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

1. 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

2. 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

3. The SCORE algorithm as a start

4. The Health Check-up • 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

5. Step by step • The 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

6. Timeline atherosclerosis Development of atherosclerosis over time Foam cell Fatty streak Intermediary lesion Atheroma Fibrous plaque Complicated lesion/rupture Low risk High risk Moderate risk Very high risk

7. Results all participants

8. Results all participants

9. Results occupational health vs com pharmacy

10. Results occupational health vs com pharmacy

11. Results occupational health vs com pharmacy

12. Results occupational health vs com pharmacy

13. 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

14. Conclusions and Next Step 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

15. Thank you for your attention! • Contacts • Joep Perk Marianne Noreliusjoep.perk@ltkalmar.semarianne.norelius@apoteket.se • +46 73 676 0901 +46 70 628 80 70www.apoteket.se Twitter: m_norelius