February 26, 2024

Although cardiovascular disease (CVD) is often preventable, it has been the leading cause of death globally for decades, claiming an estimated 17.9 million lives every year.¹ Business Group on Health’s 2024 Large Employer Health Care Strategy Survey found that over the past 2 years, 30% of surveyed employers ranked cardiovascular disease as one of their top three conditions driving health care costs.² Beyond direct costs, CVD significantly impacts employee productivity and well-being, with indirect costs estimated at $168.0 billion between 2019 and 2020.³

The good news is that many underlying drivers of CVD can be controlled, prevented and/or managed through evidence-based lifestyle changes. Among the most impactful is smoking cessation; research indicates that quitting smoking can halve the risk of heart disease within a year, contributing significantly to the reduction of CVD mortality rates.⁴

The American Heart Association has played a pivotal role in the monumental strides made in cardiovascular health. Through dedicated scientific research focused on the causes, prevention, diagnosis and treatment of cardiovascular diseases, significant achievements have emerged. This research has led to a dramatic 70% decrease in heart disease rates from 1950 to 2021, highlighting the critical importance of ongoing efforts in health awareness and prevention strategies, as well as the innovation of new treatments to effectively combat cardiovascular disease.⁵

Employers can take action by promoting tailored health awareness campaigns, investing in prevention, early detection and effective management of CVD risk factors. Programs that promote physical activity and healthy lifestyles can also be beneficial in mitigating some of the negative effects related to physical inactivity and/or living with obesity, both of which are significant contributors to CVD. In addition, through implementing preventive and tailored patient support programs, employers have an opportunity to address a spectrum of employee needs while advancing health equity among populations disproportionately affected by CVD.

Gender Disparity in CVD: A Focus on Women’s Health

Despite being the leading cause of death in women worldwide ⁸, only about 56% of women recognize that heart disease is their primary health threat, and many underestimate their risk compared to other diseases like breast cancer.⁹ Among the risk factors for women, high blood pressure stands out, affecting nearly 56 million women in the U.S.¹⁰, yet less than a quarter of these cases are being well managed. Additionally, there are unique female factors contributing to heart disease risk. These include early menopause, polycystic ovary syndrome, gestational diabetes and hypertensive disorders during pregnancy.¹⁰ Each of these conditions underscores the critical need for increased awareness and better management of heart disease risk in women.

Women often experience different heart disease symptoms than men. These can include unusual fatigue, sleep disturbances, shortness of breath, indigestion, anxiety or heart racing, sometimes occurring as early as a month before a heart attack.¹¹ During a heart attack, women might not experience the classic chest pain but instead feel pressure or tightness, alongside symptoms like nausea and abdominal, neck and shoulder pain.¹¹ These differences in symptoms place women at a greater risk of not receiving the necessary urgent care in an emergency.

Therefore, it’s not surprising that heart disease in women often remains underrecognized. This oversight can be attributed to a historical focus on male-centric research, differences in symptoms and risk factors between genders and a lack of awareness among both women and health care providers.¹¹

Research has revealed that heart disease may begin in childhood and develop silently, making early prevention crucial. Gender differences in coronary risk and treatment are now being recognized, with studies highlighting factors like metabolic syndrome, diabetes and smoking as particularly significant for women.¹¹ By understanding and addressing these unique aspects of heart disease in women, it becomes possible to make significant strides in improving women's cardiovascular health.

Prevention and Treatment Options

Reducing the burden of CVD requires a multi-faceted approach that considers both modifiable and non-modifiable risk factors. This includes promoting lifestyle changes, medication adherence efforts, facilitating access to affordable and quality medical and surgical interventions and addressing genetic predispositions through early detection and targeted screening.

• Healthy living: Adopting a heart-healthy lifestyle is a cornerstone of CVD prevention and treatment. This includes eating a balanced diet low in fats and salt, engaging in regular physical activity, getting adequate sleep and avoiding smoking.¹²
• Managing symptoms and complications: When lifestyle changes alone are insufficient, medications are often necessary to control CVD symptoms and prevent complications. The specific type of medication depends on the nature of the heart disease.¹²
• Devices and surgical procedures: Various devices and surgical procedures play a crucial role in treating heart disease. These include the implantable cardioverter defibrillator (ICD), used to detect and correct severe arrhythmias¹³; the left ventricular assist device (LVAD), a mechanical pump that aids the heart in pumping blood and is often a bridge to heart transplantation¹³; and percutaneous coronary intervention (PCI), a technique commonly known as angioplasty, used to reopen blocked coronary arteries.¹³ Each of these interventions is vital in managing different cardiac conditions and improving patient outcomes.

Recent clinical and technological advancements are dramatically enhancing the way cardiovascular, diabetes and obesity conditions are managed. Personalized medicine is at the forefront, with genetic profiling informing tailored treatments, while new medications like proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and glucagon-like peptide 1 (GLP-1) agonists are setting benchmarks in managing cholesterol and blood glucose levels, respectively.¹⁴ According to clinical trial results published in November 2023, the use of semaglutide (Wegovy®), a GLP-1 medication, decreased major adverse cardiovascular events, including non-fatal heart attack and stroke, by 20% among patients with overweight or obesity and cardiovascular disease without diabetes.¹⁵ While GLP-1s may be effective for patients with weight related comorbidities, an effective cardiovascular strategy should be centered on lifestyle intervention and supported by pharmacotherapy when appropriate.

Additional information on the effectiveness of GLP-1s, as well as other Food and Drug Administration (FDA)-approved anti-obesity medications, can be found in An Employer’s Practical Playbook for Treating Obesity.¹⁶

Technology-Assisted Support

One strategy that can improve access to care for patients at high risk – including those in rural or health professional shortage areas – is access to digital technology. Recent studies have highlighted the efficacy of mobile technology interventions in promoting self-management and providing automated lifestyle coaching, which are associated with improvements in systolic and diastolic blood pressure. In fact, a recent study found that engagement with a hypertension self-management platform that leverages a blood pressure monitor and smartphone app, has been shown to result in decreased blood pressure over a span of up to 22 weeks, with sustained benefits for those who remain active in the program for as long as 3 years.¹⁹ The platform operates by integrating a user's blood pressure measurements, collected through the connected monitor, with personalized insights and guidance delivered through the smartphone app. The effectiveness of such cardiovascular health solutions can be measured by looking at the correlation between the degree of engagement and the corresponding health outcomes. For instance, the research demonstrated that a higher number of blood pressure measurements entered into a mobile app was associated with better blood pressure control and a lower probability of very high blood pressure episodes.¹⁹

Local Care vs COE Programs

For patients with CVD, selecting the most appropriate care is crucial and depends on factors such as the severity and complexity of the disease, as well as accessibility to care.

For patients with less complex cardiovascular conditions, local specialists and primary care providers likely offer a care setting that is more convenient, continuous and more intuitive for patients to use. Some employers or providers may encourage patients to supplement care in the community with a use of continuous monitoring device or a virtual care program that may remove any access barriers.

For some patients, local care may be delivered through their company’s on-site clinic, offering services ranging from preventive care to chronic condition management. Advanced primary care practices, including those in direct contracts with employers, could also be a first point of contact and the most likely source of support for patients with common cardiovascular issues.²⁰ Each of the local settings mentioned above can provide blood pressure screenings, chronic condition management, medication monitoring and lifestyle guidance, which are key in the early identification and prevention of cardiovascular diseases. By focusing on preventive measures and the handling of less severe conditions, local care promotes a sustainable health care model that improves patient outcomes through personalized and ongoing care.

For more complex and high-cost procedures, Centers of Excellence (COEs) are specialized groups of health care providers known for delivering a higher standard of care.²¹ They focus on achieving high-quality outcomes and meeting the specific needs of patients requiring more complex interventions, often in a cost-effective way. The predictability of cost is often achieved through bundled payment arrangements, an option utilized by 50% of employers in 2024, with an expected increase to 65% in 2025/2026.² For employers, integrating cardiovascular COEs into their health care strategies can facilitate directing patients to high-quality care centers with highly trained specialists and advanced technology often not available locally. Patients are often incentivized to choose COEs through reduced or waived out-of-pocket costs and travel benefits, and employers benefit from the predictability of health care expenses.²²

Key Considerations for Employers

By implementing comprehensive, inclusive and innovative health strategies, employers can contribute significantly to the prevention and management of CVD, ultimately leading to a healthier, more productive workforce and a reduction in health care costs.

Employers can consider the following strategies to improve the quality of care delivered to employees with cardiac conditions.

Related Resources

• An Employer's Practical Playbook for Treating Obesity
• Under-detected and Underdiagnosed: Optimizing Kidney Care
• Roadmap to a Global Tobacco-Free Company
• Women’s Health Guide: Preventive Health

More Topics

Articles & Guides Health Conditions and Risk Factors Health Equity Physical Health