Nearly half of adults in the US have high blood pressure or high cholesterol, which are key risk factors of heart disease – the leading cause of death in the US. HHS estimates about 30 million adults in the US have blood pressure at levels where medication use is recommended but are untreated. The American Heart Association estimates the direct and indirect costs of cardiovascular disease in the US is more than $414B. Commonly used, low-cost medications can effectively treat high blood pressure and high cholesterol and prevent more serious and costly heart-related conditions like heart attack or stroke.
In honor of American Heart Month, below are 5 highlights from an analysis of the most common cardiovascular medications using HCCI’s unique employer-based insurance dataset and data from the Centers for Medicare and Medicaid Services.
Statins are the most commonly used cardiovascular medications.
The graph above shows the average monthly utilization per 100,000 enrollees for each cardiovascular medication and payer in 2022. Among all payers, statins are the most highly utilized. Almost 44,000 per 100,000 Traditional Medicare beneficiaries were prescribed a statin per month in 2022. Beta-blockers are the second most utilized cardiovascular Medication among Medicaid and ESI users, and ace inhibitors are the second most utilized cardiovascular medication among Traditional Medicare and Medicare Advantage beneficiaries.
In general, men are more likely to use cardiovascular medications than women.
The graph above shows the average monthly rate of cardiovascular medication use between men and women in 2022 by payer. The trend deviates for certain medications and payers, however. For example, women enrolled in Medicaid utilize cardiovascular medications more often than men.
Use of cardiovascular medications increases with age.
The graph above shows the utilization of beta-blockers by age group among ESI enrollees in 2022. With some exceptions, medication use increases with age. For example, people ages 55-64 enrolled in employer-sponsored insurance receive a prescription for beta-blockers almost twice as often as people ages 45-54.
Among Medicare enrollees, Black people enrolled in Medicare Advantage received cardiovascular medications more often than Black people enrolled in Traditional Medicare.
The graph above shows the utilization of cardiovascular medications among Traditional Medicare beneficiaries and Medicare Advantage beneficiaries by race during our entire study period (2018-2022). Among Black people with Medicare coverage, the average monthly rate of statin use is around 42,000 beneficiaries per 100,000 in Medicare Advantage compared to 36,500 beneficiaries per 100,000 in Traditional Medicare.
Among people with Medicaid, use of statins ranges from 958 per 100,000 enrollees in South Carolina to 5,481 per 100,000 enrollees in West Virginia.
The map above shows the average use of statins among Medicaid enrollees by state during our entire study period (2018-2022).
This analysis examined cardiovascular medication use among the people with employer-sponsored insurance (ESI), Medicaid, Medicare Advantage, and Traditional Medicare, regardless of diagnosis. The medications we examined include:
- Diuretics help get rid of excess salt and water, which helps control blood pressure
- Beta-blockers lower the heart rate, which can lower blood pressure
- ACE inhibitors help the body produce less angiotensis, a chemical that causes arteries to narrow. As a result, blood vessels relax, which lowers blood pressure, and makes it easier for the heart to pump blood.
- Angiotensin II receptor blockers (ARBs) block the effects of angiontensin andact similarly to ACE inhibitors
- Calcium channel blockers prevent calcium from entering the heart’s muscle cells which relaxes and opens blood vessels and lowers blood pressure.
- Statins block an enzyme in the liver needed to produce cholesterol. Statins lower bad cholesterol (or LDL) which can lead to plaque build-up in the arteries.
The HCCI Vitals Dashboard allows users to examine rates of utilization of each medication type by payer, state, and demographic variables over time. To explore the data go to: https://vitals.healthcostinstitute.org/.