat that the Aetna programmed targeted individuals with particular diagnoses who had not seen a dentist in a year, we are nonetheless facing an important question:

Is it time to end the division between dental and medical insurance, treating health care for the mouth as a medical specialty like others, and dentists as medical specialists like others?

Three research pieces with a lot of heart

Posted by on September 10, 2013 Comments Off on Three research pieces with a lot of heart

Often the most heartening news comes from health research. The past couple of weeks have revealed three worthy of note. All three involve prevention measures, two before a heart attack, and one after.

First, the US Centers for Disease Control and Prevention estimate that 200,000 deaths from heart attacks can be avoided annually. The preventable deaths are concentrated in three areas.

The first area is age, where preventable deaths are concentrated in the 45-64 age cohort.
Preventable deaths by age

The second area is race, where African-American men are at the highest risk of preventable death, 143 out of 100,000.

Preventable deaths by race

Finally, the deaths are concentrated geographically in the South-Central Region.
Preventable deaths by region

Second, a study from Britain and India, published in the Journal of the American Medical Association (JAMA) found that a single pill or “polypill” with fixed doses of aspirin, anti-hypertensive, and cholesterol-lowering drugs was statistically more effective than offering separate prescriptions. While physicians point out that this approach limits flexibility, greater variation of dosage combinations in polypills is a promising approach.

Polypill study

Third, a study in JAMA Internal Medicine found that even after a heart attack, better diet, as measured with Alternative Healthy Eating Index (AHEI 2010), resulted in lowered mortality.

The good news is that either before, or failing that, after a heart attack, the good practices of medication adherence and reduction of risk factors such as poor diet, can improve our survival as individuals. Furthermore, we can move the needle in a better direction by focusing our educational and interventional efforts on those under 65, African-American, residing in the South-Central United States.

Bad News for Boomers: Our Parents Were Healthier

Posted by on March 14, 2013 Comments Off on Bad News for Boomers: Our Parents Were Healthier

As Americans we believe in progress, in a better tomorrow, sometimes with a bump in the road or a hiccough, but always a better tomorrow.

The data are in (March 4,2013 edition of JAMA Internal Medicine), and it ain’t happening for boomers. Blood pressure, cholesterol, diabetes, and obesity–all greater than the previous generation.

Boomer_Parent_Comparison_JAMAinternalmed_20130304
Source: The Status of Baby Boomers’ Health in the United States The Healthiest Generation?
Dana E. King, MD, MS; Eric Matheson, MD, MS; Svetlana Chirina, MPH; Anoop Shankar, MD, PhD, MPH; Jordan Broman-Fulks
JAMA Intern Med. 2013;173(5):385-386

Although longevity has risen during the twenty-year gap between the two groups, every other indicator of health, except smoking, has become less favorable. And the pattern is clear.

At the top of the following chart are general measures of health. Then, we can see that lifestyle factors have declined leading to the trends in the last section: declining indicators of cardiovascular health.

We can’t choose to be healthy or not: what we can do is make healthy choices by changing the lifestyle factors.

We are choosing illness at great expense to ourselves, both financially and in quality of life, while continuing to endure longer and sicker lives instead of enjoying healthier lives.

Boomer_Parent_Extract_Comparison

Calcium: Friend or foe? Part I

Posted by on March 4, 2013 Comments Off on Calcium: Friend or foe? Part I

As I approached a certain age, my doctor said, “Oh, are you taking calcium supplements?” And, I asked him, “Isn’t arterial plaque calcified cholesterol? Is it really a good idea to flood my arteries with calcium?” He is a thoughtful person. “Maybe not,” he said, upon reflection.

The main therapeutic use of calcium supplements is to ward off osteoporosis. We are beginning to live longer than our bones were intended, and we are trying to avoid turning into boneless amoebae before we die. Knowing from childhood that “calcium builds strong bones,” we thought calcium supplements made perfect sense.

Calcium Source: news@Jama

I felt really validated when studies came out showing calcium to be a cardiac risk. The most recent was published online a month ago. The NIH AARP Diet and Health Study found a higher risk of cardiovascular events in men taking supplementary calcium. Why the risk did not appear to be elevated for women is a subject for further study.

Similar findings have been reported in the British Medical Journal: Heart and Education in Heart.
Calcium supplements: bad for the heart?
Heart 2012;98:12 895-896
As well as in other European studies:
2011_BMJ_Heart_Calcium

Sugar and spice, and salt is not very nice Part I

Posted by on February 19, 2013 Comments Off on Sugar and spice, and salt is not very nice Part I

“No matter how we look at it, the story is the same – there will be huge benefits in reducing sodium,” said Pam Coxson, PhD, a UCSF mathematician and the lead author on the paper who performed one of the three analyses published in Hypertension.

The quotation is an understatement–the studies claim that hundreds of thousands of lives can be saved by less salt. What are the facts?

Let’s start with the Centers for Disease Control and Prevention (CDC):

About 90% of Americans eat more sodium than is recommended for a healthy diet. Too much sodium increases a person’s risk for high blood pressure. High blood pressure often leads to heart disease and stroke. More than 800,000 people die each year from heart disease, stroke and other vascular diseases, costing the nation $273 billion health care dollars in 2010.

The key point is the relationship of sodium to hypertension and cardiovascular events:

About 45 percent of these cardiovascular deaths are attributable to high blood pressure, and numerous medical studies have already demonstrated how reducing dietary salt – the primary source of sodium – can lower blood pressure and reduce the risk of a heart attack or stroke.

The study’s three analyses came up with varying numbers of saved lives, ranging from 250,000 to 1,200,000 over the next decade by reduced sodium intake–they averaged 280,000 to 500,000. We have long known that certain populations are more salt-sensitive and should radically reduce intake. The CDC list below tells that story, but we all should reduce sodium, not merely by not picking up the salt shaker, but by eating more fresh foods and looking at the labels on the processed foods we eat. Salt-sensitive populations

We can all benefit by a reduction in sodium, long before we become part of a vulnerable population. Next time, let’s look at some strategies we can use while waiting for food companies to offer lower sodium alternatives and government action in this domain.

Helpful links for more information about dietary sodium