Abstract 4341629: Excess Cardiovascular Events and Healthcare Resource Utilization with Lack of Lipid Lowering Therapy in US Adults with or at Risk of ASCVD

Background: Despite the effectiveness of lipid lowering therapy (LLT), many adults with or at risk of ASCVD are not being treated. Objective: To examine clinical outcomes and healthcare resource utilization (HCRU) associated with lack of LLT. Methods: We conducted a retrospective cohort study among adults with US TriNetX electronic medical records linked to claims data from 01/01/2016 to 12/01/2023. Adults with any LLT, ASCVD or with risk factors including familial hypercholesterolemia, diabetes, stage 3-5 chronic kidney disease, or coronary calcium score ≥100 AU were included. The earliest date of the first fill for a LLT prescription or evidence of ASCVD or risk factors was set as the index date and adults were followed up to 18 months. LLT treatment during follow up was defined as ≥ 2 pharmacy claims with no gaps of ≥ 60 days in the 6 months after the index date and before a post-index ASCVD event or the end of follow-up. We examined demographic, clinical and treatment characteristics in LLT treated and untreated adults and compared rates of subsequent ASCVD events and HCRU after multivariable adjustment using negative binomial regression models. Results: Among 29,119 adults included in the study, 5.2% had a history of ASCVD and 90.6% were prescribed LLT on the index date. The mean age was 64 years, 49.6% were women and 60.4% were LLT untreated during follow-up (59.2% discontinued index LLT and remained untreated). Baseline LDL-C levels were only available in 22.7% of the adults and the mean value was 107 mg/dL. Adults not treated with LLT during follow-up were younger (mean age 63 vs. 65 years), and more often reported Hispanic ethnicity (4.9% vs. 3.4%). After multivariable adjustment, compared to adults treated with LLT during follow-up, those untreated with LLT had higher rates of non-fatal ASCVD events (incidence rate ratio [IRR]=1.82), and ASCVD-specific and all-cause hospitalizations (IRR=1.51 and 1.44) and emergency department (ED) visits (IRR=1.33 and 1.36; Figures 1-2). Conclusions: Despite access to healthcare, most patients were not on LLT through follow-up, including patients with ASCVD, and more than half of the patients previously prescribed LLT discontinued treatment. Lack of persistent LLT use was associated with higher rates of non-fatal ASCVD events and more frequent hospitalizations and ED visits. Optimizing LLT treatment among those at greatest risk of ASCVD is critical for managing risk of subsequent health sequela.