title: Favorable Cardiovascular Risk Profile Is Associated With Lower Healthcare Costs and Resource Utilization: The 2012 Medical Expenditure Panel Survey.
abstract: BACKGROUND
  The American Heart Association's 2020 Strategic Goals emphasize the value of optimizing risk factor status to reduce the burden of morbidity and mortality. In this study, we aimed to quantify the overall and marginal impact of favorable cardiovascular risk factor (CRF) profile on healthcare expenditure and resource utilization in the United States among those with and without cardiovascular disease (CVD).
  
  
  RESULTS
  The study population was derived from the 2012 Medical Expenditure Panel Survey (MEPS). Direct and indirect costs were calculated for all-cause healthcare resource utilization. Variables of interest included CVD diagnoses (coronary artery disease, stroke, peripheral artery disease, dysrhythmias, or heart failure), ascertained by International Classification of Diseases, Ninth Edition, Clinical Modification codes, and CRF profile (hypertension, diabetes mellitus, hypercholesterolemia, smoking, physical activity, and obesity). Two-part econometric models were used to study expenditure data. The final study sample consisted of 15 651 MEPS participants (58.5±12 years, 54% female). Overall, 5921 (37.8%) had optimal, 7002 (44.7%) had average, and 2728 (17.4%) had poor CRF profile, translating to 54.2, 64.1, and 24.9 million adults in United States, respectively. Significantly lower health expenditures were noted with favorable CRF profile across CVD status. Among study participants with established CVD, overall healthcare expenditures with optimal and average CRF profile were $5946 and $3731 less compared with those with poor CRF profile. The respective differences were $4031 and $2560 in those without CVD.
  
  
  CONCLUSIONS
  Favorable CRF profile is associated with significantly lower medical expenditure and healthcare utilization among individuals with and without established CVD.
authors.affiliation: From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.); Section of Cardiovascular Medicine, Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Yale University, New Haven, CT (E.S.S.); Divisions of Cardiology (J.S.R.) and Research (J.S.R.), Kaiser Permanente Northern California, Oakland; Department of Medicine, University of California San Francisco (J.S.R.); Section of Cardiovascular Research, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (S.S.V.); Non-Invasive Cardiovascular Imaging Program, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (R.B.); Division of Cardiology, The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD (M.J.B., K.N.); and Department of Medicine, School of Medicine, Emory University, Atlanta, GA (E.V.).
authors.forename: Javier
authors.initials: J
authors.lastname: Valero-Elizondo
authors.affiliation: From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.); Section of Cardiovascular Medicine, Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Yale University, New Haven, CT (E.S.S.); Divisions of Cardiology (J.S.R.) and Research (J.S.R.), Kaiser Permanente Northern California, Oakland; Department of Medicine, University of California San Francisco (J.S.R.); Section of Cardiovascular Research, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (S.S.V.); Non-Invasive Cardiovascular Imaging Program, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (R.B.); Division of Cardiology, The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD (M.J.B., K.N.); and Department of Medicine, School of Medicine, Emory University, Atlanta, GA (E.V.).
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Salami
authors.affiliation: From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.); Section of Cardiovascular Medicine, Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Yale University, New Haven, CT (E.S.S.); Divisions of Cardiology (J.S.R.) and Research (J.S.R.), Kaiser Permanente Northern California, Oakland; Department of Medicine, University of California San Francisco (J.S.R.); Section of Cardiovascular Research, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (S.S.V.); Non-Invasive Cardiovascular Imaging Program, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (R.B.); Division of Cardiology, The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD (M.J.B., K.N.); and Department of Medicine, School of Medicine, Emory University, Atlanta, GA (E.V.).
authors.forename: Oluseye
authors.initials: O
authors.lastname: Ogunmoroti
authors.affiliation: From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.); Section of Cardiovascular Medicine, Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Yale University, New Haven, CT (E.S.S.); Divisions of Cardiology (J.S.R.) and Research (J.S.R.), Kaiser Permanente Northern California, Oakland; Department of Medicine, University of California San Francisco (J.S.R.); Section of Cardiovascular Research, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (S.S.V.); Non-Invasive Cardiovascular Imaging Program, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (R.B.); Division of Cardiology, The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD (M.J.B., K.N.); and Department of Medicine, School of Medicine, Emory University, Atlanta, GA (E.V.).
authors.forename: Chukwuemeka U
authors.initials: CU
authors.lastname: Osondu
authors.affiliation: From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.); Section of Cardiovascular Medicine, Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Yale University, New Haven, CT (E.S.S.); Divisions of Cardiology (J.S.R.) and Research (J.S.R.), Kaiser Permanente Northern California, Oakland; Department of Medicine, University of California San Francisco (J.S.R.); Section of Cardiovascular Research, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (S.S.V.); Non-Invasive Cardiovascular Imaging Program, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (R.B.); Division of Cardiology, The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD (M.J.B., K.N.); and Department of Medicine, School of Medicine, Emory University, Atlanta, GA (E.V.).
authors.forename: Ehimen C
authors.initials: EC
authors.lastname: Aneni
authors.affiliation: From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.); Section of Cardiovascular Medicine, Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Yale University, New Haven, CT (E.S.S.); Divisions of Cardiology (J.S.R.) and Research (J.S.R.), Kaiser Permanente Northern California, Oakland; Department of Medicine, University of California San Francisco (J.S.R.); Section of Cardiovascular Research, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (S.S.V.); Non-Invasive Cardiovascular Imaging Program, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (R.B.); Division of Cardiology, The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD (M.J.B., K.N.); and Department of Medicine, School of Medicine, Emory University, Atlanta, GA (E.V.).
authors.forename: Rehan
authors.initials: R
authors.lastname: Malik
authors.affiliation: From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.); Section of Cardiovascular Medicine, Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Yale University, New Haven, CT (E.S.S.); Divisions of Cardiology (J.S.R.) and Research (J.S.R.), Kaiser Permanente Northern California, Oakland; Department of Medicine, University of California San Francisco (J.S.R.); Section of Cardiovascular Research, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (S.S.V.); Non-Invasive Cardiovascular Imaging Program, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (R.B.); Division of Cardiology, The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD (M.J.B., K.N.); and Department of Medicine, School of Medicine, Emory University, Atlanta, GA (E.V.).
authors.forename: Erica S
authors.initials: ES
authors.lastname: Spatz
authors.affiliation: From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.); Section of Cardiovascular Medicine, Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Yale University, New Haven, CT (E.S.S.); Divisions of Cardiology (J.S.R.) and Research (J.S.R.), Kaiser Permanente Northern California, Oakland; Department of Medicine, University of California San Francisco (J.S.R.); Section of Cardiovascular Research, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (S.S.V.); Non-Invasive Cardiovascular Imaging Program, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (R.B.); Division of Cardiology, The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD (M.J.B., K.N.); and Department of Medicine, School of Medicine, Emory University, Atlanta, GA (E.V.).
authors.forename: Jamal S
authors.initials: JS
authors.lastname: Rana
authors.affiliation: From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.); Section of Cardiovascular Medicine, Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Yale University, New Haven, CT (E.S.S.); Divisions of Cardiology (J.S.R.) and Research (J.S.R.), Kaiser Permanente Northern California, Oakland; Department of Medicine, University of California San Francisco (J.S.R.); Section of Cardiovascular Research, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (S.S.V.); Non-Invasive Cardiovascular Imaging Program, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (R.B.); Division of Cardiology, The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD (M.J.B., K.N.); and Department of Medicine, School of Medicine, Emory University, Atlanta, GA (E.V.).
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
authors.affiliation: From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.); Section of Cardiovascular Medicine, Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Yale University, New Haven, CT (E.S.S.); Divisions of Cardiology (J.S.R.) and Research (J.S.R.), Kaiser Permanente Northern California, Oakland; Department of Medicine, University of California San Francisco (J.S.R.); Section of Cardiovascular Research, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (S.S.V.); Non-Invasive Cardiovascular Imaging Program, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (R.B.); Division of Cardiology, The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD (M.J.B., K.N.); and Department of Medicine, School of Medicine, Emory University, Atlanta, GA (E.V.).
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
authors.affiliation: From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.); Section of Cardiovascular Medicine, Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Yale University, New Haven, CT (E.S.S.); Divisions of Cardiology (J.S.R.) and Research (J.S.R.), Kaiser Permanente Northern California, Oakland; Department of Medicine, University of California San Francisco (J.S.R.); Section of Cardiovascular Research, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (S.S.V.); Non-Invasive Cardiovascular Imaging Program, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (R.B.); Division of Cardiology, The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD (M.J.B., K.N.); and Department of Medicine, School of Medicine, Emory University, Atlanta, GA (E.V.).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.affiliation: From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.); Section of Cardiovascular Medicine, Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Yale University, New Haven, CT (E.S.S.); Divisions of Cardiology (J.S.R.) and Research (J.S.R.), Kaiser Permanente Northern California, Oakland; Department of Medicine, University of California San Francisco (J.S.R.); Section of Cardiovascular Research, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (S.S.V.); Non-Invasive Cardiovascular Imaging Program, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (R.B.); Division of Cardiology, The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD (M.J.B., K.N.); and Department of Medicine, School of Medicine, Emory University, Atlanta, GA (E.V.).
authors.forename: Emir
authors.initials: E
authors.lastname: Veledar
authors.affiliation: From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.); Section of Cardiovascular Medicine, Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Yale University, New Haven, CT (E.S.S.); Divisions of Cardiology (J.S.R.) and Research (J.S.R.), Kaiser Permanente Northern California, Oakland; Department of Medicine, University of California San Francisco (J.S.R.); Section of Cardiovascular Research, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (S.S.V.); Non-Invasive Cardiovascular Imaging Program, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (R.B.); Division of Cardiology, The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD (M.J.B., K.N.); and Department of Medicine, School of Medicine, Emory University, Atlanta, GA (E.V.). KhurramN@baptisthealth.net.
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000191:economics* / Q000209:etiology / Q000517:prevention & control*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D019538:Health Care Surveys; D005102:Health Expenditures; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011314:Preventive Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States
keywords: cardiovascular disease; health expenditures; health resources; preventive medicine; risk factor