Abstract 14373: Treatment Trends Among High Cardiovascular Disease Risk Patients Treated With Lipid-lowering Therapies: A United States Real-world Study

Abstract

Introduction: Strong evidence exists linking LDL-C as a causal factor of atherosclerotic CVD. Statins are the cornerstone for lipid lowering therapy (LLT) so it is important to understand treatment trends in light of current guidelines. Objective: To evaluate LLT trends in a US real-world setting. Methods: Patients (aged ≥18y) who initiated LLT (statins and/or ezetimibe) from 01/01/2007-06/30/2011 were retrospectively identified from IMS commercial claims. Patients were classified into two cohorts: 1) Prior CVD and 2) Prior CHD RE conditions [Definitions in Figure 1] and stratified by age group (<65 and ≥65y). Eligible patients had continuous health plan enrollment for ≥1 year pre- and post-index date (LLT initiation date). The following were assessed: index statin intensity (defined by ACC/AHA 2013 guidelines), first treatment modification (e.g., switch, re-initiation after temporary discontinuation of >60 days, permanent discontinuation of all LLT) and time-to-first treatment modification. Results: A total of 41,934 patients with prior CVD (mean age: 58y) and 170,344 patients with CHD RE (mean age: 57y) were analyzed. From 2007-2011, 66.6-77.8% and 8.8-25.1% of the cohorts were prescribed moderate-intensity and high-intensity statins, respectively, on the index date. Among the CVD and CHD RE cohorts, 18.8% and 26.2% reinitiated index LLT, 11.6% and 13.2% permanently discontinued all LLT and 19.5% and 13.6% switched to a different statin, respectively, as the first treatment modification (Figure 1). A similar trend was observed among patients aged ≥65y. Average number of days to first treatment modification was 130-399 days. Conclusion: With 79% of patients modifying their index LLT, of which 12-13% permanently discontinuing all LLT, such treatment modifications may potentially be indicative of index statin intolerability and/or ineffectiveness. High-intensity statin therapy initiation is low, potentially resulting in residual risk of CVD.