OBJECTIVES

The 2013 American College of Cardiology/American Heart Association (ACC /AHA) guidelines expanded primary prevention using cholesterol-lowering therapy to all diabetic patients. Our research documents the potential for expanded primary prevention eligibility to improve cardiovascular outcomes and reduce cost.

METHODS

Patients meeting 2013 guidelines for primary prevention were identified using laboratory and diagnostic data from Humana [2007-2013]. Patients were classified into three risk groups: LDL levels ≥ 190 mg/dL, patients with diabetes (aged 40 to 75), and patients with both elevated LDL-C and diabetes. Patients with no pre-classification cholesterol treatment were then selected and divided in two treatment groups: [1] patients who initiated treatment before experiencing any cardiovascular disease-related event and [2] patients who did not initiate treatment until after experiencing a CVD event (or who never initiated treatment). Clinical outcomes measured were the time to four separate events: AMI, stroke, coronary angioplasty, coronary artery bypass graft surgery (CABG). Costs were measured over the first year following a risk classification. Clinical outcomes were analyzed using Cox proportional hazards models. Costs were analyzed using generalized linear models [GLM].

RESULTS CONCLUSIONS

Primary prevention using cholesterol-lowering medications, as specified in the new 2013 guidelines for patients with high-LDL or/and diabetes, is projected here to both reduce CVD event risk and lower healthcare costs.