Cardiovascular risk assessment at the pharmacy may identify the population at risk

Joep Perk, Kalmar, Marianne Norelius, Stockholm

Sweden

Amsterdam 2014-05-08

Declaration of interest

Joep Perk: Nothing to declare

Marianne Norelius: Employed by Apoteket AB

Why provide a health check-up at a community pharmacy?

Over the past 20 years overweight and obesity in the population has doubled in Sweden

Total costs for health care and loss of income caused by sick leave or premature death due to diet, physical activity, alcohol and tobacco, have been estimated to more than 5 billion EUR per year in Sweden (9 million inhabitants)

The primary health care situation is strained

The needs and demands of the pharmacy clients

Apoteket´s mission is to make it easier to live a healthy life

The 100 community pharmacies (out of our 370) that provide the health check up today have good accessibility and more than 25.000 customer visits per day

The SCORE algorithm as a start

Shows how to have anown impact on one's health

Includes:- health questionnaire- blood pressure- total cholesterol- blood glucose- waist circumference

30 minutes meeting with aspecially trained pharmacist

Is offered to community pharmacy clients as well as to employees at B2B-customers as a part of their Occupational health programme

The Health Check-up

Step by stepThe client books an appointment on Apotekets website and fills in the health questionnaire on the web

A specially trained community pharmacist performs the tests and the client gets immediate feed back on his possibilities to lower his CVD risk

The client has the opportunity to reflect on his/her living habits and his motivation to change. He/she can decide on a focus-area (start exercising, better eating habits etc) to improve his/her health

Photo: Håkan Lindgren

Timeline atherosclerosis

Foam cell Fattystreak

Intermediarylesion

Atheroma Fibrousplaque

Complicatedlesion/rupture

Low risk Moderate risk High risk Very high risk

Development of atherosclerosis over time

 All Females SD Males

Age + SD 45,3 13,5 45,9 13,1 44,1 12,8N 21483 14262 66,4 7221 33,6Blood pressure   %   %   %N 21450   14237 66,4 7212 33,6 > 140 mm Hg 3819 17,8 2059 14,4 1760 24,4 > 90 mm Hg 3701 17,3 2192 15,4 1508 20,9

Cholesterol    %    %    %N 20636   13628 66 7008 34> 5mmol/l 8789 42,6 5935 43,6 2854 40,7

Results all participants

Blood glucose All % Females % Males %

N 10809 6317 4492

> 6,1 och < 7.0 mmol/l 1207 11,2 730 11,6 477 10.6

> 7,0 mmol/l 510 4,7 299 4,7 211 4,7

SCORE  N 16160 10157 6003

1-5% 3238 20,0 1721 16,9 1517 25,3

> 5% 517 3,2 83 0,8 434 7,2

Waist circumference

N 21394 14183 66,3 7211 33,7

Risk zone: f. 80-88 cm, m. 94-102 cm 4466 31,6 2249 31,1

Adiposity: f.> 88 cm, m. >102 cm   4460 31,5 1369 19

Results all participants

All SD Females SD Men SD

Occ Health

N 10139   5675 56% 4464 44%

Age 41,4 yr 10 41,2 10,2 41,7 7,8

PharmacyN 11 344   8587 75,7% 2757 24,3%

Age 48,7 yr 15,2 49 15 47,9 15,8

Results occupational health vs com pharmacy

Blood pressure All % Females % Males %

Occupational health

> 140 mm Hg 1379 13,6 452 7,8 927 20,7

> 90 mm Hg 1455 14,4 645 11,3 810 18,1

Pharmacy > 140 mm Hg 2440 21,5 1607 18,7 833 30,2

> 90 mm Hg 2245 19,8 1547 18,0 698 25,3

Results occupational health vs com pharmacy

Cholesterol All % Females % Males %

Occ Health

> 5mmol/l 3239 31,9 1669 29,4 2501 35,2

Pharmacy > 5mmol/l 5550 48,9 4266 50.1 1284 46,8

Blood glucose All % Females % Males %

Occ Health

> 6,1 and < 7.0 mmol/l

676 9,5 329 9,0 347 10

> 7,0 mmol/l 256 3,6 120 3,3 136 3,9

Pharmacy

> 6,1 and < 7.0 mmol/l

531 14,7 401 15,3 130 13

> 7,0 mmol/l 254 7 179 6,8 75 7,5

Results occupational health vs com pharmacy

Results occupational health vs com pharmacySCORE All % Females % Males %

Occ Health1-5% 1520 15 446 7,9 1074 24,1> 5% 151 1,5 11 0,2 140 3,1

Pharmacy1-5% 1718 28,5 1275 28,4 443 28,8> 5% 366 6,1 72 1,6 294 19,1Waist circumference

All % Females % Males %

Occ Health

Risk zone: f. 80-88 cm, m. 94-102 cm 

2952 29,3 1637 29,1 1315 29,5

Adiposity: f.> 88, m. >102 cm

 1838 18,2  1197 21,3 641 14,4

Pharmacy

Risk zone: f. 80-88 cm, m. 94-102 cm 

3763 28,3  2829 33,1 934 34,0

Adiposity: f.> 88, m. >102 cm 

3991 30,0  3263 38,2 728 26,5

Most confounding findings…..

More than 40% of all clients had a cholesterol value >5 mmol/l

> 60% of women and > 50% of men had an elevated waist circumference or even manifest adiposity

A significant number of prediabetes/diabetes cases were detected

One in five men had a high blood pressure

One in five men attending the pharmacy had a SCORE level above 5%, thus being at high cardiovascular risk

From more than 20.000 health check-ups we conclude that it is relevant to provide cardiovascular risk assessment at community pharmacies as it contributes to identifying a significant part of the population at an elevated risk.

We meet clients with a risk scenario from very low risk to high risk and we refer all clients at medium risk to high risk to their doctors

The results in general show that an important part of the clients have one or more elevated CVD risk factors and therefore should take action to improve their lifestyle

The Pharmacy group is at a significant higher risk than the Occupational group

The next step is to evaluate to what extent the health check up has had an impact on clients behaviour and if it has led to a more healthy lifestyle and a lowered CVD risk

Conclusions and Next Step

ContactsJoep Perk Marianne Noreliusjoep.perk@ltkalmar.se marianne.norelius@apoteket.se

+46 73 676 0901 +46 70 628 80 70www.apoteket.seTwitter: m_norelius

Thank you for your attention!