Employer actions can play a role in decreasing premature heart disease and death

October 16, 2023

Source: Our World in Data LINK

Life expectancy decreased globally in 2020 and 2021 due to the ravages of COVID-19. The drop in the US was steeper than in other developed countries. US life expectancy lags other developed countries, and many of the excess deaths are among those between 50 and 65, who would otherwise be expected to be in the workforce. Deaths from gun violence and from drug overdoses are one cause, but many Americans are prematurely dying of chronic diseases. 

This trend was highlighted in a series in the Washington Postlast week, and researchers Ann Case and Angus Deaton reported on the growing increase in premature death among those who have less education last week in the New York Times. 

The New England Journal last week published “Global Effect of Modifiable Risk Factors on Cardiovascular Disease and Mortality,” a compilation of 112 studies from around the world using statistical techniques to tease out the role that reversible risk factors play in increasing cardiovascular disease and decreasing life expectancy. They found that five risk factors, tobacco smoking, diabetes, high blood pressure, obesity and high cholesterol, were responsible for the majority of premature cardiovascular disease globally, 55.5% in women and 50.3% in men. These five risk factors were responsible for 22% of deaths from any cause in women, and 19% of deaths from any cause in men.

Here’s a graphic to demonstrate the impact of these five risk factors on risk of premature cardiovascular disease in men and women in North America.

Risk factor hazard ratio for cardiovascular disease

Source: New England Journal, October 3, 2023 LINK  This data is from supplement 13a. 
Note that hazard ratio of  2.01x means that diabetes approximately doubles risk of cardiovascular disease. 
 SBP = Systolic (top number) Blood Pressure; HDL = High Density Lipoprotein

Implications for employers:

• Employers can help workers and plan members lower their risk of premature cardiovascular disease or death due to these five risk factors

  • Smoking: Provide coverage for tobacco cessation treatment - and recognize that most smokers want to quit, and it takes many of them multiple quit attempts. Workplaces should also be tobacco-free. Although 43% of employers use tobacco surcharges, these can adversely impact lower wage workers and generally only give people an incentive once a year to quit. 

  • Obesity: Companies should be sure that cafeterias and vending machines don’t promote obesity, and can make programs available to help employees and plan members improve their nutrition. There are many apps and programs to help people lose weight. Employers can also encourage employees to use their EAP benefits or to see a nutritionist as ways to get started. The Diabetes Prevention Program and ketogenic diets are effective at promoting weight loss. New GLP-1 drugs (like Wegovy, Ozempic and Mounjaro) are highly effective at promoting weight loss, although they are very expensive. Employers can also offer coverage for bariatric surgery. 

  • Hypertension: Almost half of American adults (47%) have hypertension, and many of them don’t know it. Even those who have known hypertension are likely not treated to target blood pressure of <130/<80. Employers can encourage employees to get their blood pressure checked and offer generic blood pressure medicines at low or no cost.

  • Diabetes: Effective diabetes treatment lowers the risk of heart disease, and many employers offer diabetes testing and treatment at low or no cost. Pharmaceutical companies recently lowered the prices of many insulins. Treatment of obesity can help treat Type 2 diabetes. GLP-1 medications are effective at treating diabetes.  

  • High cholesterol: Lowering cholesterol reduces risk of premature death, and very effective statin drugs are available generically for prices of under $100 a year. Many employers cover these with no cost sharing which can improve adherence.