Repeat cardiovascular-related procedures and real-world treatment in high-risk patients with hypercholesterolemia or mixed dyslipidemia

AIM: To determine the real-world treatment patterns and recurrence of cardiovascular-related procedures and hospitalizations in patients at very-high atherosclerotic risk.

METHODS: In this retrospective observational study, atherosclerotic cardiovascular disease (ASCVD)-related procedures and hospitalizations, and lipid-lowering therapy (LLT) medication data were assessed in adults with hypercholesterolemia or mixed dyslipidemia with an incident ASCVD-related procedure using health claims data from the German AOK PLUS (2010-2020) and GWQ ServicePlus databases (2013-2019). Differences in time-to-first event between LLT and non-LLT groups were assessed using a propensity score matched (PSM) comparison.

RESULTS: Following the index procedure, approximately 20% of patients had at least one subsequent ASCVD-related procedure in the first 12 months, and approximately 50% had an ASCVD-related re-hospitalization. The total proportion of patients prescribed LLT prior to the index ASCVD-related procedure was approximately 30%. In the index procedure quarter, 68% of patients received a prescription for LLT (non-intensified LLT: 63%; intensified LLT: 5%); 32% did not receive any LLT. PSM comparative analysis showed a reduced risk of time to all-cause death in the LLT versus non-LLT group (AOK PLUS, hazard ratio [HR] 0.62 [95% confidence interval {CI}: 0.60-0.65]; GWQ ServicePlus, HR 0.46 [95% CI: 0.43-0.49]).

LIMITATIONS: Limitations inherent to retrospective health claims data including bias owing to unobservable confounders; potential incomplete capture of patients at "very-high atherosclerotic risk" given the defined nature of categorization criteria used in the study.

CONCLUSION: This real-world study demonstrates that a substantial proportion of very-high-risk patients have recurrent ASCVD-related hospitalizations and events following an initial procedure. Many patients receive no LLT after an ASCVD-related procedure, and among those who do, a large percentage receive only non-intensified LLT. These findings have implications for mortality, morbidity, and healthcare costs and warrant further investigation.