Abstract 18086: Rates of Cardiovascular Events in Patients Receiving High-Intensity Statin Therapy in the United Kingdom

Abstract

Background: Cardiovascular (CV) event rates have declined, in part due to extensive use of treatments such as statin therapy, but rates in specific real-world populations are unknown. Our aim was to provide contemporary estimates of CV event rates across five high-risk cohorts receiving high-intensity statin therapy in the UK. Hypothesis: CV event rates will vary by cohort and over time. Methods: Five cohorts receiving high-intensity statins were studied in the Clinical Practice Research Datalink: (1) high-risk primary prevention (HRPP - diabetes with no other CV event), (2) evident CV disease (ECVD - CV disease excluding acute coronary syndrome (ACS), ischemic stroke (IS), and heart failure (HF)), (3) incident ACS, (4) incident IS, and (5) incident HF (in patients with ACS or IS). Patients were followed from 1/1/2005 (HRPP, ECVD) or qualifying index event (ACS/IS/HF) until the next CV event, death, or end of observation (12/31/2011). Outcome CV events were based on hospitalization primary diagnoses and cause of death data. These were combined to form a composite endpoint (ACS, IS, HF, or CV death) for all cohorts. For HRPP, the ECVD conditions were included as outcomes. Crude rates were estimated at 2-month intervals over time. Results: Cohort sizes ranged from 414 patients for IS to 9,411 for ECVD. Observation time ranged from 3.6 years for HF to 7.0 years for HRPP. Mean, unadjusted composite CV event rates per 1,000 person years were 37 for HRPP, 43 for ECVD, 107 for IS, 135 for ACS, and 201 for HF (Figure). The rates for secondary prevention cohorts were highest after the index CV event and then declined and became stable by one year. Conclusions: In the incident cohorts, event rates were highest in the first year and declined over time. However, rates were higher than the prevalent cohorts even at 1500 days after the index event. These rates are higher than in clinical trials and further research should identify methods of reducing CV risk in these high intensity statin patients.