Although there have been some successes in cardiovascular disease prevention in the past, principally through education appealing to the good sense of the population, disease prevention through education alone has, in general, had limited success over the current obesity-diabetes global epidemic. This is perhaps not surprising in the context that we are programmed to crave carbohydrates when they are available as a manifestation of the primitive drive to consume as much of this once scarce resource when available, and so the current, somewhat defeatist emphasis appears to be on legislation by governments to reduce sugar content in foods.
Other more interventional preventative successes include a program set up by Kaiser Permanente to treat 350,000 high-risk patients with a simple medication bundle, including aspirin, a statin, and an ACE inhibitor – all agents known to have preventative benefits. In addition, partnerships with community-based health systems helped to further extend the program to their patient populations. The program has a direct cost of $205 per year for each participating high-risk patient, which translates into a total investment of $205,000 per 1,000 participating patients. The program prevents 19 heart attacks or strokes per 1,000 participating patients per year, which results in 147 fewer unhealthy years per 1,000 high-risk patients. Those additional healthy life years have a socio-economic value of $7.8 million, giving a projected return on investment of 3,700%. Impressive though this figure is, this projected return on investment does not include savings on the resulting efficiency and cost structure of the healthcare delivery system, nor does it include a projected further halving of cardiovascular events if all eligible quit smoking, took recommended levels of exercise, and lost weight – illustrating the striking impact of behavior change.