High Cholesterol and Hypertension Have the Greatest Economic Impact Across the Asia-Pacific
HONG KONG, CHINA - Media OutReach - 5 December 2018 - Amgen and The Economist Intelligence Unit (EIU) today released a comprehensive new report entitled, "The Cost of Silence: Cardiovascular disease in Asia." The report, which was developed by EIU and sponsored by Amgen, estimates that in the eight Asian economies studied, US$53bn of the total costs ofprimary ischaemic heart disease (IHD) and stroke are attributable to four modifiable risk factors: smoking, hypertension, obesity and high cholesterol.
Amgen's Ms. Penny Wan, Regional Vice-President and General Manager, JAPAC (left) and The Economist Intelligence Unit's Ms. Rashmi Dalai, Managing Editor (right), present the report "The Cost of Silence: Cardiovascular disease in Asia."
Amgen's Ms. Penny Wan, Regional Vice-President and General Manager, JAPAC shares the findings of the report.
The white paper, which examines China, Japan, South Korea, Australia, Taiwan, Hong Kong, Singapore and Thailand, was launched over a media roundtable presented by The Economist's Rashmi Dalai, Managing Editor; and Amgen's Penny Wan, Regional Vice-President and General Manager, JAPAC.
"Silent" risk factors -- high cholesterol and hypertension -- are costing governments and health agencies across Asia billions of dollars every year, which together with smoking and obesity, threaten the sustainability of healthcare systems. The biggest challenge with these silent risk factors is that individuals often have little knowledge of their underlying risks until symptoms become more pronounced, and the illnesses more advanced.
In addition, the risks of cardiovascular disease (CVD), the general term for conditions affecting the heart or blood vessels, are more elevated among older populations; as a result, countries with aging demographics face even greater challenges. This is a major issue in Asia, which is rapidly aging: in 2016 approximately 12.4% of Asia's population was 60 years of age or older.[i] This proportion is projected to increase to more than a quarter by 2050.[ii] How countries in the region address the CVD burden has enormous economic and human implications. For example, the recurrence rates for people suffering from a CVD event are high. Prioritising at-risk groups, where the cost for treatment can be significant, will help drive positive impact on CVD cost management.
CVD is already the leading cause of death globally and it is estimated that half the cases of CVD occur in Asia[iii]. The economic burdens of these conditions are rising dramatically, as the report found:
- The cost of ischemic heart disease and stroke is USD 24.3 billion in Japan and USD 21.7 billion in China, top 2 amongst the 8 markets.
- China has the highest stroke incidence rate at 403 cases per 100,000, according to the latest WHO data from 2016. IHD incidence is highest in Japan and Hong Kong, with approximately 396 cases and 365 cases per 100,000 respectively in 2016.
- Asian heart failure patients spend between 5 and 12.5 days in hospital, with 3% to 15% readmitted within 30 days.
- Early retirement and disability caused by CVD has the potential to erode tax bases and put pressure on national budgets.
- Hypertension is the risk factor that contributes the highest cost, with an estimated total of US$18bn annually. Across the other estimated annual risk factor costs, high cholesterol contributes US$15bn.
In addition, the report found a lack of awareness among Asian populations of the risks and symptoms of CVD, an issue that has serious health and economic consequences. The danger from lack of awareness and poor information can lead patients to make bad decisions, such as discontinuing treatments.
The consequences of insufficient awareness are also reflected by patients failing to take steps to treat CVD in its early stages. If early warning signs were addressed, treatments would be easier and cheaper. Lifestyle changes and medications are convenient and cost-effective ways to manage CVD, and they reduce the chance of life threatening incidences. However, most importantly, by creating more awareness of early symptoms and diagnosing silent risks, it is possible to prevent illnesses such as CVD. Penny Wan, Regional VP and General Manager, JAPAC at Amgen, explained further:
"As a leading global biopharmaceutical company, understanding the healthcare landscape and demographic trends in Asia are critical to Amgen's mission to serve patients. Looking at this part of the world, we see how aging populations are putting pressure on economies and amplifying risk factors for illnesses such as CVD. We are dedicated to changing the trajectory of healthcare, and our innovative medicines make a difference to ensure people live healthier, longer lives.
However, as we see in this report, more needs to be done to improve awareness of CVD risks, while shifting away from treating illnesses, towards predicting and preventing conditions before they become life-threatening. Through multi-stakeholder collaborations, we can change behavior and transform healthcare systems to create a new 'predict and prevent paradigm' that is a better, safer and more cost-effective way to address CVD in the face of demographic headwinds."
Speaking on the report, and the silent CVD risks it highlights, Rohan Greenland, President of the Asia Pacific Heart Network (APHN), said: "The Asia-Pacific is facing a cardiovascular crisis on an immense scale. All governments need to do much more to prevent and control CVD, starting with national action plans as a key part of a comprehensive response to tackle non-communicable disease. Modifiable risk factors including smoking, physical inactivity and overweight/obesity need to be aggressively addressed. Alarming rates of high blood cholesterol and high blood pressure - silent killers - also need to be countered through appropriate risk assessment, treatment and on-going management."
There are several key takeaways specific for Singapore. Of the four risk factors, the population attributable fractions (PAFs) for hypertension in men and high cholesterol in women indicate that eliminating these risk factors in the population would reduce CVD incidence by 11% and 13% respectively.
CVDs levy $8.1bn in direct and indirect costs on individuals, their households and the public finances, with the four modifiable risk factors accounting for an estimated US$4.9bn or 60% of the total.
A rise in the prevalence of hypercholesterolemia, widely linked with changing diets and increasingly sedentary lifestyles, also suggests a gradual increase in incidence of ischaemic heart disease over a longer time frame.[iv] While stroke's mortality rate has decreased over recent decades, it remains one of the leading causes of death and disability. The incidence of CVD in men could be reduced by over 20% if hypertension and smoking were eliminated. Eliminating hypertension and high cholesterol in women would have a similar effect on their CVD incidence rate.
CVDs levy $24.3bn in direct and indirect costs on individuals, their households and the public finances, with the four modifiable risk factors accounting for US$15.9bn or approximately 65% of the total.
Ischemic heart disease is the third leading cause of death in Hong Kong, and while mortality rates are falling, incidence rates are not. Ischemic heart disease is on the rise due to growing proportion of older people, diminished physical activity and susceptibility to obesity from dietary causes. In 2016, 11 people died from coronary heart disease per day with a male/female ratio of 1.5:1.[v] The incidence of CVD in men could be reduced by 15% if hypertension was eliminated. For women, this would reduce their CVD incidence by 10%.
CVDs levy $4.8bn in direct and indirect costs on individuals, their households and the public finances, with the four modifiable risk factors accounting for an estimated US$3.1bn or approximately 65% of the total.
Ischaemic heart disease is the number one cause of mortality in Thailand, according to WHO estimates.[vi] Hypertension is the most prevalent risk factor for both genders.
CVDs levy $1.3bn in direct and indirect costs on individuals, their households and the public finances, with the four modifiable risk factors accounting for an estimated US$1.0bn or approximately 77% of the total.
CVD remains the number one cause of death in the country and the leading cause of premature death. High cholesterol is the leading modifiable risk factor in terms of prevalence in Australia for men and women respectively. Of the four risk factors, high cholesterol has the highest PAF for both genders.
These diseases impose US$12.3bn in direct and indirect costs on individuals, their households and the public finances, with the four modifiable risk factors accounting for US$7.5bn or 61% of the total.
Ischaemic heart disease has, over the last thirty years, been the single fastest riser among causes of premature death in China, from seventh in 1990 to second, behind stroke, by 2010.[vii] Stroke is the leading cause of family poverty in rural China.[viii]
Risk factors, including age and obesity, have combined with environmental issues such as ambient particulate air pollution to drive ischaemic heart disease-related hospital admissions, particularly in urban centres. Hypertension is of particular concern for both genders, reducing this risk factor would reduce CVD incidence by 13% for men and 12% for women.
CVDs levy $21.7bn in direct and indirect costs on individuals, their households and the public finances, with the four modifiable risk factors accounting for US$13.6bn or approximately 63% of the total.
Stroke is the dominant CVD nationally with limited reduction in risk factors over recent decades. According to EIU, high cholesterol has the highest PAF amongst women.
CVDs levy $7.2bn in direct and indirect costs on individuals, their households and the public finances, with the four modifiable risk factors accounting for US$4.0bn or approximately 56% of the total.
Low levels of physical activity, associated with risks of high blood pressure and cholesterol, and a higher sodium intake due to a contemporary diet, are all broader trends of concern. Stroke was the leading cause of death in Taiwan in 2014. Of the four risk factors, hypertension's PAF is highest for both genders; reducing this risk factor would decrease CVD incidence by around 10% for men and women.
CVDs levy US$4.7bn in direct and indirect costs on individuals, their households and the public finances, with the four modifiable risk factors accounting for US$2.7bn or approximately 57% of the total.
The full report, "The Cost of Silence: Cardiovascular disease in Asia", can be downloaded here: https://eiuperspectives.economist.com/healthcare/cost-silence/white-paper/cost-silence-cardiovascular-disease-asia
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[i] UN ESCAP, Ageing in Asia and The Pacific: Overview, 2017
[ii] UN ESCAP, Ageing in Asia and The Pacific: Overview, 2017
[iii] Ohira, Tetsuya & Iso, Hiroyasu. (2013). Cardiovascular Disease Epidemiology in Asia - An Overview - Circulation journal: official journal of the Japanese Circulation Society. 77. 10.1253/circj.CJ-13-0702.
[iv] Kita T. "Coronary heart disease risk in Japan--an East/West divide?", European Heart Journal, 2004
[v] Hong Kong Department of Health, Coronary Heart Diseases, 2018
[vi] WHO Country Cooperation Strategy, Thailand, 2017--2021 [New Delhi]: World Health Organization, Regional Office for South-East Asia; 2017. Licence: CC BY-NC-SA 3.0 IGO.
[vii] GBD PROFILE: CHINA. GBD PROFILE: CHINA, Healthdata.org, 2010.
Authors: Media Outreach