Disease Management Update
Volume V, No. 29
November 13, 2008
Dear Healthcare Intelligence Network Client,
According to the American Heart Association, the cholesterol levels of nearly 106.7 million Americans are considered to be borderline-high risk, while an additional 37.2 million have high-risk levels of cholesterol. This week's Disease Management Update showcases a study involving high-cholesterol treatments and low-cholesterol patients, while another emphasizes the positive effects of combination therapy in high-risk patients.
Your colleague in the business of healthcare,
Editor, Disease Management Update
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Table of Contents
- Low Cholesterol Patients Benefit from High-Cholesterol Meds
- Disease Management Q&A: Putting HRA Data to Work
- HealthSounds Podcast: Health Coach Hiring
- Researchers Identify Treatment Effects of Combination Therapy
- Survey of the Month: Healthcare Profitability Ideas for an Ailing Economy
- Health & Wellness Coaching in 2008
1. Low Cholesterol Patients Benefit from High-Cholesterol Meds
A recent study from Brigham and Women's Hospital (BWH) demonstrates for the first time that statin therapy is highly effective in the prevention of heart attack, stroke and cardiovascular death among apparently healthy men and women who had low levels of cholesterol but were nonetheless at high risk for vascular disease.
A daily regimen of rosuvastatin was associated with a 54 percent reduction in heart attack, a 48 percent reduction in stroke, a 46 percent reduction in need for angioplasty or bypass surgery and a 20 percent reduction in all-cause mortality compared to participants who were given a placebo. These effects are nearly twice as large as what doctors expect when using statin therapy among patients with high cholesterol, demonstrating the importance of elevated high-sensitivity C-reactive proteins (hsCRP) as a major risk factor for cardiovascular disease. Among trial participants with elevated hsCRP but no other risk factors, rosuvastatin reduced cardiovascular events by 37 percent.
“Our results are relevant for patient care and the prevention of heart attack and stroke,” said Paul Ridker, M.D., director of the Center for Cardiovascular Disease Prevention at BWH and lead author of the study. “Physicians can no longer assume that patients are at low risk for heart disease simply because they have low cholesterol. We have confirmed that patients with increased hsCRP are at high risk even if cholesterol levels are low, and we now have evidence that a simple and safe therapy cuts that risk and saves lives.”
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2. Disease Management Q&A: Putting HRA Data to Work
Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is David Sensibaugh, director of Integrated Health at Eastman Chemical Company.
Question: Once you have HRA data, what do you do with it?
Response: (David Sensibaugh) We look at this data and identify individuals who would benefit from some type of intervention. Since we are fortunate now to have a couple of years of data that represents 90 percent or more of our participation, that helps to give us a fairly accurate picture of the health status of our population. Clustering is combining two or more health risks from the HRA data to help us identify subsets of our population that have either high health risks or might be a predictor of risk in the future. With regard to intervention, some subsets of our people would benefit and clearly need clinical treatment, and then there are other people who clearly do not need clinical treatment but just need some kind of health coaching.
When looking at people in our population who have very high cholesterol, or hyperlipidemia, 6 percent have cholesterol in those very high ranges. Likewise, people in our population with diabetes have blood glucose at a very high level. We’re trying to steer people to specific diabetes programs or lipid clinic programs that would help them get treatment. These people are not so much in need of coaching; they’re in need of treatment. As an extension of this focus on cholesterol, we matched our data with our claims data through our data aggregator. For the 417 people who had that very high level of cholesterol and LDL, the opportunity for us is in the fact that almost half of these people were not even seeing a doctor about their condition. Eighty-four percent of these people were not taking cholesterol-lowering medication, and 45 percent were totally untreated. Our challenge is to drive, to incent, to encourage — we can’t force these people to get the treatment that they need.
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3. HealthSounds Podcast:
Health Coach Hiring
With so many companies focusing on wellness and prevention, it's a great time to be a health coach, explains Darcy Hurlbert, health and wellness product specialist for Ceridian Lifeworks. She describes the criteria for pairing a health coach with a client and emphasizes the value of a veteran Ceridian health coach in the 100 hours of training delivered to the company's health coaches each year.
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Researchers Identify Treatment Effects of Combination Therapy
Researchers discovered that combination therapy achieved greater reductions in cholesterol classes in high-risk patients and resulted in greater positive changes in lipoprotein profile than monotherapy. Coadministration of ezetimibe/simvastatin and fenofibrate results in more favorable lipid profile in mixed hyperlipidemia patients. Because of the complex nature of mixed hyperlipidemia, medical guidelines recommend treating patients with a combination of lipid-lowering agents. However, clinicians continue to search for the optimal combination to achieve target lipid levels.
Researchers reported that ezetimibe/simvastatin and fenofibrate, both as separate therapy and in coadministration, produced beneficial changes in the distribution of lipoprotein subclasses within the very low density lipoprotein (VLDL) to LDL density range. The combination of ezetimibe/simvastatin + fenofibrate produced greater reductions in VLDL, intermediate density lipoprotein (IDL), and LDL relative to other treatment groups and greater improvements in the distribution of LDL subfractions with a shift from smaller, more dense to larger, more buoyant LDL particle size in patients with mixed hyperlipidemia.
"Mixed hyperlipidemia is characterized by an excess of small, dense LDL associated with an increase of triglyceride and a decrease of HDL cholesterol levels," said Michel Farnier, M.D., lead author of the study. "The patients with mixed dyslipidemia frequently require a combination therapy to normalize this atherogenic lipoprotein profile, and in this specific study the combined therapy of ezetimibe/simvastatin and fenofibrate has produced favorable effects on all the atherogenic lipoprotein subclasses."
To learn more about this research, please visit:
5. Survey of the Month: Healthcare Profitability Ideas for an Ailing Economy
Despite the dawn of a new administration, rising costs and a volatile economic climate are forcing healthcare organizations to explore alternative revenue streams to boost bottom lines and recover from lower net investment income levels. Complete HIN's Survey of the Month on Healthcare Profitability in an Ailing Economy by November 30 and you’ll get a free executive summary of the compiled results. Your responses will be kept strictly confidential. In exchange for your time and participation, you will also receive a $25 discount off the complete "Healthcare Trends & Forecasts in 2009" report when it is published in December 2008.
To participate in this survey and receive its results, please visit:
Health & Wellness Coaching in 2008
Health coaching — with its focus on wellness, prevention and healthy lifestyle choices — has established its value to the healthcare industry. HIN conducted an e-survey on health and wellness coaching programs and received response from 235 organizations, many of whom have implemented successful coaching programs. This white paper discusses patient outcomes, factors that contribute to a successful program and the challenges of calculating ROI in a fledgling program.
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