Reducing major vascular events among VA primary care patients: an extraordinary opportunity

Data from randomized trials document that the frequency of major vascular events can be significantly reduced by lowering serum cholesterol and systolic blood pressure in high-risk patients. The recent publication of the Heart Protection Study (HPS) provided randomized trial evidence to support the recommendation of the National Cholesterol Education Program Adult Treatment Panel III to broaden statin use to include patients whose risk for a coronary event is equivalent to that among patients with manifest coronary artery disease, such as those with diabetes or cerebral, aortic, or peripheral vascular disease. Similarly, recent meta-analyses of hypertension trials provide us precise estimates of the benefits of lowering blood pressure. Risk and risk reduction data from these trials were applied to 153,305 Veterans Health Administration primary care patients to assess the health impact and costs of lowering cholesterol and blood pressure more aggressively in this population. Based on the results, it was estimated that 98,598 major vascular events might be prevented and $302,074,587 saved over 5 years if all patients were treated according to the HPS criteria and the recommendations of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. It is anticipated that achieving these goals will not be possible without significant, innovative system changes, such as disease management programs with electronic chart abstraction to identify patients who do not meet these recommendations.