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Primary Prevention Using Cholesterol-Lowering Medications in Patients Meeting New Treatment Guidelines: A
Xue Han1, D Steven Fox1, Michelle Chu2
11 Department of Pharmaceutical and Health Economics, School of Pharmacy, Leonard Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles.
Insights
Starting cholesterol-lowering medication for primary prevention reduces cardiovascular events and healthcare costs. The 2013 ACC/AHA guidelines identified high LDL-C and diabetic patients for this treatment.
Area of Science:
- Cardiology
- Preventive Medicine
- Health Economics
Background:
- The 2013 ACC/AHA cholesterol guidelines identified specific groups for primary prevention.
- This study focused on patients with LDL-C ≥ 190 mg/dL and diabetic patients aged 40-75 years.
Purpose of the Study:
- To evaluate the impact of 2013 ACC/AHA guideline-based primary prevention on cardiovascular event risk.
- To assess the effect of this primary prevention strategy on healthcare costs.
Main Methods:
- Utilized Humana member data (2007-2013) to identify patients for primary prevention.
- Classified patients into elevated LDL-C, diabetes, or combined risk groups.
- Compared cardiovascular event risk and costs between patients initiating treatment before or after a CVD event.
Main Results:
- 91,066 patients met criteria; primary prevention rates varied by group (35% for diabetics, 65% for high LDL-C, 78% for combined).
- Initiating cholesterol-lowering medication was linked to up to 37% reduction in cardiovascular events.
- Primary prevention was associated with $673 lower total all-cause costs in the first post-index year.
Conclusions:
- Initiating cholesterol-lowering medication for primary prevention in high LDL-C and diabetic patients aligns with reduced CVD risks.
- This strategy also demonstrated a significant decrease in healthcare expenditures.
Background:
The American College of Cardiology and American Heart Association (ACC/AHA) issued new cholesterol treatment guidelines in 2013. Two of the groups designated for primary prevention were analyzed: patients with a low-density lipoprotein cholesterol (LDL-C) level ≥ 190 mg per dL and diabetic patients aged 40-75 years.
Objective:
To estimate the effects of primary prevention as specified in the 2013 guidelines on cardiovascular event risk and cost.
Methods:
Primary prevention patients were identified using laboratory and diagnostic data for Humana members from 2007 to 2013. Potential study patients were classified into 3 risk groups: elevated LDL-C, diabetes, and elevated LDL-C and diabetes. Patients receiving cholesterol-lowering medications before their index date were excluded. Eligible patients were divided into 2 treatment groups: (1) primary prevention patients who initiated treatment before experiencing any cardiovascular disease (CVD)-related event, and (2) patients who either did not initiate treatment until after experiencing a CVD event or never initiated treatment. The associations between initiating cholesterol-lowering medications for primary prevention and the risk for acute myocardial infarction, stroke, coronary angioplasty, or coronary artery bypass graft surgery were estimated using Cox proportional hazards models. The effect of primary prevention on health care costs was estimated using generalized linear models.
Results:
91,066 patients met study selection criteria. Primary prevention rates were the lowest in diabetic patients (35%), who were newly designated for treatment in the 2013 guidelines. Primary prevention rates were higher for patients designated for treatment under earlier guidelines: 65% for patients with elevated LDL-C and 78% for the combined LDL-C and diabetes group. Primary prevention treatment was associated with significant reductions in cardiovascular event risk (up to 37%) and lower total all-cause costs (by $673) in the first post-index year.
Conclusions:
Initiating cholesterol-lowering medications for primary prevention, as specified in the ACC/AHA 2013 guidelines, for patients with high LDL-C and diabetes is associated with reduced CVD event risks and lower health care costs.
Disclosures:
No outside funding supported this study. Han received fellowship support from the Pharmaceutical Research and Manufacturers Association Foundation (PhRMA) during the conduct of this study. Dougherty is employed by PhRMA. The authors have nothing to disclose.
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