(70) Long-Term Relative Effectiveness of Anti-Hypertensive and Anti-Hyperlipidemic Drug Monotherapy in Primary Prevention of Cardiovascular Events

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 744

Presenting Author(s)

Xuechun Li
– Rijksuniversiteit Groningen, Groningen, Groningen, Netherlands

Co-Author(s)

Maarten J. Bijlsma
– Unit of PharmacoTherapy, -Epidemiology, & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, 9713 AV Groningen, The Netherlands, Groningen, Netherlands
Jens H J Bos
– Unit of PharmacoTherapy, -Epidemiology, & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, 9713 AV Groningen, The Netherlands, Groningen, Netherlands
Catharina C M Schuiling-Veninga
– Unit of PharmacoTherapy, -Epidemiology, & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, 9713 AV Groningen, The Netherlands, Netherlands
Eelko Hak
– Unit of PharmacoTherapy, -Epidemiology, & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, 9713 AV Groningen, The Netherlands, Groningen, Netherlands

Background: Cardiovascular disease (CVD) is the leading cause of death globally and primary prevention by anti-hypertensive or anti-hyperlipidemic drug treatment may reduce this burden. However, real-world long-term comparative drug effectiveness studies are rare.

Objectives: To determine the long-term relative effectiveness of registered anti-hypertensive drugs (ACEi, ARB, BB, CCB, thiazides) and lipid-lowering drugs (BAS, fibrates, statins).

Methods: We conducted a retrospective inception cohort study using the University of Groningen IADB.nl pharmacy prescription database with data from 1996 to 2020. We included patients aged 18 years or older free of any CVD drugs prior to initiation of preventive monotherapy. Outcome was the time to first prescription of cardiac drug therapy.

Results: Among 33,427 patients with anti-hypertension monotherapy, 5204 (15.6%) patients experienced a CV event during an average follow-up time of 7.9 (SD:5.5) years. The 25 years incidence rate per 1000 person-years were 25.3, 22.4, 18.2, 24.4, and 22.0 for ACEi, ARB, BB, CCB, and thiazides starters, respectively. Inverse probability of treatment weighted Cox regression showed that thiazides starters had lower hazards compared with those who used BB (HR: 0.84, [95% CI]: 0.78, 0.91). Among 18,711 patients with hyperlipidemia monotherapy, 3250 (17.4%) patients experienced a CV event during an average follow-up time of 7.5 (SD:5.2) years. The 25 years incidence rate per 1000 person-years were 16.8, 30.6, and 24.8 for BAS, fibrates, and statins starters, respectively. Inverse probability of treatment weighted Cox regression showed fibrates starters had higher hazards compared to statins starters (HR: 1.71, [95% CI]: 1.00, 2.93).

Conclusions: Monotherapy with thiazides and statins appeared to be more effective than other anti-hypertensive and lipid-lowering drugs, respectively, in the prevention of a CV event. Other drugs had comparable effectiveness profiles.