Better Strategies to Reduce Cardiovascular Events

Following a discussion on the use of newer therapies to improve the management of residual cardiovascular risk in patients at high risk for cardiovascular events, stakeholders consider better ways to implement cost-effectiveness data and provide patients with access to newer therapies.


Deepak L. Bhatt, MD, MPH: I’d like to thank all of you for this extremely rich and informative discussion. Before concluding, I’d like to get some final thoughts from each of you. Maybe we’ll just go alphabetically. I’ll start with Adam Bress.

Adam Bress, PharmD, MS: Sure. There are only a few health care interventions that I would label as public health best buys. I mentioned generic statins. I mentioned treating hypertension. The recent analysis around icosapent ethyl in high-risk patients puts it in that category as a public health best buy, and we should be considering how to best implement these data to reduce cardiovascular disease risk to the greatest extent to the largest population.

Deepak L. Bhatt, MD, MPH: Really good thoughts. Let me turn to Dr Budoff.

Matthew J. Budoff, MD: Going from cost-effectiveness toward clinical effectiveness or event reduction, icosapent ethyl ends up giving us the biggest bang for our buck as far as event reduction. We’ve seen 25% to 30%-plus event reductions by adding icosapent ethyl to statins. Although we don’t see head-to-head studies, we see a significantly larger number than what we’ve seen from other therapies, like ezetimibe or PCSK9s. Even the diabetes agents—SGLT2s or GLP1s—have not achieved that event reduction. That incremental benefit in the right patients, such as the patients with high triglycerides, will be very beneficial.

Deepak L. Bhatt, MD, MPH: Terrific. Eric Cannon?

Eric Cannon, PharmD, FAMCP: Thank you. This conversation has been amazing, and it’s highlighted many of the advances we’ve had in this area. Ultimately, though, we need to find these patients. Having appropriate strategies to identify the patients who can benefit from these therapies is really incumbent on all of us. As we look at our clients and those employer groups that we take care of, how do we, within their population, identify those patients who may not be looking to go to the doctor but are at high risk and could definitely benefit from these therapies? This is 1 of those things that we’re really focused on, and it’s a huge opportunity for us going forward because we now have a lot of treatments that will benefit our patients.

Deepak L. Bhatt, MD, MPH: Great. Dr Navar?

Ann Marie Navar, MD, PhD: I’ll just piggyback on the last comment around finding the patient. If we look at PCSK9 inhibitors, we did a lot of work showing high rates of rejection by payers and high rates of abandonment due to co-pay. But even if every patient who had been prescribed a PCSK9 inhibitor was able to get on it, we would have been treating only about 1% to 2% of eligible patients in the United States. The reality is that a lot of the burden still rests on us, the providers, to identify and prescribe the right treatments for the right patients.

We still don’t have every eligible patient on a statin or on appropriate antiplatelet medication. There are a lot of therapies in secondary prevention that we have yet to reach the full value of because we’re not getting them to the patients who need them. We need to do a better job of shortening the time between when a new therapy is made available to us and when we have the majority of our patients on that treatment.

Given the remarkable cost-effectiveness if not cost savings of icosapent ethyl, we really have no excuse to not be treating all our eligible patients with this therapy, or at least giving them the opportunity to make a decision for themselves about whether or not they want the treatment. It shouldn’t be because we’re not prescribing it or not recommending it for our patients.

Deepak L. Bhatt, MD, MPH: Wonderful. Thank you, again, to all the faculty. I found this discussion to be extremely interesting and educational. I learned a lot. Hopefully the viewing audience did as well. Thank you to those of you watching, and hopefully you found this AJMC® panel discussion to be educational, useful, and informative. Thank you so much.

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