Individuals with cardiovascular disease risk factors who switched to high-deductible health care plans (HDHPs) do not have an increased risk of heart attack or stroke, according to a new study published in Jama Network Open. 

Cardiovascular disease is the leading cause of death in the United States. In 2017, it accounted for 30% of deaths, according to study. Improvements to cardiovascular mortality began to slow a decade ago and major cardiovascular events such as stroke began increasing in adults under the age of 65 years. Although reasons for this trend are unclear, experts said it could be due to the earlier onset of cardiovascular risk factors, stagnation of preventative care, and changes to health insurance coverage. 

The study population was drawn from a large national health insurance plan and included individuals with risk factors for cardiovascular disease who were continuously enrolled in low-deductible (<$500) health plans during a baseline year that was followed up by up to 4 years in HDHPs (<$1000 plans) after an employer-mandated switch. The control group included individuals with the same risk factors who were enrolled in low-deductible plans.

The study found that individuals enrolled in HDHPs did not experience an increase in major adverse cardiovascular events compared with the control group. However, researchers caution that policymakers and employers should remain careful when promoting HDHPs among low-income employees and other vulnerable patients. According to the press release, there is a potential for adverse health and financial outcomes that the study did not address. 

"HDHPs typically include features such as low or no out-of-pocket costs for medications and preventive services. Our study detected small changes in cardiovascular medication use and preventive services which may have protected HDHP members from increased adverse cardiovascular events” Frank Wharam, MD, lead author and associate professor of Population Medicine at the Harvard Pilgrim Health Care Institute and Harvard Medical School, said in the press release. 

Researchers should extend follow up time to better assess long-term outcomes in future studies, according to the press release. Future studies should also examine whether individuals enrolled in HDHPs ultimately require more intensive workups and more advanced treatment for cardiovascular events. 

Reference:
High-deductible health plans and major cardiovascular outcomes (News release), Cambridge, Mass. July 24, 2020, EurekAlert!, accessed July 27, 2020