Thirty per cent of deaths in Canada are due to cardiovascular disease. It kills more woman than all cancers combined. And it cost $21 billion 10 to 15 years ago, so with the rising cost of health care, it’s easy to imagine what that number looks like today.
“While I’m up here, four Canadians are going to die of cardiovascular disease,” said Dr. Milan Gupta, cardiologist at Osler, during Benefits Canada’s Chronic Disease at Work conference in Toronto on June 5. “This disease needs to be brought to the forefront.”
Read: Heart disease unique among chronic illnesses for preventability
A study published three years ago looked at the relationship between chronic conditions and absenteeism, said Dr. Gupta, noting it found mood disorders, bowel disorders and cardiovascular disease were the three conditions associated with the greatest number of absenteeism. Another study, which investigated the effects of cardiovascular events on work and earnings in Canada, found people who have heart attacks are unlikely to ever return to work, meaning their earnings decrease and there’s a huge increase in absenteeism.
Dr. Gupta’s own research, a study aiming to capture details on the costs and absenteeism effects posed by cardiovascular disease, found 55 days of lost productivity in the case of heart attacks and 53 days for strokes. In terms of the costs, people who suffered a heart attack cost $10,000 in productivity loss, while those who had a stroke cost $9,000, he said. “CVD clearly exerts a substantial financial burden on society, including workplace absenteeism.”
Preventing cardiovascular disease isn’t easy because it means living a healthy lifestyle right from infancy, noted Dr. Gupta. He said obesity rates among young people are currently surging, only one in five meet the recommended physical activity guidelines; just 40 per cent are eating the appropriate amount of healthy fruits and vegetables; and a quarter have a lot of stress.
Read: New advances in tackling cardiovascular disease
The most important factor for cardiovascular disease is low-density lipoprotein cholesterol, said Dr. Gupta. “This is the holy grail of CVD eradication. When we lower LDL, we lower the risk of dying from CVD. End of story.”
However, despite an abundance of evidence, a large portion of the highest-risk patients aren’t meeting their LDL targets, he noted. “Forty-five per cent of patients with CVD, the highest risk group, even when prescribed appropriate therapy, are not meeting recommended targets.”
The Canadian Cardiovascular Society sets guidelines related to LDL cholesterol targets, added Dr. Gupta. “We can set the targets based on science, but hitting the targets is an art.”
A few years ago, PCSK9 inhibitors were introduced. “They work in a complementary mechanism and provide profound LDL lowering, and their use is restricted to only the highest-risk patients.
“Of every 100,000 privately insured high-risk patient in Canada, roughly 15 to 25 may be eligible for this niche class of drug,” he added. “When we lower LDL profoundly, by adding a PCSK9 inhibitor to the background of a statin, not only does the plaque not grow, it regresses.”
Read more articles from the 2019 Chronic Disease at Work conference.