The most important question for corporate benefits managers is this: What is the source of our biggest health risk? Statistically, cardiovascular disease is the biggest risk. But cardiovascular disease is often silent, causing no symptoms until a sudden event, which can be fatal. So the most effective way to answer the risk question is by engaging a screening process that combines the best available blood bio-marker technology with the best available anatomical testing to assess the actual arteries themselves. At CardioSound, we present the information in an understandable format that not only leaves the executive well-informed but also well-motivated toward effective personal change.
heart attacks and strokes put your company at risk:
When the new CEO of United Airlines had a heart attack, stock prices dropped. Read the Reuters article at http://reut.rs/1ZIRuUQ.
Key employees with high risks for cardiovascular events can increase the risk your company carries. Of heart attack survivors 45 and older, 1 in 5 men (18%) and 1 in 4 women (23%) will die within 1 year (1). Within 5 years after surviving a heart attack at 45 or older, 1 of 2 women (47%) and 1 of 3 men (36%) will die (1).
We can help you mitigate that risk. We can help your people identify, understand and dramatically reduce their own risk. Check out our stats for heart attack survivors.
know your risk: Cardiovascular disease:
Heart disease is the biggest killer. Cardiovascular disease (heart attacks, strokes and sudden death) kills one out of three Americans. Of first events, about 30% are sudden death (1).
Half of men and about 2/3 of women who die suddenly from heart disease had no previous symptoms (1).
Why so unpredictable?
People who have chest pain when they exercise need a stress test to diagnose "Obstructive" blockage (see below, far right) which needs a surgical procedure like by-pass or stent. But that's not where most heart attacks strike.
Most heart attacks shut off the blood flow suddenly and without warning. When "vulnerable" or soft plaque ruptures, a clot or "thrombus" forms, and often blocks off the entire artery within moments (see "Rupture, Thrombus, Myocardial Infarction" above). You would think that most heart attacks occur where plaque causes severe obstruction. Not true. Less than 20% of heart attacks do. Over 80% of heart attacks occur in "vulnerable" plaque where the blood flow was fine just moments before the heart attack (2). Vulnerable plaque causes no symptoms. No warning signs. Just a sudden event. Sometimes lethal. That's why this disease is so unpredictable. Almost everyone knows someone who has dropped dead from this disease.
Soft vulnerable plaque causing no obstruction to blood flow is so much more common than obstructive plaque needing a stent. It's common. It's silent. And it's dangerous. That's why this disease has been so unpredictable. Until now.
What about executive physical programs?
Popular with corporate executives, "Executive Physical" programs can give a false sense of security. Most executive physical programs include an exercise stress test. Yet stress tests, even though they are commonly employed to assess cardiovascular risk, are woefully inadequate (3,4,5). Remember that "vulnerable" plaque is not bad enough to obstruct blood flow or to cause symptoms of chest pain. That means 80% of heart attack victims would have passed a stress test the day before the event. Passing a stress test makes people feel better about their health. It means they don't need a stent or bypass surgery. It does not mean they have low risk for having a heart attack.
Some executive programs plug risk factors into a formula, using gender, blood pressure and cholesterol, age and smoking history to calculate the risk of having an event. These risk calculators, although easy to use and popular with doctors and patients, are not very successful at identifying people at risk for CV events (6). They often miss high-risk patients, giving a false sense of security.
Performing screening health physicals has no effect on overall mortality or on cardiovascular mortality (7). Ask your executive physical program to provide their CV event statistics. How many executives have been through their program? During that period of time, how many of their executives have had events? How many who had heart attacks died within the first year after the event? And how many died within 5 years after?
the best key person insurance:
Does your firm have a corporate-owned "key person" life insurance policy in place for high-value executives?
The best corporate policy is one that has the power to identify risk and then also empower your people to do something about it.
We do that. Start with our screening program to identify event risk. For those who have high risk for events, our Critical Care program is designed to cool off the arteries and reduce risk as quickly as possible.
For those committed to their current doctor's treatment program, we offer our "Ask the Arteries" trending program, designed to show whether prevention is working or not working. Initially and then after 6 months, the primary care doctor or cardiologist will receive a report card, with an opportunity to address the issues. Again at 12 months, a third report clarifies treatment successes and failures.
When prevention programs fail, people need procedures like stents or bypass. Or they have events. Or they find out by testing the arteries in time to change the course of their disease. That's the power of personalized trending technology: the linking of unseen cause-effect relationships, bringing clarity to therapeutic decision points. A prevention program that actually works.
Benjamin, EJ, et al, Heart Attack and Stroke Statistics-2017 update. Circulation 2017 Mar 7; 135(10): e146-e603
Symptoms are treated with procedures like stents and bypass surgery when the degree of stenosis or obstruction is 70% or more. Yet 86% of heart attacks are caused by plaque lesions which are < 70% obstructed, and 68% of heart attacks are caused by lesions which cause a stenosis < 50%. E. Falk, PK Shah, V Fuster, Circulation 1995;92:657
Chou, Cardiac screening with electrocardiography, stress echocardiography or myocardial perfusion imaging: Advice for high-value care from the American College of Physicians. Ann Intern Med. 2015;162:438-447
E. Falk, PK Shah, V Fuster, Coronary Plaque Disruption. Circulation 1995;92:657
Little WC, Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild-to-moderate coronary artery disease? Circulation. 1988;78:1157-1166
Framingham-based risk calculators tend to miss too many high-risk people. A medical way of saying this is that risk calculators are fairly specific for CV disease but are not very sensitive. Doneen AL, Bale BF, ISA June 15, 2009
This meta-analysis of 14 randomized trials involving 183,000 adults who had screening health physicals showed no effect on overall mortality, cardiovascular-related mortality, or cancer-related mortality. Several trials showed that screening physicals did result in more diagnoses and in better self-reported health. General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis. BMJ. 2012;345;e7191