Claims data highlights new heart health trends in Canadians 

February 20, 2024

For plan members, sponsors and administrators

How cardiovascular insights can help promote employee health

As a complete record of insured services and medication claims, our data can give valuable insights into the health of Canadians. Tracking and analyzing information such as healthcare utilization or medication adherence rates can play a crucial role in highlighting and understanding emerging health trends. 

These trends can not only provide a window into the well-being of Canadians, but they bring into focus the health status and needs of your employees. By leveraging claims data, employers can make data-driven decisions that may help promote a healthier workforce, may reduce absenteeism and disability claims.

February is recognized as Heart Month in Canada, a time when we are encouraged to take proactive steps to improve our cardiovascular health. While “cardiovascular health” extends beyond just the heart to include the health of the blood vessels throughout our body, this term will be used interchangeably in this report with “heart health.”

In this article, we will highlight some trends we’re seeing in our claims data when it comes to heart health such as the increase in the number of younger individuals submitting drug claims for cardiovascular conditions and the rise in the number of people submitting claims for medications to manage hypertensive disorders in pregnancy. 

As an employer, we encourage you to help your employees take charge of their cardiovascular health this Heart Month, while working towards preventing heart disease for a healthier workforce.

More young adults being treated for cardiovascular conditions

While they’re often thought of as health issues in older adults, cholesterol and blood pressure concerns are increasingly identified in younger people as well. 

Recent Manulife drug claims data indicates that the prevalence of cardiovascular conditions, such as high blood pressure and high cholesterol, among young individuals is on the rise. Having high cholesterol and high blood pressure, or hypertension, earlier in life can increase the risk for major health problems at a younger age, including heart disease or kidney disease.²

The number of people aged 18 to 24 taking medication for cardiovascular conditions has increased by 35% over the past four years.³ And, the number of people 17 years and younger taking medication for cardiovascular conditions also saw an increase of 17% during this same period.³

These increases are in line with rising rates of hypertension and obesity among youth in Canada in recent years.⁴ In 2019, 24.5% of youth ages 12 to 17 self-reported as being overweight or obese and in 2022, that number increased to 30.1%, according to Statistics Canada.⁴ This data on self-reported body mass index in youth (12 to 17 years old) was released by Statistics Canada in 2023.

Because obesity is linked to elevated cholesterol and high blood pressure, these trends are likely linked to some of the increases in medication use for cardiovascular conditions in younger age groups. And, reduced physical activity, poor nutrition, and stress are likely also to be contributing factors. Over the course of the pandemic, fewer youth have been meeting the recommendations for physical activity.⁵ In 2018, youth spent an average of 27 minutes per day on physical activity which dropped to 20.3 minutes per day in 2020.⁵

A few other trends may be playing a role. For example, greater awareness of the prevalence of these conditions in younger age groups might also be leading to increases in diagnosis and claims for these medications. And, newer clinical guidelines have suggested a lower threshold for diagnosing high blood pressure, and thus more individuals may be diagnosed and receiving treatment.

It's important for young adults to take these conditions seriously and work with their healthcare providers to manage them effectively.

"Delaying treatment for high blood pressure or cholesterol can have serious long-term consequences on a young adult's health. While these conditions may not present immediate life-threatening symptoms, over time they can cause damage to the heart, brain, and other organs,” says Dr. Anthony Crocco, physician with Cleveland Clinic Canada, Manulife’s Medical Director. “By taking steps to manage their blood pressure and cholesterol levels now, young adults can protect their future cardiovascular health.” 

Young people should continue to prioritize improving their heart health by following a healthy diet, getting regular exercise, and avoiding smoking and excessive alcohol consumption.⁶

Hypertensive disorders in pregnancy on the rise

Hypertensive disorders in pregnancy, which include pre-existing high blood pressure or new onset of high blood pressure during pregnancy, can lead to serious complications if left untreated. This group of disorders also includes pre-eclampsia, a condition that can cause organ damage in the pregnant person, premature delivery, low birth weight, and even stillbirth.⁷ Working with a healthcare provider for treatment and management of the condition is important to ensure the best possible outcomes for both the pregnant person and the baby.

Hypertensive disorders in pregnancy can have a direct impact on your workforce. For example, a pregnant person who develops these types of conditions might require additional time off work to manage their condition or could have significant health impacts (or impacts to their child) as a result of the condition. 

Our claims data shows more people in recent years are being treated for these types of disorders. From 2019 to 2023, there has been a 17.5% increase in the number of people being prescribed medications commonly used to treat hypertensive disorders in pregnancy.³

There are a few underlying trends that might be influencing these increases, according to Cleveland Clinic Canada. This might include more individuals getting appropriate and timely care in pregnancy, with their elevated blood pressure being detected and treated. We’ll have more on this topic later.

Medication adherence for cardiovascular drugs

Medication adherence refers to a patient's ability to take their prescribed medication as directed by their doctor.⁸ Adherence is particularly important for the effective management of cardiovascular conditions, such as high blood pressure or other related chronic conditions, like diabetes.⁸

Taking a medication inconsistently or not as prescribed can lead to reduced effectiveness of treatment, and can increase the risk of complications, such as a heart attack or stroke related to high blood pressure, disease progression, hospitalization, and even death.⁸

Manulife’s data related to medication adherence for cardiovascular drugs reveals that many individuals face challenges in maintaining adherence to their prescribed medication regimen.⁹ Analysis of this data from Express Scripts Canada, Manulife’s pharmacy provider, suggests that more than 30% of claimants are not taking their medications as directed for high blood pressure and nearly 30% are not taking their medications as directed for high cholesterol.⁹

In fact, the more medications someone is prescribed (for any illness or condition), the less likely they are to be taking them as directed. Forty percent of claimants using one medication, 46.6% of claimants using 2 to 3 medications, and 62.7% of claimants using 4 or more medications aren't taking them as prescribed.
 
Several factors can influence medication adherence for cardiovascular drugs, including:

• Fitting dosing schedules into daily routines, 
• Side effects, and,
• Patient education around understanding the importance of consistent medication use.

Looking for ways to support your staff?  How to help employees with medication adherence

Heart attack the leading cause of cardiovascular-related short-term disability

Untreated cardiovascular conditions can significantly impact an individual's ability to work and earn a living.¹¹ In such cases, short and long-term disability benefits become essential.

According to Manulife disability claims data, for cardiovascular conditions, heart attacks and high blood pressure are the top two causes of short-term disability (STD).¹⁰ Stroke and heart attacks are the top two causes of long-term disability (LTD).¹⁰

Men make up the majority of both short- and long-term disability claims for cardiovascular disease.¹⁰

“The majority of premature cardiac events, including heart attacks and strokes, can be prevented by healthy lifestyle choices and managing your cardiovascular risk factors,” says Dr. Heather Warren, Vice President of Medical Programs and Quality, St. Mary's General Hospital in Kitchener, Ontario.

“Small steps – including a healthy diet and smoke-free, active lifestyle – make a big difference to heart health. Plus, screening allows for early detection and management of risk factors such as high blood pressure, high cholesterol and diabetes. These prevention practices work; the expert team at the Regional Cardiac Care Centre has been shaping community health for more than 20 years - it’s at the heart of what we do.”

The importance of employer involvement in promoting cardiovascular health

Preventing and managing cardiovascular disease has an important role in reducing the number of disability claims related to this condition. Employers can take proactive steps to reduce the risk of cardiovascular disease among employees by:

• Offering workplace wellness programs that can help educate staff members about cardiovascular conditions,
• Encouraging regular health screenings, either on-site or with primary care providers in the community, and
• Providing access to a group benefits plan.¹²

Cardiovascular health is a critical component of overall well-being, and monitoring and analyzing claims data plays a vital role in identifying trends in cardiovascular health. By prioritizing employee health and wellness, employers may not only improve the health outcomes of their workforce but may also reduce healthcare costs.     
 
While we use the terms “women” and "men" in this article, we recognize that gender is a spectrum and acknowledge individuals who identify beyond the gender binary.

This article is for informational purposes only. It is not intended to diagnose or treat a condition. If you have questions or concerns about your specific situation or are seeking medical advice, contact your medical doctor or your healthcare provider.

References:

_{² https://www.medicalnewstoday.com/articles/how-high-cholesterol-and-hypertension-increase-heart-disease-risks-in-younger-adults, 2023 
³ Manulife aggregate drug claims data, 2023 
⁴ https://www150.statcan.gc.ca/n1/pub/82-625-x/2021001/article/00002-eng.htm, 2021 
⁵ https://www150.statcan.gc.ca/n1/pub/45-28-0001/2021001/article/00032-eng.htm, 2021 
⁶ https://www150.statcan.gc.ca/n1/daily-quotidien/230419/dq230419e-eng.htm, 2023 
⁷ https://onlinecjc.ca/article/S0828-282X(18)30182-X/fulltext, 2018 
⁸ https://www.bmj.com/content/374/bmj.n1493, 2021 
⁹ ESC Nonadherence Reporting – Manulife, Express Scripts Canada, 2024 
¹⁰ Manulife disability claims data, 2023 
¹¹ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9884880/, 2023
¹² https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8649235/#:~:text=At%20the%20workplace%2C%20employers%20can,community%20resources%20for%20physical%20activity, 2021}