Forecasting the Future of Cardiovascular Disease in the United States

Heidenreich, Paul A.; Trogdon, Justin G.; Khavjou, Olga; Butler, Javed; Dracup, Kathleen; Ezekowitz, Michael D.; Finkelstein, Eric A.; Hong, Yuling; Johnston, S. Claiborne; Khera, Amit V.; Lloyd‐Jones, Donald M.; Nelson, Sue; Nichol, Graham; Orenstein, Diane; Wilson, Peter W.F.; Woo, Y. Joseph

doi:10.1161/cir.0b013e31820a55f5

Cited by 2,803 publications

(1,869 citation statements)

References 62 publications

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“…Despite the widespread use of statins, the economic burden associated with CVD is onerous, with > US$650 billion spent on CVD‐related costs annually in the United States 1, 2. These costs are projected to nearly double by 2030 1.…”

Section: Introductionmentioning

confidence: 99%

Cost‐Effectiveness ofLDL‐C Lowering With Evolocumab in Patients With High Cardiovascular Risk in the United States

Gandra

Villa

Fonarow

et al. 2016

Clinical Cardiology

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Randomized trials have shown marked reductions in low‐density lipoprotein cholesterol (LDL‐C), a risk factor for cardiovascular disease (CVD), when evolocumab is administered. We hypothesized that evolocumab added to standard of care (SOC) vs SOC alone is cost‐effective in the treatment of patients with heterozygous familial hypercholesterolemia (HeFH) or atherosclerotic CVD (ASCVD) with or without statin intolerance and LDL‐C >100 mg/dL. Using a Markov cohort state transition model, primary and recurrent CVD event rates were predicted considering population‐specific trial‐based mean risk factors and calibrated against observed rates in the real world. The LDL‐C–lowering effect from population‐specific phase 3 randomized studies for evolocumab was used together with estimated LDL‐C–lowering effect on CVD event rates per 38.67‐mg/dL LDL‐C lowering from a statin‐trial meta‐analysis. Costs and utilities were included from published sources. Evolocumab treatment was associated with both increased cost and improved quality‐adjusted life‐years (QALY): HeFH (incremental cost: US$153 289, incremental QALY: 2.02, incremental cost‐effectiveness ratio: US$75 863/QALY); ASCVD (US$158 307, 1.12, US$141 699/QALY); and ASCVD with statin intolerance (US$136 903, 1.36, US$100 309/QALY). Evolocumab met both the American College of Cardiology/American Heart Association (ACC/AHA) and World Health Organization (WHO) thresholds in each population evaluated. Sensitivity and scenario analyses confirmed that model results were robust to changes in model parameters. Among patients with HeFH and ASCVD with or without statin intolerance, evolocumab added to SOC may provide a cost‐effective treatment option for lowering LDL‐C using ACC/AHA intermediate/high value and WHO cost‐effectiveness thresholds. More definitive information on the clinical and economic value of evolocumab will be available from the forthcoming CVD outcomes study.

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Section: Introductionmentioning

confidence: 99%

Cost‐Effectiveness ofLDL‐C Lowering With Evolocumab in Patients With High Cardiovascular Risk in the United States

Gandra

Villa

Fonarow

et al. 2016

Clinical Cardiology

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“…The number of older adults in the developed world is expected to at least double by 2050 (Petsko, 2008), and this is associated with projections of marked increases in CVD burden (Heidenreich et al ., 2011). Therefore, there is an urgent need to develop treatments that reduce the risk of CVD with aging.…”

Section: Introductionmentioning

confidence: 99%

Nicotinamide mononucleotide supplementation reverses vascular dysfunction and oxidative stress with aging in mice

et al. 2016

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SummaryWe tested the hypothesis that supplementation of nicotinamide mononucleotide (NMN), a key NAD + intermediate, increases arterial SIRT1 activity and reverses age‐associated arterial dysfunction and oxidative stress. Old control mice (OC) had impaired carotid artery endothelium‐dependent dilation (EDD) (60 ± 5% vs. 84 ± 2%), a measure of endothelial function, and nitric oxide (NO)‐mediated EDD (37 ± 4% vs. 66 ± 6%), compared with young mice (YC). This age‐associated impairment in EDD was restored in OC by the superoxide (O2−) scavenger TEMPOL (82 ± 7%). OC also had increased aortic pulse wave velocity (aPWV, 464 ± 31 cm s−1 vs. 337 ± 3 cm s−1) and elastic modulus (EM, 6407 ± 876 kPa vs. 3119 ± 471 kPa), measures of large elastic artery stiffness, compared with YC. OC had greater aortic O2− production (2.0 ± 0.1 vs. 1.0 ± 0.1 AU), nitrotyrosine abundance (a marker of oxidative stress), and collagen‐I, and reduced elastin and vascular SIRT1 activity, measured by the acetylation status of the p65 subunit of NFκB, compared with YC. Supplementation with NMN in old mice restored EDD (86 ± 2%) and NO‐mediated EDD (61 ± 5%), reduced aPWV (359 ± 14 cm s−1) and EM (3694 ± 315 kPa), normalized O2− production (0.9 ± 0.1 AU), decreased nitrotyrosine, reversed collagen‐I, increased elastin, and restored vascular SIRT1 activity. Acute NMN incubation in isolated aortas increased NAD + threefold and manganese superoxide dismutase (MnSOD) by 50%. NMN supplementation may represent a novel therapy to restore SIRT1 activity and reverse age‐related arterial dysfunction by decreasing oxidative stress.

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“…HF is associated with ≈1.1 million hospitalizations and 3.4 million ambulatory care visits annually 2. Over 20% of patients hospitalized for HF are rehospitalized within 30 days, and almost a quarter of these patients are seen in an Emergency Department (ED) within 30 days after hospitalization for HF 3.…”

Section: Introductionmentioning

confidence: 99%

Dual Healthcare System Use During Episodes of Acute Care Heart Failure Associated With Higher Healthcare Utilization and Mortality Risk

Axon

Gebregziabher

Everett

et al. 2018

JAHA

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BackgroundIndividuals receiving cross‐system care (dual users) have higher rates of healthcare utilization and worse outcomes for heart failure (HF) and other conditions. Individuals can be dual users or single‐system users at different times, though, and little is known about utilization and mortality within discrete episodes of care.Methods and ResultsA retrospective cohort of 3439 patients with 5231 discrete episodes of HF exacerbation were identified between 2007 and 2011. Episodes encompassed the period from 2 weeks before an initial HF emergency department (ED) visit or hospitalization, included any acute care visits within 30 days after initial visit, and ended 30 days after the last acute care visit in the episode chain. All‐cause and HF‐specific ED visits and hospitalization within 30 days of index visit were analyzed using generalized estimating equations with robust variance. Hazard for death within episodes of acute illness was analyzed using Cox proportional hazards models. In adjusted analyses, dual use acute HF episodes were associated with higher odds of all‐cause ED visits (odds ratio 1.61, 95% confidence interval [CI], 1.33, 1.95), HF‐specific ED visits, (odds ratio 1.54, 95% CI, 1.12, 2.13), all‐cause hospitalization (odds ratio 1.89, 95% CI, 1.50, 2.38), and HF‐specific hospitalization (odds ratio 1.62, 95% CI, 1.15–2.30) as compared with Veterans Health Administration–only episodes of acute HF care. Dual use episodes of care were associated with higher hazard for mortality (hazard ratio=1.52, 95% CI 1.07, 2.16) as compared with all–Veterans Health Administration episodes of care.ConclusionsEpisodes of acute HF care spanning across healthcare systems appear to be associated with higher risk of subsequent ED visits, hospitalization, and mortality.

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Forecasting the Future of Cardiovascular Disease in the United States

Cited by 2,803 publications

References 62 publications

Cost‐Effectiveness ofLDL‐C Lowering With Evolocumab in Patients With High Cardiovascular Risk in the United States

Cost‐Effectiveness ofLDL‐C Lowering With Evolocumab in Patients With High Cardiovascular Risk in the United States

Nicotinamide mononucleotide supplementation reverses vascular dysfunction and oxidative stress with aging in mice

Dual Healthcare System Use During Episodes of Acute Care Heart Failure Associated With Higher Healthcare Utilization and Mortality Risk

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