Author + information
- Christopher P. Cannona,b,
- Irfan Khana,b,
- Alexa Klimchaka,b,
- Robert Sancheza,b,
- William Sasielaa,b and
- Matthew Reynoldsa,b
Background: Non-statin lipid-lowering therapies (LLT) are recommended in atherosclerotic cardiovascular disease (ASCVD) patients including those with full or partial statin intolerance (SI).
Purpose: To estimate the proportion of ASCVD patients requiring ezetimibe (EZE) or PCSK9 inhibitors (PCSK9i) with varying SI rates.
Methods: ASCVD patients in the MarketScan database (2012-2013) were sampled with replacement (bootstrapping) and entered into a simulation model which applied the following treatment intensification algorithm in those with low-density lipoprotein cholesterol (LDL-C) >70 mg/dL. Patients not initially on statin were given atorvastatin (A) 20 mg, or they entered the model on their initial LLT, followed by uptitration to A80 mg, add-on EZE, and add-on alirocumab to achieve LDL-C <70 mg/dL. We tested several rates of full SI (inability to tolerate A20) or partial SI (could tolerate A20, but not A80).
Results: A total of 105,269 ASCVD patients met inclusion criteria (mean age 66 yrs; LDL-C 93.6 mg/dL). Table summarizes the use of various LLTs pre/post intensification under different rates of SI. Assuming no SI, intensification with LLT would result in approximately 32.3% of ASCVD patients requiring EZE (18.1%) or PCSK9i (14.2%). SI rates as high as 15% (5% full; 10% partial) resulted a minimal increase in the use of EZE (+0.9%) or PCSK9i (+2.5%).
Conclusions: Accounting for SI in a LLT intensification model would result in only a modest increase in percentage of patients requiring PCSK9i.
Moderated Poster Contributions
Prevention Moderated Poster Theater, Poster Hall, Hall C
Friday, March 17, 2017, 11:15 a.m.-11:25 a.m.
Session Title: The PCSK9 Revolution: New Insights Into Evaluation and Treatment
Abstract Category: 32. Prevention: Clinical
Presentation Number: 1133M-13
- 2017 American College of Cardiology Foundation