Nagar SP, Fox KM, Rane PP, Beaubrun A, Qian Y, Inomata H, Davis KL, Meyers J, Kajinami K. Incidence of cardiovascular events among secondary prevention patients treated with statins or ezetimibe in Japan. Poster presented at the 2017 ISPOR 22nd Annual International Meeting; May 23, 2017. Boston, MA. [abstract] Value Health. 2017 May; 20(5):A261.

OBJECTIVE: To estimate the incidence of cardiovascular events (CVE) among secondary prevention patients in Japan

METHODS: A retrospective cohort study examined adults initiating either a statin or ezetimibe from 1/1/2006-5/31/2014 in the Japan Medical Data Center database (2005-2015). The first observed statin or ezetimibe prescription defined the index date. Patients had ≥12 months of pre- and post-index date plan enrollment. Patients with atherosclerotic cardiovascular disease (ASCVD) during the pre-index period were identified, including the subgroup of patients with ≥25 % statin up-titration in the follow-up period. Incidence of CVE, defined as a new inpatient claim for myocardial infarction (MI), unstable angina, stroke, coronary revascularization procedure, heart failure (HF), transient ischemic attack, or peripheral artery disease was reported.

RESULTS: 5,302 patients with previous ASCVD were included (mean [SD] age: 55.7 [9.5] years, 63.8% males). Diabetes (59.6%) and hypertension (59.5%) were the most prevalent comorbidities, pre-index. 69.8% of patients received moderate intensity statins and 0.8% received both statins and ezetimibe. Post-index date, 8.1% had any new CVE over a mean follow-up of 2.8 years; stroke (2.4%), MI (2.2%) and HF (1.5%) were the most common events; incident rates of these events per 1000 person-years of follow-up were 8.6 (stroke), 7.9 (MI) and 5.5 (HF).  Among ASCVD patients who up titrated statin (N=385), 8.6% had a new CVE after statin up titration over a mean follow-up of 2.7 years; MI (2.9%), stroke (2.3%) and HF (1.6%) were the most common CVEs. Incidence rates of these events per 1000 person-years in patients with ASCVD and statin up-titration were 10.6 (MI), 8.7 (stroke) and 5.8 (HF).

CONCLUSIONS: In a real world Japanese cohort with ASCVD, many patients still had recurrent CVEs despite receiving statins and/or ezetimibe. These findings highlight a continued unmet medical need in the area of secondary CVE prevention in Japanese patients.   

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