The Potential Benefits and Costs of an Intensified Approach to Low Density Lipoprotein Cholesterol Lowering in People with Abdominal Aortic Aneurysm,European Journal of Vascular and Endovascular Surgery

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The Potential Benefits and Costs of an Intensified Approach to Low Density Lipoprotein Cholesterol Lowering in People with Abdominal Aortic Aneurysm
European Journal of Vascular and Endovascular Surgery ( IF 5.7 ) Pub Date : 2021-09-08 , DOI: 10.1016/j.ejvs.2021.06.031
Domenico R Nastasi ₁ , Richard Norman ₂ , Joseph V Moxon ₃ , Frank Quigley ₄ , Ramesh Velu ₅ , Jason Jenkins ₆ , Jonathan Golledge ₇

Affiliation

Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
Curtin University, Perth, Western Australia, Australia.
Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; Centre for Molecular Therapeutics, The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia.
Department of Vascular and Endovascular Surgery, Mater Hospital, Townsville, Australia.
The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia.
Department of Vascular and Endovascular Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; Centre for Molecular Therapeutics, The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia; The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia.

Objective

The aims of this study were to assess the incidence of major vascular events (MVE) and peripheral vascular events (PVE) in people with a small asymptomatic abdominal aortic aneurysm (AAA) and model the theoretical benefits and costs of an intensified low density lipoprotein cholesterol (LDL-C) lowering programme.

Methods

A total of 583 participants with AAAs measuring 30 – 54 mm were included in this study. The control of LDL-C and prescription of lipid lowering drugs were assessed by dividing participants into approximately equal tertiles depending on their year of recruitment into the study. The occurrence of MVE (myocardial infarction, stroke, cardiovascular death, and coronary or non-coronary revascularisation) and PVE (non-coronary revascularisation, AAA repair, and major amputation) were recorded prospectively, and the incidence of these events was calculated using Kaplan–Meier analysis. The relative risk reduction reported for these events in a previous randomised control trial (RCT) was then applied to these figures to model the absolute risk reduction and numbers needed to treat (NTT) that could theoretically be achieved with a mean LDL-C lowering of 1 mmol/L. The maximum allowable expense for a cost effective intensive LDL-C lowering programme was estimated using a cost utility analysis.

Results

At entry, only 28.5% of participants had an LDL-C of < 1.8 mmol/L and only 18.5% were prescribed a high potency statin (atorvastatin 80 mg or rosuvastatin 40 mg). The five year incidences of MVE and PVE were 38.1% and 44.7%, respectively. It was estimated that if the mean LDL-C of the cohort had been reduced by 1 mmol/L, this could have reduced the absolute risk of MVE and PVE by 6.5% (95% CI 4.4 – 8.7; NNT 15) and 5.3% (95% CI 1.4 – 7.5; NNT 19), respectively. It was estimated that the maximum allowable expense for a cost effective LDL-C lowering programme would be between $1 239 AUD (€768) and $1 582 AUD (€981) per person per annum over a five year period.

Conclusion

People with a small asymptomatic AAA are at high risk of MVE and PVE. This study provides evidence of the possible benefits and allowable expense for a cost effective intensive LDL-C lowering programme in this population.

中文翻译：

腹主动脉瘤患者降低低密度脂蛋白胆固醇的强化方法的潜在益处和成本

客观的

本研究的目的是评估无症状腹主动脉瘤 (AAA) 患者主要血管事件 (MVE) 和外周血管事件 (PVE) 的发生率，并对强化低密度脂蛋白胆固醇的理论收益和成本进行建模。 (LDL-C) 降低计划。

方法

本研究共包括 583 名 AAA 尺寸为 30 – 54 mm 的参与者。LDL-C 的控制和降脂药物的处方通过将参与者分成大致相等的三分位数来评估，这取决于他们被招募到研究的年份。前瞻性记录 MVE（心肌梗塞、中风、心血管死亡、冠状动脉或非冠状动脉血运重建）和 PVE（非冠状动脉血运重建、AAA 修复和大截肢）的发生率，并使用 Kaplan 计算这些事件的发生率——迈尔分析。然后将先前随机对照试验 (RCT) 中报告的这些事件的相对风险降低应用于这些数字，以模拟绝对风险降低和需要治疗的人数 (NTT)，理论上可以通过平均 LDL-C 降低来实现1 毫摩尔/升。使用成本效用分析估算了具有成本效益的强化 LDL-C 降低计划的最大允许费用。

结果

入组时，只有 28.5% 的参与者的 LDL-C < 1.8 mmol/L，只有 18.5% 的参与者服用了高效他汀类药物（阿托伐他汀 80 毫克或瑞舒伐他汀 40 毫克）。MVE 和 PVE 的五年发生率分别为 38.1% 和 44.7%。据估计，如果队列的平均 LDL-C 降低 1 mmol/L，则 MVE 和 PVE 的绝对风险可降低 6.5%（95% CI 4.4 – 8.7；NNT 15）和 5.3% （95% CI 1.4 – 7.5；NNT 19），分别。据估计，一项具有成本效益的 LDL-C 降低计划的最大允许费用将在五年期间每人每年 1,239 澳元（768 欧元）至 1,582 澳元（981 欧元）之间。