title: Cholesterol treatment patterns and cardiovascular clinical outcomes associated with colesevelam HCl and ezetimibe.
abstract: BACKGROUND
  Pharmaceuticals are commonly used to help at-risk patients reduce low-density lipoprotein cholesterol (LDL-C) levels in an effort to prevent atherosclerotic coronary artery disease. Although both the cholesterol inhibitor ezetimibe and the newer generation bile acid sequestrant colesevelam hydrochloride (HCl) effectively reduce LDL-C levels in patients with hypercholesterolemia, real-world evidence based on clinical outcomes is lacking.
  
  
  METHODS
  A retrospective analysis of healthcare insurance claims data from a large national healthcare payer was conducted to evaluate outcomes within 12 months among 2,067 patients with hypercholesterolemia after the initiation of treatment with colesevelam HCl (679 patients) as compared with ezetimibe (1,388 patients). Outcomes evaluated were (1) composite cardiovascular event which included myocardial infarction, stroke, angina, or revascularization and (2) macrovascular complication event which was a wider-encompassing measure that included all composite cardiovascular outcomes along with atherosclerosis, aneurysm, embolism, and peripheral vascular disease.
  
  
  RESULTS
  An adjusted logistic regression model found lower odds of a composite cardiovascular event (odds ratio [OR] 0.54, 95 % confidence interval [CI] 0.30-0.97) within 12 months for subjects initiating treatment with colesevelam HCl compared with subjects initiating treatment with ezetimibe. The unadjusted OR was slightly lower (OR 0.52, 95 % CI 0.30-0.90). The odds ratio for the wider-encompassing macrovascular complication event occurring within 12 months of initiating treatment with colesevelam HCl or ezetimibe was not statistically significant (OR 0.821, 95 % CI 0.49-1.35).
  
  
  CONCLUSIONS
  The evidence of lower risk for composite cardiovascular event rates for subjects treated with colesevelam HCl compared with those treated with ezetimibe suggests the potential need to consider risk of clinical outcomes, in addition to LDL-C levels, in real-world practice when choosing a pharmaceutical treatment.
authors.affiliation: Comprehensive Health Insights Inc., a Humana Company, 325 W. Main St., WFP6W, 40202, Louisville, KY, USA, pschwab@humana.com.
authors.forename: Philip
authors.initials: P
authors.lastname: Schwab
authors.forename: Anthony
authors.initials: A
authors.lastname: Louder
authors.forename: Yong
authors.initials: Y
authors.lastname: Li
authors.forename: Rajiv
authors.initials: R
authors.lastname: Mallick
authors.forename: Harold
authors.initials: H
authors.lastname: Bays
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000499:Allylamine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000924:Anticholesteremic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001384:Azetidines / Q000008:administration & dosage* / Q000009:adverse effects; D015331:Cohort Studies; D000069472:Colesevelam Hydrochloride; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000517:prevention & control; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D000069438:Ezetimibe; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000924:Anticholesteremic Agents; D001384:Azetidines; D000499:Allylamine; D000069438:Ezetimibe; D000069472:Colesevelam Hydrochloride
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