Abstract 35: Estimated Impact of Achieving Optimal Cardiovascular Health in the US Adult Population on Cardiovascular Disease Events

Introduction: Quantifying the potential impact of achieving optimal cardiovascular health (CVH) in US adults could aid researchers, clinicians, and policymakers in developing and implementing strategies to reduce the burden of cardiovascular disease (CVD). Hypothesis: CVH is suboptimal in US adults. Attaining an optimal level of CVH in all US adults would prevent a substantial number of CVD events. Methods: We pooled individual-level data from 7 US cohort studies (n=30447) included in the Lifetime Risk Pooling Project to estimate annual incidence rates of major CVD (CVD deaths, myocardial infarction, stroke, heart failure) by sex, race, and age. Using data from the National Health and Nutrition Examination Survey 2013 to 2016, we estimated the proportions of US adults in different CVH groups, defined by levels of 7 health factors: smoking status, body mass index, physical activity, dietary pattern, total cholesterol, blood pressure, and fasting glucose. Each factor was scored as ideal (2 points), intermediate (1 point), or poor (0 points). We defined overall CVH as optimal (12-14 points), moderate (9-11 points), or poor (0-8 points). Using the 2 data sources and Monte Carlo simulation, we estimated hazard ratios (HRs) for CVD, population attributable fractions, and the number of CVD events that could be prevented annually if all US adults achieved optimal CVH. Results: An optimal level of CVH was identified in 6.5% (95% CI, 4.5-8.5%) of US adults (Table) and was associated with a lower risk for CVD (HR [95% CI], 0.29 [0.17-0.43]). Our analysis suggests that 70% (95% CI, 55-82%) of all CVD events can be attributed to non-optimal levels of CVH. If US adults attained an optimal level of CVH, 2.0 (95% CI, 1.6-2.3) million CVD events could be prevented annually. Conclusions: The potential impact of achieving an optimal level of CVH in all US adults is considerable, and even a partial improvement would be beneficial. Population- and individual-level strategies to maintain or restore optimal CVH to reduce CVD event rates are highly desirable.

Trends in Opioid Prescribing Among Hemodialysis Patients, 2007–2014

Background: Hemodialysis (HD) patients frequently experience pain. Previous studies of HD patients suggest increased opioid prescribing through 2010. It remains unclear if this trend continued after 2010 or declined with national trends. Methods: Longitudinal cohort study of 484,745 HD patients in the United States Renal Data System/Medicare data. We used Poisson/negative binomial regression to estimate annual incidence rates of opioid prescribing between 2007 and 2014. We compared prescribing rates with the general US population using IQVIA’s National Prescription Audit data. Outcomes included the following: percent of HD patients receiving an opioid prescription, rate of opioid prescriptions, quantity, days supply, morphine milligram equivalents (MME) dispensed per 100 person-days, and prescriptions per person. Results: In 2007, 62.4% of HD patients received an opioid prescription. This increased to 63.2% in 2010 then declined to 53.7% by 2014. Opioid quantity peaked in 2011 at 73.5 pills per 100 person-days and declined to 62.6 pills per 100 person-days in 2014. MME peaked between 2010 and 2012 then declined through 2014. In 2014, MME rates were 1.8-fold higher among non-Hispanic patients and 1.6-fold higher among low-income patients. HD patients received 3.2-fold more opioid prescriptions per person compared to the general US population and were primarily prescribed oxycodone and hydrocodone. Between 2012 and 2014, HD patients experienced greater declines in opioid prescriptions per person (18.2%) compared to the general US population (7.1%). Conclusion: Opioid prescribing among HD patients declined between 2012 and 2014. However, HD patients continue receiving substantially more opioids than the general US population.