Factors Associated With PCSK9 Inhibitor Initiation Among US Veterans.

Autor: Derington CG; Division of Health System Innovation and Research Department of Population Health Sciences University of Utah School of Medicine Salt Lake City UT., Colantonio LD; Department of Epidemiology University of Alabama at Birmingham School of Public Health Birmingham AL., Herrick JS; Division of Epidemiology Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT.; Informatics, Decision-Enhancement and Analytic Sciences Center of Innovation Veterans Affairs Salt Lake City Health Care System Salt Lake City UT., Cook J; Division of Epidemiology Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT.; Informatics, Decision-Enhancement and Analytic Sciences Center of Innovation Veterans Affairs Salt Lake City Health Care System Salt Lake City UT., King JB; Division of Health System Innovation and Research Department of Population Health Sciences University of Utah School of Medicine Salt Lake City UT.; Institute for Health Research Kaiser Permanente Colorado Aurora CO., Rosenson RS; Mount Sinai Heart Icahn School of Medicine at Mount Sinai New York NY., Poudel B; Department of Epidemiology University of Alabama at Birmingham School of Public Health Birmingham AL., Monda KL; Center for Observational Research and Medical Affairs Amgen Inc Thousand Oaks CA., Navar AM; University of Texas Southwestern Medical Center Dallas TX., Mues KE; Center for Observational Research and Medical Affairs Amgen Inc Thousand Oaks CA., Stevens VW; Division of Epidemiology Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT.; Informatics, Decision-Enhancement and Analytic Sciences Center of Innovation Veterans Affairs Salt Lake City Health Care System Salt Lake City UT., Nelson RE; Division of Epidemiology Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT.; Informatics, Decision-Enhancement and Analytic Sciences Center of Innovation Veterans Affairs Salt Lake City Health Care System Salt Lake City UT., Vanneman ME; Division of Health System Innovation and Research Department of Population Health Sciences University of Utah School of Medicine Salt Lake City UT.; Division of Epidemiology Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT.; Informatics, Decision-Enhancement and Analytic Sciences Center of Innovation Veterans Affairs Salt Lake City Health Care System Salt Lake City UT., Muntner P; Department of Epidemiology University of Alabama at Birmingham School of Public Health Birmingham AL., Bress AP; Division of Health System Innovation and Research Department of Population Health Sciences University of Utah School of Medicine Salt Lake City UT.; Informatics, Decision-Enhancement and Analytic Sciences Center of Innovation Veterans Affairs Salt Lake City Health Care System Salt Lake City UT.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2021 Apr 20; Vol. 10 (8), pp. e019254. Date of Electronic Publication: 2021 Apr 06.
DOI: 10.1161/JAHA.120.019254
Abstrakt: Background Few adults at high risk for atherosclerotic cardiovascular disease events use a PCSK9i (proprotein convertase subtilisin/kexin type 9 inhibitor). Methods and Results Using data from the US Veterans Health Administration, we identified veterans who initiated a PCSK9i between January 2018 and December 2019, matched 1:4 to veterans who did not initiate this medication over this time period (case-cohort study). Two cohorts of veterans were analyzed: (1) atherosclerotic cardiovascular disease, with a most recent low-density lipoprotein cholesterol (LDL-C) ≥70 mg/dL; and (2) severe hypercholesterolemia (ie, familial hypercholesterolemia or any prior LDL-C ≥190 mg/dL, with most recent LDL-C ≥100 mg/dL). Conditional logistic regression was used to analyze factors associated with PCSK9i initiation, adjusting for all factors, simultaneously. There were 2394 initiators and 9576 noninitiators in the atherosclerotic cardiovascular disease cohort (median LDL-C, 141 and 96 mg/dL, respectively; P <0.001). Factors associated with a higher likelihood of PCSK9i initiation included age 65 to <75 versus <65 years, highest versus lowest quartile of median area-level income, familial hypercholesterolemia, former statin use, and current ezetimibe use. PCSK9i initiation was lower among veterans of a race/ethnicity other than non-Hispanic White. There were 245 initiators and 980 noninitiators in the severe hypercholesterolemia cohort (median LDL-C, 183 and 151 mg/dL, respectively; P <0.001). Age ≥75 versus <65 years, history of chronic kidney disease, former statin use, and current ezetimibe use were associated with a higher likelihood of PCSK9i initiation. Conclusions Several patient-level factors, including age, sex, and race/ethnicity, were significantly associated with PCSK9i initiation, suggesting an unmet treatment need in several patient groups.
Databáze: MEDLINE
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