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Howard Weintraub, MD: The next thing I’d like to mention, as you’ve brought this up, is this rising concern about worsened cardiovascular outcomes. It turns out, interestingly, that this has been directed toward younger groups. You have people—and oddly enough, women particularly—entering the cardiac care group at an age that is much lower than anticipated by the people who make models for budgets. You get people who are now having very costly cardiac ailments and even more costly cardiac interventions. As a consequence, stresses are placed on society, on the budget, and more important, on these individuals’ lives.
One of the problems with stroke is that it is frequently not a mortal event, but it can be something that changes someone’s quality of life forever. You can’t underestimate the role of genetics and then obesity in even moderate degrees, along with the genetic predisposition toward more glucose intolerance. Now, we’re finding an even newer player, which is steatosis or the condition of NASH—nonalcoholic steatohepatitis. This all becomes involved with glucose intolerance and diabetes, dyslipidemia, and cardiovascular disease. We’re paying the price as this tornado begins to roll even more, flattening a lot of the expectations in health care. People are becoming consumers of health care, but economically, we’re hoping they’d simply be paying premiums and not actually using many of these dollars. I’m sure you guys have had a problem with this in Chicago as well.
Alan S. Brown, MD, FACC, FAHA, FNLA: Yes, absolutely.
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