title: A US Claims-Based Analysis of Real-World Lipid-Lowering Treatment Patterns in Patients With High Cardiovascular Disease Risk or a Previous Coronary Event.
abstract: The objective was to examine real-world treatment patterns of lipid-lowering therapies and their possible associated intolerance and/or ineffectiveness in patients with high cardiovascular disease (CVD) risk initiating statins and/or ezetimibe. Patients aged ≥18 years who initiated statins and/or ezetimibe from January 01, 2007, to June 30, 2011, were retrospectively identified from the IMS LifeLink PharMetrics Plus commercial claims database. Patients were further classified into 2 cohorts: (1) history of cardiovascular event (CVE) and (2) history of coronary heart disease risk equivalent (CHD RE). Patients had continuous health plan enrollment ≥1 year pre- and post-index date (statin and/or ezetimibe initiation date). Primary outcomes were index statin intensity, treatment modifications, possible associated statin/nonstatin intolerance and/or ineffectiveness issues (based on treatment modification), and time-to-treatment modifications. Analyses for each cohort were stratified by age group (<65 and ≥65 years). A total of 41,934 (history of CVE) and 170,344 patients (history of CHD RE) were included. On the index date, 8.8% to 25.1% of patients were initiated on high-intensity statin. Among patients aged <65, 79.2% and 48.8% of those with history of CVE and 78.6% and 47.3% of those with a history of CHD RE had ≥1 and 2 treatment modifications, respectively. Among all patients, 24.6% to 25.6% had possible statin intolerance and/or ineffectiveness issues after accounting for second treatment modification (if any). In conclusion, in patients with high CVD risk, index statin treatment modifications that imply possible statin intolerance and/or ineffectiveness were frequent; low use of high-intensity statins indicates unmet need in the management of hyperlipidemia and possible remaining unaccounted CVD residual risk.
authors.affiliation: Global Health Economics, Amgen Inc., Thousand Oaks, California. Electronic address: rquek@amgen.com.
authors.forename: Ruben G W
authors.initials: RGW
authors.lastname: Quek
authors.affiliation: Strategic Healthcare Solutions, LLC, Aiken, South Carolina.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Fox
authors.affiliation: STATinMED Research, Plano, Texas.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.affiliation: STATinMED Research, Plano, Texas.
authors.forename: Lu
authors.initials: L
authors.lastname: Li
authors.affiliation: Global Health Economics, Amgen Inc., Thousand Oaks, California.
authors.forename: Shravanthi R
authors.initials: SR
authors.lastname: Gandra
authors.affiliation: Division of Cardiology, University of California, Irvine, California.
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Wong
mesh_terms: D002318:Cardiovascular Diseases / Q000097:blood / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D007345:Insurance Claim Review; D008055:Lipids / Q000097:blood*; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014481:United States
chemical_list: D000960:Hypolipidemic Agents; D008055:Lipids