Clinical characteristics, patterns of lipid-lowering medication use, and health care resource utilization and costs among patients with atherosclerotic cardiovascular disease

Figures & data

Table 1 Baseline demographic and clinical characteristics of ASCVD patients

Characteristics	All patients		Filled high-intensity statins in all first four quarters		With >50% LDL-C reduction at 12-month follow-up		With LDL-C <70 mg/dL at 12-month follow-up		With LDL-C <100 mg/dL at 12-month follow-up
	n	%	n	%	n	%	n	%	n	%
Number of patients	128,017	100	6,044	4.7	865	8.4*	3,556	19.9*	9,636	53.8*
Mean age (SD), mediana	59 (13)	58	55 (10)	55	60 (11)	59	60 (12)	59	60 (12)	59
Female	55,136	43.1	1,351	22.4	281	32.5	1,111	31.2	3,568	37.0
Geographic region
Northeast	31,179	24.4	1,163	19.2	354	40.9	1,367	38.4	3,978	41.3
Midwest	49,979	39.0	2,503	41.4	189	21.9	865	24.3	2,215	23.0
South	23,450	18.3	1,285	21.3	199	23.0	734	20.6	1,967	20.4
West	23,409	18.3	1,093	18.1	123	14.2	590	16.6	1,476	15.3
Insurance plan type
HMO	41,398	32.3	1,585	26.2	433	50.1	1,690	47.5	4,786	49.7
PPO	80,762	63.1	4,056	67.1	398	46.0	1,717	48.3	4,501	46.7
Others	5,857	4.6	403	6.7	34	3.9	149	4.2	349	3.6
Type of ASCVD**
ACS	26,887	21.0	3,873	64.1	298	34.5	1,233	34.7	2,564	26.6
CHD	71,884	56.2	4,473	74.0	599	69.3	2,364	66.5	6,044	62.7
ACD	22,311	17.4	511	8.5	90	10.4	431	12.1	1,276	13.2
PAD	23,457	18.3	123	2.0	93	10.8	439	12.4	1,552	16.1
QCI, mean (SD), mediana	0.86 (1.41)	0.00	0.46 (1.05)	0.00	0.86 (1.41)	0.00	0.96 (1.44)	0.00	0.94 (1.41)	0.00
Selected comorbidities of interest
Anxiety	9,619	7.5	320	5.3	44	5.1	180	5.1	549	5.7
Chronic kidney disease	4,161	3.3	79	1.3	24	2.8	115	3.2	299	3.1
Depression	7,599	5.9	232	3.8	44	5.1	156	4.4	423	4.4
Diabetes mellitus	20,954	16.4	621	10.3	202	23.4	853	24.0	2,175	22.6
Dyslipidemia	45,208	35.3	1,727	28.6	488	56.4	1,440	40.5	4,038	41.9
Hypertension	60,121	47.0	2,113	35.0	480	55.5	1,850	52.0	5,006	52.0
Obesity	6,759	5.3	227	3.8	52	6.0	173	4.9	485	5.0
Pain	81,501	63.7	3,068	50.8	575	66.5	2,182	61.4	6,037	62.7
Baseline lipid panel values‡,§
≥1 LDL-C value available	26,653	20.8	775	12.8	865	100.0	1,843	51.8	5,319	55.2
LDL-C <100 mg/dL	8,279	31.1	137	17.7	89	10.3	977	53.0	2,518	47.3
LDL-C <70 mg/dL	1,803	6.8	35	4.5	5	0.6	418	22.7	637	12.0
≥1 HDL-C value available	26,964	21.1	792	13.1	856	99.0	1,859	52.3	5,343	55.4
HDL-C >40 mg/dL for males, >50 mg/dL for females	17,655	65.5	437	55.2	539	63.0	1,106	59.5	3,380	63.3
≥1 triglyceride value available	27,196	21.2	804	13.3	860	99.4	1,865	52.4	5,377	55.8
Triglycerides <150 mg/dL	17,757	65.3	459	57.1	500	58.1	1,158	62.1	3,480	64.7
≥1 total cholesterol value available	27,292	21.3	808	13.4	860	99.4	1,870	52.6	5,386	55.9
Total cholesterol <200 mg/dL	14,703	53.9	307	38.0	244	28.4	1,359	72.7	3,640	67.6
≥1 non-HDL-C value available	26,924	21.0	792	13.1	854	98.7	1,857	52.2	5,335	55.4
Non-HDL-C <130 mg/dL	9,780	36.3	153	19.3	108	12.6	1,001	53.9	2,701	50.6
Baseline medications
Anti-claudication medications	445	0.4	9	0.2	4	0.5	13	0.4	31	0.3
Antidiabetic medications	12,561	9.8	472	7.8	140	16.2	571	16.1	1,400	14.5
Antihypertensive medications	58,008	45.3	2,132	35.3	450	52.0	1,769	49.8	4,783	49.6
Digoxin	2,214	1.7	21	0.4	8	0.9	56	1.6	162	1.7
Prescription antiplatelet and anticoagulant medications	8,785	6.9	165	2.7	46	5.3	214	6.0	616	6.4
Prescription omega 3 fatty acids	689	0.5	31	0.5	9	1.0	23	0.7	69	0.7

Notes:

a Data presented as mean (SD), median.

* The denominator for 8.4% was patients with valid LDL-C values at both baseline and 12-month follow-up (n = 10,297); the denominator for 19.9% and 53.8% was patients with valid LDL-C values at 12-month follow-up (n = 17,915).

** A patient could have multiple types of ASCVD on index date.

‡ In cases where there was more than one eligible baseline laboratory result for the same lipid measure, the one closest to index date was used.

§ For each type of lipid panel value, the denominator for the percentage of patients with any given lipid level was the number of available patients with that lipid value.

Abbreviations: ACD, atherosclerotic cerebrovascular disease; ACS, acute coronary syndrome; ASCVD, atherosclerotic cardiovascular disease; CHD, coronary heart disease; HDL-C, high-density lipoprotein cholesterol; HMO, health maintenance organization; LDL-C, low-density lipoprotein cholesterol; PAD, peripheral artery disease; PPO, preferred provider organization; QCI, Quan-Charlson Comorbidity Index.

Table 2 Utilization patterns of index LLM among monotherapy initiators at 12- and 36-month follow-up

Utilization patterns	12-month follow-up		36-month follow-up
	n	%	n	%
Number of monotherapy initiators	47,587	100	21,198	100
Dose titration assessment
Up-titration of index LLM	4,180	8.8	2,635	12.4
Down-titration of index LLM	1,462	3.1	793	3.7
No dose change of index LLM	41,945	88.1	17,770	83.8
Discontinuation/persistence
Discontinued index LLM	25,938	54.5	16,488	77.8
Days from index fill date to first discontinuation date, mean (SD), mediana	116 (91)	90	270 (274)	155
Persistence of index LLM (days), mean (SD), mediana	219 (133)	242	449 (412)	275
Switch
Switched to non-index LLMs	4,579	9.6	2,935	13.8
Days from index fill date to first switch date, mean (SD), mediana	129 (88)	101	293 (278)	173
Augmentation
Augmented index LLM	1,403	2.9	586	2.8
Days from index fill date to first augmentation, mean (SD), mediana	157 (92)	157	310 (299)	194

Note:

a Data presented as mean (SD), median.

Abbreviation: LLM, lipid-lowering medication.

Figure 1 All-cause and ASCVD-related HCRU over 12-month follow-up.

Note: The percentages in the figure show the percentage of patients with ≥1 specific visit or pharmacy fill.
Abbreviations: ASCVD, atherosclerotic cardiovascular disease; ER, emergency room; HCRU, health care resource utilization; LDL-C, low-density lipoprotein cholesterol.

Figure 2 Mean all-cause and ASCVD-related costs over 12-month follow-up.

Note: Costs were adjusted to 2013 dollar values based on the consumer price index for medical care from the US Bureau of Labor Statistics.¹⁹
Abbreviations: ASCVD, atherosclerotic cardiovascular disease; LDL-C, low-density lipoprotein cholesterol.

Figure 3 GLM results: baseline factors associated with all-cause health care costs over 12-month follow-up.

Notes: Dependent variable: all-cause health care costs at 12-month follow-up. Costs were adjusted to 2013 dollar values based on the consumer price index for medical care from the US Bureau of Labor Statistics.¹⁹
Abbreviations: ACD, atherosclerotic cerebrovascular disease; ACS, acute coronary syndrome; CHD, coronary heart disease; GLM, generalized linear model; HDL-C, high-density lipoprotein cholesterol; HMO, health maintenance organization; LDL-C, low-density lipoprotein cholesterol; PAD, peripheral artery disease; PPO, preferred provider organization; QCI, Quan-Charlson Comorbidity Index.

Figure S1 Cumulative all-cause and ASCVD-related HCRU over 36-month follow-up.

Note: The percentages in the figure show the percentage of patients with ≥1 specific visit or pharmacy fill.

Abbreviations: ASCVD, atherosclerotic cardiovascular disease; ER, emergency room; HCRU, health care resource utilization; LDL-C, low-density lipoprotein cholesterol.

Figure S2 Mean cumulative all-cause and ASCVD-related costs over 36-month follow-up.

Note: Costs were adjusted to 2013 dollar values based on the consumer price index for medical care from the US Bureau of Labor Statistics.¹⁹

Abbreviations: ASCVD, atherosclerotic cardiovascular disease; LDL-C, low-density lipoprotein cholesterol.

Figure S3 GLM results: baseline factors associated with ASCVD-related health care costs over 12-month follow-up.

Notes: Dependent variable: ASCVD-related health care costs at 12-month follow-up. Baseline medications of interest: anti-claudication medications, antidiabetic medications, antihypertensive medications, digoxin, prescription antiplatelet and anticoagulant medications, and prescription omega 3 fatty acids. Costs were adjusted to 2013 dollar values based on the consumer price index for medical care from the US Bureau of Labor Statistics.¹⁹

Abbreviations: ACD, atherosclerotic cerebrovascular disease; ACS, acute coronary syndrome; ASCVD, atherosclerotic cardiovascular disease; CHD, coronary heart disease; GLM, generalized linear model; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; PAD, peripheral artery disease; QCI, Quan-Charlson Comorbidity Index.

Table S1 ASCVD groups

Group	Type	Diseases/events	ICD-9-CM diagnosis code
1	ACS	MI	410.xx
		Unstable angina	411.1x, 411.81, 411.89
	CHD	Old MI	412.xx
		Stable angina	413.xx
		Coronary atherosclerosis	414.0x, 414.2x, 414.3x, 414.4x, 414.8x
2	ACD	Ischemic stroke	433.x1, 434.x1
		TIA	435.xx
3	PAD	PAD	440.2x, 440.3x, 440.4x, 443.9x, 445.0x, 447.1x

Abbreviations: ACD, atherosclerotic cerebrovascular disease; ACS, acute coronary syndrome; ASCVD, atherosclerotic cardiovascular disease; CHD, coronary heart disease; MI, myocardial infarction; PAD, peripheral artery disease; TIA, transient ischemic attack.

U.S. Bureau of Labor Statistics [database on the Internet]Consumer Price Index (CPI) for Medical Care2014 Available from: http://data.bls.govAccessed March 6, 2014

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