If your organization offers an annual wellness-screening program, you are in good company. According to a report by The Kaiser Family Foundation, nearly half of all U.S. companies with more than 200 employees provide wellness screenings. These programs provide workers the opportunity to have their height, weight, blood pressure, blood sugar and cholesterol conveniently tested on site.
Participants receive a printout of their results and, if the test values are abnormal, they are encouraged to see their primary care physician for a follow-up appointment.
Employers are provided with a confidential report of aggregate health data. This allows companies to tailor on-site educational programs and incentives to best match employees’ risk status. The new Affordable Care Act rules, set to take effect this year, provide companies more power to align insurance premiums with specific health goals.
For the employee, the tests provide a snapshot of their health status and at-risk participants may become more aware of and better motivated to make health behavior changes.
At issue, however, is the idea that traditional finger stick testing for total cholesterol and LDL (bad cholesterol) can create a “false negative” by providing the employee with reassurance that they have little or no near-term risk for a cardiovascular event.
According to the American Heart Association, 50 percent of all heart attacks and strokes occur in individuals with normal cholesterol. It’s estimated that for 30 percent of patients with cardiovascular disease, their first sign of disease is death. Clearly, something is missing if, after intense efforts by the medical community over the last 20 years to identify lipid abnormalities, we cannot provide employees with a more accurate assessment of their risk.
In 1976, Russell Ross, Ph.D., at the University of Washington, published a sentinel paper entitled “Atherosclerosis: An Inflammatory Disease.” Ross clearly outlined two components that lead to the clogging of arteries: an injury and a response.
It is inflammation, the response to the insult, that is the culprit in arterial disease. Oxidized cholesterol is but one of many independent factors that can damage the body’s 60,000 miles of blood vessels. Others include dental cavities, sleep apnea, insulin resistance (pre-diabetes or metabolic syndrome), cigarette smoking and stress.
Making work site screenings better
A growing body of research is showing that a multi-marker approach — adding several additional inflammation-specific blood tests to the traditional screening panel — can identify at-risk employees who would previously have gone undetected.
A recent study by Marc Penn, M.D., PhD. , and Andrea Klemes, D.O., published in Future Cardiology, evaluated 95,144 patients assessed by MDVIP physicians at their annual physicals. Based on a lipid-only wellness panel, approximately 30 percent of patients presented as being at risk. When the additional tests for inflammation were added, an additional 40 percent were identified.
These advanced inflammatory biomarkers are able to detect employees with “vulnerable plaque” that is likely to rupture into the artery lumen, thereby blocking blood flow, leading to heart attack or stroke. Studies conducted by Cleveland Heart Lab, provider of an advanced inflammation panel, have shown that approximately 10 percent of a screened population fit into this category.
Clearly, a multi-marker approach provides additive information. Employees deserve cardiovascular risk information that is better than the flip of a coin. Companies need the data to target resources to best promote individual and organizational well-being.
Dr. Mark J. Tager is CEO of ChangeWell Inc., a San Diego-based consulting and training company focused on maximizing the health/productivity connection. For more information, visit www.changewell.com