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Heart Disease Adds Significant Costs to Treatment for Obesity

The cost of treating adults at high cardiovascular risk who were also obese could be more than twice that of people who were only obese, preliminary results from a study suggested.

An analysis found that people with high cardiovascular risk had a higher incidence of stroke, heart attack, major adverse cardiac events, and heart failure, compared with others in the general population, with the risk increasing for each successive class of obesity.

The study, which is yet to be published, was led by pensions and investment consultancy firm Lane Clark & Peacock and funded by Novo Nordisk, which manufactures drugs for treating diabetes and obesity. The findings were presented today at the European Congress on Obesity in Dublin and peer reviewed by the congress selection committee.

London Cohort

The retrospective, open cohort study reviewed primary and secondary electronic health records on the Discover-NOW database for 429,358 adults in North-West London who had been diagnosed with obesity or were living with overweight and obesity and at high cardiovascular risk between 2004 and 2019. 

Adults with obesity were divided into three body mass index (BMI) groups. These were: class 1 (BMI of 30-35 kg/m²; 278,782 individuals, average age 43 years, 51% women); class 2 (BMI of 35-40 kg/m² 80,621 individuals, average age 43 years, 61% women); and class 3 (BMI of 40 kg/m² or more; 42,642 individuals, average age 41, 65% women).

A fourth group comprised 27,313 adults (average age 65, 35.6% women) with a BMI of at least 27 kg/m2 and at least one established cardiovascular event, including heart attack, stroke, or peripheral artery disease. Individuals with evidence of type 1 or type 2 diabetes, pancreatitis, end-stage renal disease or renal replacement therapy, or presence or recent history of malignant neoplasms were excluded from the analysis.

Results from the analysis indicated that adults with a high cardiovascular risk had a significantly higher incidence of all cardiovascular events than those in the obesity groups. For example, adults at high cardiovascular risk were almost five times (4.8) as likely to experience a stroke than those living with class III obesity. Also, all-cause mortality was four times higher in the cardiovascular burden group than in the group with class 1 obesity.

Cost of Treatment

The analysis also found that annual costs per person for people in the group with established cardiovascular risk was more than twice those for obesity classes 1 and 2 (£2,856 vs £1,182 and £1,390, respectively), and 1.75 times higher than for obesity class 3.

Costs in all the groups were primarily driven by inpatient admissions, which grew for each successive obesity class, and the use of prescription drugs. In the group with established cardiovascular risk, inpatient admissions accounted for 50.9% of their total costs.

The study authors concluded that the presence of cardiovascular disease in people with high BMI represented a "substantial burden" for both individuals and healthcare systems.

Lead researcher Dr Jonathan Pearson-Stuttard, head of health analytics at Lane Clark & Peacock, said: "Our analyses highlight that risk of adverse outcomes is not equal within populations. Targeted efforts to more effectively manage chronic diseases and prevent complications would materially help reduce demand for acute healthcare services and lead to improved health and prosperity in communities."

The authors acknowledged that selection bias and the influence of race and ethnicity on the risk of developing cardiovascular disease may have affected the results.

Dr Pearson-Stuttard is partner and head of health analytics at Lane Clark & Peacock LLP, chair of the Royal Society for Public Health, and reports personal fees from Novo Nordisk A/S and Pfizer Ltd outside of the submitted work.