PCV84 - Primary Prevention Using Cholesterol-Lowering Medications in Patients Meeting New Treatment Guidelines: A Retrospective Cohort Analysis

Abstract

The 2013 American College of Cardiology/American Heart Association (ACC /AHA) guidelines expanded primary prevention using cholesterol-lowering therapy to all diabetic patients. Our research documents the potential for expanded primary prevention eligibility to improve cardiovascular outcomes and reduce cost. Patients meeting 2013 guidelines for primary prevention were identified using laboratory and diagnostic data from Humana [2007-2013]. Patients were classified into three risk groups: LDL levels ≥ 190 mg/dL, patients with diabetes (aged 40 to 75), and patients with both elevated LDL-C and diabetes. Patients with no pre-classification cholesterol treatment were then selected and divided in two treatment groups: [1] patients who initiated treatment before experiencing any cardiovascular disease-related event and [2] patients who did not initiate treatment until after experiencing a CVD event (or who never initiated treatment). Clinical outcomes measured were the time to four separate events: AMI, stroke, coronary angioplasty, coronary artery bypass graft surgery (CABG). Costs were measured over the first year following a risk classification. Clinical outcomes were analyzed using Cox proportional hazards models. Costs were analyzed using generalized linear models [GLM]. 91,066 patients were selected according to ACC/AHA guidelines and met study selection criteria. Primary prevention treatment rates were the lowest in diabetic patients [35%], most of whom were newly designated for treatment in the 2013 guidelines. Primary prevention treatment rates were higher for patients identified in earlier guidelines: 65% for patients with elevated LDL and 78% for the combined LDL+diabetes group. Primary prevention was associated with significant reductions in cardiovascular event risk (up to 37%) and lower total all-cause costs in the first post-index year (by $673). Primary prevention using cholesterol-lowering medications, as specified in the new 2013 guidelines for patients with high-LDL or/and diabetes, is projected here to both reduce CVD event risk and lower healthcare costs.