New Jersey Preventive Cardiology uses care innovations to deliver preventive care that is both cost effective and evidence-based with improved patient outcomes. Healthcare reform will require employers and health insurance companies to provide heart attack and stroke prevention. NJPC has already been providing this service for over five years. It has developed its own clinical management system to successfully treat most high risk patients to recommended treatment goals and published its own performance data in 2006. Eighty five percent of patients achieved LDL goal of less than 100 mg/dl, compared to 18% in a national survey, the L-TAP study. NJPC is a best practice model for delivering preventive cardiovascular care.
Cardiovascular disease (heart attack and stroke) is the number 1 public health problem in the US. It causes more deaths and disabilities than the next 4 leading causes combined. Its total economic burden was estimated at about $431 billion in 2007. Healthcare spending due to cardiovascular disease represents a major component of the nearly $2.5 trillion annual expenditures. With the aging of the baby boomers, cardiovascular disease accounts for a major portion of the escalating healthcare cost. Fortunately, both heart attack and stroke are now considered largely preventable. Cholesterol therapy has been demonstrated in many placebo-controlled clinical trials to reduce combined cardiovascular events by about 40% in 2 to 4 years. A comprehensive cardiovascular disease prevention clinic that optimally treats lipid abnormalities and high blood pressure, while also promoting smoking cessation, active lifestyle and healthier diet can achieve even higher cardiovascular event reduction. These are the healthcare reform proposals regarding prevention and wellness: - The plan must invest in public health measures proven to reduce cost drivers in our system, such as obesity, sedentary lifestyles, and smoking, as well as guarantee access to proven preventive treatments. The American Recovery and Reinvestment Act provides $1 billion for prevention and wellness.
- Promote prevention by providing premium discounts (including for Medicare Part B premiums) for participation in approved wellness and chronic disease management programs.
- Develop a national strategy to improve the nation’s health through evidenced-based clinical and community-based prevention and wellness activities. Create task forces on Clinical Preventive Services and Community Preventive Services to develop, update, and disseminate evidenced-based recommendations on the use of clinical and community prevention services.
- Improve prevention by covering only proven preventive services in Medicare and Medicaid. Eliminate any cost-sharing for preventive services in Medicare and increase Medicare payments for certain preventive services to 100% of actual charges or fee schedule rates.
- Support a sustained, nationwide focus on public health wellness through creation of a Public Health and Wellness Fund to invest in evidenced-based prevention and wellness activities. These activities and provisions include: no or limited cost sharing for proven preventive services, a new wellness visit for Medicare beneficiaries to receive a personalized health risk assessment and prevention plan, a federal tax credit for certified employer-based wellness programs that meet accountability and reporting requirements, and a $3 billion annual investment in wellness and prevention programs.
- Allow insurers that offer health coverage through Individual Membership Associations and the individual market to establish premium discounts/rebates for individuals for adherence to health promotion and disease prevention programs.
New Jersey Preventive Cardiology Makes an Argument for More Aggressive Preventive Therapy, with or without Healthcare Reform The Human Tolls of Lack of Appropriate Care in the US 
This recent study concluded that in the US, the treatment levels are generally low and that this lack of appropriate care has serious consequences in human casualties. Poor implementation of proven preventive therapies causes a large number of preventable deaths from heart attacks alone. This study did not include preventable deaths from strokes and preventable disabilities.
Many studies have demonstrated that statin therapy in high risk patients is cost effective. Even more so now that Zocor is available in generic formulation. Lipitor will also become generic soon. Major companies that have been providing corporate prevention for a long time have realized good Return on Investment as shown above.
The L-TAP study shown the widespread problem of lack of physician compliance to the NCEP ATP guidelines. 82% were not treated appropriately according to recommended NCEP ATP treatment guidelines.
Improving Delivery of Preventive Care 
The real problem in the healthcare is not the lack of advanced medical science. It is a problem of healthcare delivery and the human aspects of it. This problem can be solved.
Using Passion, Knowledge and System (PaKS), NJ Preventive Cardiology was able to treat a high percentage of high risk patients to recommended LDL goal of less than 100 mg/dl. There were more patients with LDL below 50 mg/dl than patients over 130 mg/dl. Unlike placebo-controlled statin clinical trials which were terminated as early as 1.9 years because significant benefits were already reached and the ethical issue of continuing to treat the participants with placebo, the duration of treatment is clinical practice does not have the same constraint. New Jersey Preventive Cardiology started aggressive prevention in 2001 and patients that have been on optimal medical therapy for over 8 years have experienced much greater event reduction that exceeds those reported in clinical trials.
Offsetting the Cost of Preventive Therapy by Reducing the Human Tolls and Reducing the Economic Burden of Preventable Heart Attacks and Strokes 
Does the cost of providing evidence-based preventive care to all high risk Americans outweighs the benefits of reducing deaths, disabilities and the cost of expensive healthcare resources consumed by preventable heart attacks and strokes? Yes, it does. The total economic burden of cardiovascular disease was $431 billion in 2007. If only 60% of eligible patients received appropriate medical therapy in 2000, there would have been 297,470 fewer deaths from heart attacks alone. Deaths from preventable strokes and the number of preventable disabilities not included. | 
