Predicted impact of lipid lowering therapy on cardiovascular and economic outcomes of Swedish atherosclerotic cardiovascular disease guideline

Abstract

Background: The effects on cardiovascular disease (CVD) by treatment recommendations on prevention of atherosclerotic CVD remain to be evaluated. The objectives were to assess treatment gap for low density lipoprotein cholesterol (LDL-C) according to guidelines, potential impact on CVD outcomes, and possible avoided economic costs, in post myocardial infarction (MI) patients, if target LDL-C levels of ≤1.8 mmol/L would be achieved.

Methods: All patients registered in the Swedish Secondary Prevention after Heart Intensive care Admission register, with one-year post-MI follow-up during 2013 were selected. The REACH risk prediction and a calibrated model for recurrent cardiovascular events and death were used to estimate unadjusted risk prediction based on the REACH equation henceforth called base case, and calibrated CVD outcomes based on gender-specific risk factors. The predicted impact of the LDL-C reduction on the risk of CVD was based on the Cholesterol Treatment Trialists´ Collaboration findings.

Results: A sample of n = 5904 patients (74% men) with a mean age of 64 years were included. Around 70% did not reach LDL-C target ≤1.8 mmol/L. Over a 10-year period, 820-2262 events were predicted to occur in those who did not reach target corresponding to 20% - 55% risk of CVD events. To achieve LDL-C target, the mean LDL-C had to be reduced by 0.73 mmol/L (29%). If this LDL-C reduction was achieved, 195-544 life years, 132-343 CVD events, and 7.9-20.9 million Swedish crowns (MSEK) of direct costs, and 19.3-51.0 MSEK of total costs would be avoided.

Conclusion: Lowering of LDL cholesterol to achieve target levels according to guidelines for post-MI patients may lead to fewer cardiovascular events and avoidance of event costs.

Keywords: Cardiovascular disease; Costs; Guidelines; Lipids; Myocardial infarction.

Conflict of interest statement

Ethics approval and consent to participate

According to the Swedish Patient Data Act (2008:355), it is not necessary for persons participating in registers to submit written consents. They are informed that the registration will take place, and may refuse it. The study protocol was approved by the Regional Ethical Review Board in Stockholm (reference number 2015/4:7).

Not applicable.

Competing interests

Financial disclosures: GJ has received consultant fee from Amgen. KH has received lecture fees from Amgen, and Astra Zeneca, and an unrestricted grant from Gilead Inc. EH is an expert committee member, and have received lecture fees, and institutional research grant from Sanofi; institutional research grant and lecture fees from Amgen; institutional research grants from AstraZeneca; expert committee member for Ariad and MSD. BP and ML are employed by Amgen.

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Figures

Fig. 1

Predicted number of cardiovascular events in base-, and calibrated cases over a ten year period

Fig. 2

Predicted number of cardiovascular events avoided by percent LDL-C reduction in base-, and calibrated cases over a ten year period

Fig. 3

Predicted direct cardiovascular events costs avoided by percent LDL-C reduction in base-, and calibrated cases