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CDC Vital Signs: Prevalence, Treatment, and Control of High Blood Pressure and High Cholesterol

Tuesday, February 1, 2011 – 12:00pm ET

Operator: Welcome and thank you for standing by. At this time, all participants are in a listen-only mode. In the question and answer session today, you can press star one to ask a question. The conference is being recorded. I turn the call over to Mr. Tom Skinner, you may begin, sir.

Tom Skinner: Thank you, Shirley, thank you for joining us for the release of another Vital Signs report from the CDC. This one is on the prevalence, treatment, and control of high blood pressure and high cholesterol. With us today is the director of the CDC, Dr. Thomas Frieden, who will give some introductory remarks. We also have with us Dr. Darwin, d-a-r-w-i-n, Labarthe, spelled l-a-b-a-r-t-h-e. He's the director of the Division of Heart Disease and Stroke Prevention here at CDC who will be available to help answer questions. Without further ado, I'll turn it over to Dr. Frieden.

Tom Frieden: Good afternoon, everyone. Thanks very much for joining us. The topic of today's Vital Signs is extremely important because heart disease is the leading killer in America, and the bottom line is that high blood pressure and high cholesterol are out of control for most Americans who have these conditions. Although there has been progress in the past decade, it hasn't been nearly enough. About a third of adults have high blood pressure and half of those who have high blood pressure don't have it under control. And about a third of adults also have high cholesterol and two thirds of those don't have it under control. In fact, about 100 million U.S. adults, nearly half of all adults in this country, 47 percent, have either high cholesterol or high blood pressure.

High cholesterol and high blood pressure have serious health and economic consequences. There are about 800,000 deaths per year from cardiovascular disease. There are an estimated 100,000 deaths per year from high blood pressure and high cholesterol that could be prevented with readily available, low-cost, highly effective treatments. And the economic costs of high blood pressure and high cholesterol are substantial. Cardiovascular disease costs the country nearly $300 billion a year in direct medical costs alone. And those costs are projected to triple in the next 20 years. High blood pressure is often referred to as a silent killer, because there are generally no effects that someone senses from having it. One of the things that today's report highlights is that having insurance is a necessary but not a sufficient condition for most people to have their conditions controlled. If you don't have health insurance, you're much less likely to have your high blood pressure or your high cholesterol controlled. But even among people who do have health insurance, levels of control are not what they could or should be. In fact, more than 80 percent of people who have out of control blood pressure or out of control cholesterol do have either private or public health insurance. Health care system improvements can greatly increase those numbers and reduce the risk of heart attack or stroke. How likely it is that an individual with high blood pressure or high cholesterol has their condition under control is determined much more by the system that they're cared for than by their personal characteristics, if they have coverage.

There are important things that can be done to improve the control of blood pressure and cholesterol. First off, the Affordable Care Act provides coverage for blood pressure and cholesterol screening with no cost sharing. The electronic health records initiatives enable registries and clinical decision support which facilitate better treatment and follow-up. Focus in clinical attention on the importance of blood pressure and cholesterol control, using standardized protocol so that everyone gets the best treatment, supporting the patients through care, reducing the barriers to adherence, ensuring that nurses and pharmacists and others are an important part of the health care teams supporting patients. And individuals can do more, knowing your own numbers and ensuring that they're in control. There are important initiatives at the national level that can affect the overall rate of high blood pressure and high cholesterol. For example, the Let's Move program could reduce rates of obesity, therefore, reducing both high cholesterol and high blood pressure. Yesterday's release of the dietary guidelines for Americans called for a substantial reduction in both salt and fat consumption. This could reduce high blood pressure and cholesterol. Last week, we had a very positive announcement from one of the major food sellers in this country – Wal-Mart, committing to very ambitious and very positive changes in the food supply over the next five years.

So bottom line again is that the leading preventable cause of death and the leading cause of death in this country is cardiovascular disease – heart disease and stroke, and the leading causes of that include high blood pressure and high cholesterol. Although there has been progress in recent years, it's far too little and still most Americans with these conditions don't have them under control.

Tom Skinner: Shirley, I think we're ready for questions, please.

Operator: Thank you. We're ready to begin the question and answer session. If you would like to ask a question, please press star one, un-mute your phone and record your name clearly. Press star one to ask the question. One moment for our first question. The first question comes from Mike Stobbe from the Associated Press. Ask your question.

Mike Stobbe: Hi, thank you for taking the question. I want to clarify the trends with high LDL cholesterol. Has the prevalence been decreasing, stalled? What's going on with that? And the successful control of it. I want to understand where we are historically and what the trend is.

Tom Frieden: We are steadily increasing the proportion of Americans with high cholesterol that have it under control. It's gone up from 15 percent or so previously to about 33 percent now. So it's a steady increase in the proportion of control. However, the – the overall proportion of Americans who require medications, that's something we'll have to get back to you on in terms of the long-term trends.

Tom Skinner: Next question, Shirley?

Operator: Thank you. If you have a question, press star 1. My next question comes from Heidi Splete, Internal Medicine News. Ask your question.

Heidi Splete: Hi, thank you for taking my question. What is the take-home message for doctors from this?

Tom Frieden: Controlling blood pressure and cholesterol is one of, if not the, most important thing you can do for your patients. There are systems that get levels of control that are quite high. As any practicing doctor should know what proportion of your patients have high blood pressure and cholesterol, what proportion of them have it under control and what can be done to help those not yet under control. We've seen many examples of health systems, health programs, doctors' offices using information technology supports to patients that have been able to drastically improve the levels of control, and that's something that's needed throughout the – throughout health care in our country.

Heidi Spletz: Thank you.

Tom Skinner: Are there any other questions?

Operator: At this time, we are showing no further questions.

Tom Skinner: Okay. We'll give it a second or two for others to dial in and ask questions if they want, wait a little bit. If not, we'll conclude the call.

Operator: Again, if you have a question, just press star one. A question from Tom Maugh, from the Los Angeles Times. You may ask your question.

Tom Maugh: This has been an ongoing problem for years, if not decades. Is there anything that makes you think you can make it an – an indention in the problem now that's difference from in the past?

Tom Frieden: Yes, actually. I think there are some very promising developments. And I think we can be optimistic about significant future progress. First, in terms of preventing the problems in the first place, we have much broader awareness and commitment to reducing sodium levels in the population. And that would have a substantial impact. Reducing sodium from 3,400 to 2,300 would prevent 11 million patients, people, from developing hypertension and would save billions of dollars in this country, about 18 billion dollars in health care alone. Second, the further reduction in artificial transfat and other healthy dietary changes could further reduce cholesterol. And third, in terms of within the health care sector, there are now very positive examples of providers that have gotten to very high control rates. We need to learn the positive lessons, spread those lessons, support health care providers to help them support patients more to get their numbers under control.

Operator: Thank you. The next question comes from Steve Sternberg with USA Today. Ask you question.

Steve Sternberg: Dr. Frieden, I just want to be clear on the news here. There's been so many – as Tom said, this has been an ongoing issue. And I've attended so many briefings on this subject. So now I'm just wondering what – what the news is today? What is it that you're presenting today that is brand new?

Tom Frieden: First off, it's the latest information on the leading killers. It shows that while there's been some progress, it's not quick enough and not enough. We have real opportunities to make substantial improvements in not only increasing health care coverage but also with many possible intervention to improve the quality of care, whether it's health information technology or accountable care organizations or innovations in the management of systems to improve blood pressure control as has been done at the VA, at Kaiser, at other systems. I think the news here is that we continue, despite all that we spend on health care, we continue to have most Americans with the leading preventable causes of death not adequately cared for. And it's possible to greatly improve that without the big expenditures of dollars and with – but with really reorienting our systems to make sure that patients are well cared for.

Steve Sternberg: Thank you very much.

Operator: Thank you, the next question from Cathy Clark with Radio Pennsylvania Network. You may ask your question.

Cathy Clark: Thank you for taking my question. I'm trying to get a feel in a nutshell for what it is that the systems that are successful in helping their patients control their blood pressure and/or cholesterol are doing differently than some of the other systems where the lack of care is happening?

Tom Frieden: One is information. So, being able to know which patients in your practice have these conditions and have them out of control and what medications they're on and whether they fill the prescription. The second is focus. Making sure that doctors, nurses, and the whole health care team understand that it's crucially important to control these numbers. The third is supporting patients, making it easier for patients to pick up prescriptions or get prescriptions for longer periods of time to take drugs that are just once a day, that are easier to take to address concerns that patients have. Another is to empower patients to take their own blood pressure, to understand what it means to have high blood pressure and understand that even though they may feel fine, it's crucially important they continue the medication because that could save their life.

Tom Skinner: Next question, Shirley.

Operator: I'm showing no further questions.

Tom Frieden: Well, I want to thank everyone for your interest and attention again just to reiterate that cardiovascular disease, heart disease and stroke, is the leading cause of death and the leading cause of differences in life expectancy between rich and poor and black and white in this country. It's killing people. And many of those deaths, about 100,000 of them per year, are preventable by simple, low-cost improvements in our ability to control high blood pressure and high cholesterol. Currently a third of adults with high cholesterol only have it under control and a half of adults with high blood pressure have it under control. So our glass is only half full for blood pressure and only a third full for cholesterol control. There have been – there has been progress in recent years, but much more progress is possible. And doing that can save lives and can save money. Thank you very much.

Tom Skinner: Thank you, Shirley. Thank you all for joining us.

Operator: Thank you, and this does end today's call. We thank you for your participation. At this time, you may disconnect your line.


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