The Cardiovascular Sector of the Healthcare Industry is Ripe for Disruptive Innovations

1. Highest cost among all the rich countries. Heavy economic burden of cardiovascular disease - $1.5 billion a day ($555 billion a year and projected increase to $1.1 trillion a year by 2035). Unsustainable and unaffordable.

2. Poor clinical outcomes despite higher and higher healthcare spending. High heart attack rate, stroke rate, mortality rate, use of stents and heart bypass. Most of these are largely preventable with higher quality evidence-based medical care.

Incidence CHD AHA 2019

720,000 new heart attacks in 2019 - most of them could have been identified earlier by coronary calcium scoring few years before and medical plaque therapy could be been initiated to stop plaque progression and stop the heart attack (and stroke too) before it happens.

356,461 out-of-hospital cardiac arrests - only 8.4% had good functional status at discharge!

What reasons can justify not to prevent as many of them as possible? Could you or someone older in your family be the next victim? Don’t be.

3. Gross underutilization of available test and medical treatment that saves lives and reduces cost. Inexpensive, accurate and recommended test available and effective, safe medications are also available but not prescribed optimally or not at all.

Coronary calcium scoring (cost about $80) - 2 years before a prevented heart attack:

Very High Coronary Calcium Score

Medical plaque therapy was initiated after plaques were detected by coronary calcium scoring - heart attack prevented before it could happen:

Impact of Advanced Cholesterol Treatment

3. Our healthcare payment system helps maintain the status quo by not reimbursing for coronary calcium scoring and aggressive heart attack prevention in high risk patients but reimbursing generously for what happens without prevention - heart attacks, strokes, expensive testing, procedures and treatments. Our healthcare system is like a very large but old tanker that wants to keep on moving in the same direction. The rudder is controlled by many self-interested parties who are refusing to hear the public demands for lower premiums and better clinical outcomes - much fewer heart attacks, much fewer strokes, much fewer hospitalizations, much fewer premature deaths, etc.

Time To Turn Off the Faucet

4. There is a need for a new fourth player to the three others to shake things up and create a win-win-win solution.

Reducing heart attack and stroke has major impact on these three players:

Player 1: The American public and employers

Player 2: The US federal government (Medicare and Medicaid)

Player 3: The hospitals and private insurance companies

Player 4: A best practice model Heart Attack and Stroke Prevention Center

It is not possible to solve the problem that is a win-win-win solution that includes for Player 3 - they thrive on more cardiovascular events not less. Player 1 and Player 2 can’t do it by themselves. Player 4 can help Player 1 and Player 2 get what they want - lower cost and better health outcomes.

My Practice - A Strong Line of Defense

My preventive cardiology-clinical lipid practice creates a strong barrier (optimal comprehensive cardiometabolic medical therapy) that prevents high risk patients from crossing into the right side (turning off the faucet). The right side involves “mopping the floor”. Our goal is to stop the first event from occurring by earlier plaque detection and if plaques are present, to stop plaque progression, prevent plaque rupture and induce plaque regression. And for those who already had an event, to stop the recurring cycle of events.

Does intensive lifestyle intervention alone reduce cardiovascular events in high risk patients?

This ten-year, $120 million NIH-sponsored Look AHEAD trial showed regular exercise and healthier diet did not!

If one has coronary plaques already, regular exercise and healthy diet are not enough to reduce cardiovascular events.

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