PATIENTS 03.02.2023

Cardiovascular Disease – A Public Health Crisis with Underutilized Solutions

Despite decades of scientific advances and innovation, news headlines continue to report regularly on the many people having heart attacks and strokes.1,2 Cardiovascular disease has long been among the greatest public health challenges of the modern era – in the U.S. someone suffers a heart attack every 40 seconds – and cardiovascular disease remains a leading global public health crisis.3,4 Investing in technological advancements for cardiovascular care was beneficial in the 1990s, however, despite increased spending, current trends in cardiovascular outcomes show that this is no longer the case.3

The reality is that an estimated 80% of cardiovascular events—including heart attacks and strokes—are preventable.5 It is now well established that high low-density lipoprotein cholesterol (LDL-C) is the main culprit for blockages in the arteries, which can lead to cardiovascular events.4 Aiming for, and maintaining, low LDL-C using widely available medicines is the best way for atherosclerotic cardiovascular disease (ASCVD) patients to reduce their risk of cardiovascular events.6

“We know there are many ways to prevent cardiovascular disease, but the one with most evidence in data is managing LDL-C,” says Dr. Jyothis George, global & U.S. Medical Therapeutic area head, General Medicine, at Amgen. “The correlation between cardiovascular events and elevated levels of LDL-C has been studied for over 60 years.”7

Amgen on LDL-C at ACC: #AimLow #StayLow

Amgen’s bold ambition is to halve the number of cardiovascular events by 2030 so we’re taking aim at ASCVD by calling on healthcare professionals to #AimLow and #StayLow so that their ASCVD patients’ LDL-C gets below, and stays below, LDL-C thresholds recommended by the American College of Cardiology Expert Consensus Decision Pathway (ACC ECDP).

Challenges include barriers to care, lack of treatment, and failure to reach treatment goals

Despite having the knowledge and tools available to reduce large numbers of cardiovascular events, many people don’t receive preventative care that could help them identify high LDL-C numbers and take steps to improve heart health before an event.5 Barriers to care and access cut across financial, geographical, and social determinants.8 “The rates of diagnoses are poor, especially for underprivileged patients,” George explains. “And even when people see a doctor, often the advice is to just exercise a bit more and eat healthy food.”

Outcomes remain poor even among patients who have access to care, including those who have been diagnosed with ASCVD and prescribed first line medicine to help lower LDL-C. One observational trial found that only half of patients in the study received insurance approval for prescribed non-statin therapy, yet almost one-third of those who received insurance approval never filled the prescription at the pharmacy.3

“There are gaps in patients getting the right diagnoses. There are gaps in prescribing the recommended treatment. And even when treatments are initiated, there are gaps in getting patients to appropriate LDL-C target and staying there,” George says. “Every step of the way, there is a huge amount of need for improvement.”

The risks are highest for ASCVD patients who have already experienced a heart attack or stroke—nearly half of these patients fail to achieve their guideline recommended LDL-C goals.4,9 And only 3.2% of an estimated 18.7 million adults with cardiovascular disease in the U.S. actually take an add-on lipid-lowering therapy, despite add-on treatments being recommended to 61.4% of those patients.10

These gaps can also be seen in data from organizations like the Family Heart Foundation, which advocates for patients with familial hypercholesterolemia. According to a recent analysis of this patient population, more than 70% of people in the U.S. with ASCVD being treated for cardiovascular disease never reach their treatment goals.11

What’s one solution?

Given the range of severity that can be present in ASCVD, there is a need for healthcare professionals to have and use the variety of tools in their arsenal to help patients achieve their LDL-C treatment goals. The existing standard of care of taking statins alone often isn’t enough for the highest risk patients.12 The ACC recently issued an Expert Consensus Decision Pathway, in which it recommended that non-statin therapies be prioritized for the highest risk patients who need to intensify their lipid-lowering therapy. They also recommend LDL-C numbers less than 55 mg/dL for very-high risk ASCVD patients.13

In addition to ongoing research into new and existing therapies for people at high risk of cardiovascular disease, Amgen maintains partnerships with stakeholders to address barriers to care and help improve care and outcomes, and its actively working to bring together diverse groups of stakeholders to address the gaps that are present at every stage of the patient journey for ASCVD.

“We’ve been doing individual partnerships for years, but we’ve realized the need to bring multiple stakeholders together under one umbrella so we can amplify each other’s work,” George says. “We want to create a multiplication effect with patient advocacy organizations, professional organizations, industry peers, providers and others coming together to unlock this public health challenge.”

Whether you’ve had a cardiovascular event or not, you should know your LDL-C number so you can take steps to lower it if needed. If you have had an event, if you’re at high-risk for a second and if you’re not achieving your LDL-C treatment goals, you should talk to your cardiologist about adding a lipid lowering therapy.

References

  1. Gary H. Gibbons, M.D., Christine E. Seidman, M.D., and Eric J. Topol, M.D. Conquering Atherosclerotic Cardiovascular Disease — 50 Years of Progress. N Engl J Med 2021; 384:785-788. DOI: 10.1056/NEJMp2033115. 2021 Mar 4.
  2. Connie W. Tsao, Aaron W. Aday, Zaid I. Almarzooq, et al. Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association. Circulation. 2023;147:e93–e621. https://doi.org/10.1161/CIR.0000000000001123. 25 Jan 2023.
  3. Mark McClellan, Nancy Brown, Robert M. Califf and John J. Warner. Call to Action: Urgent Challenges in Cardiovascular Disease: A Presidential Advisory From the American Heart Association. Circulation. 2019;139:e44–e54. https://doi.org/10.1161/CIR.0000000000000652. 24 Jan. 2019
  4. Centers for Disease Control and Prevention. Heart Disease Facts. Accessed February 2023. https://www.cdc.gov/heartdisease/facts.htm
  5. Centers for Disease Control and Prevention. Preventing 1 Million Heart Attacks and Strokes. Accessed February 2023. https://www.cdc.gov/vitalsigns/million-hearts/index.html
  6. Grundy SM, Feingold KR. Guidelines for the Management of High Blood Cholesterol. [Updated 2022 May 28]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK305897/
  7. Endo A. A historical perspective on the discovery of statins. Proc Jpn Acad Ser B Phys Biol Sci. 2010;86(5):484-93. doi: 10.2183/pjab.86.484. PMID: 20467214; PMCID: PMC3108295.
  8. Michelle A. Albert, Mercedes R. Carnethon and Karol E. Watson. Disparities in Cardiovascular Medicine. Circulation. 2021;143:2319–2320. https://doi.org/10.1161/CIRCULATIONAHA.121.055565. 14 Jun 2021.
  9. Danchin N, Almahmeed W, Al-Rasadi K, et al. Achievement of low-density lipoprotein cholesterol goals in 18 countries outside Western Europe: The International ChoLesterol management Practice Study (ICLPS). Eur J Prev Cardiol. 2018 Jul;25(10):1087-1094. doi: 10.1177/2047487318777079. Epub 2018 May 17. PMID: 29771156; PMCID: PMC6039862.
  10. Data on File, Amgen; 2022.
  11. Katherine Wilemon, Diane MacDougall, Mary McGowan, William Howard, Kelly Myers, Family Heart Foundation. 71% of High Risk Hypercholesterolemia Patients Never Reach ACC AHA Guidelines. American College of Cardiology 2023 Annual Meeting. https://www.abstractsonline.com/pp8/#!/10674/presentation/18948
  12. Gencer B, Giugliano RP. Management of LDL-cholesterol after an acute coronary syndrome: Key comparisons of the American and European clinical guidelines to the attention of the healthcare providers. Clin Cardiol. 2020 Jul;43(7):684-690. doi: 10.1002/clc.23410. Epub 2020 Jun 29. PMID: 32596859; PMCID: PMC7368309.
  13. Lloyd-Jones D, Morris P, et al. 2022 ACC Expert Consensus Decision Pathway on the Role of Nonstatin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk. J Am Coll Cardiol. 2022 Oct, 80 (14) 1366–1418. https://doi.org/10.1016/j.jacc.2022.07.006

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