All things Cardiovascular and Atherosclerosis Flashcards
How many people are on statins in the US? Worldwide?
40 million Americans are on statins
200 million are on statins worldwide
What drug types lower LDL?
Statins
Bile acid sequestrants
Niacin
Zetimibe
PCSK9 inhibitors
CETP inhibitors
How do PCSK9 inhibitors work?
The liver is able to take up excess cholesterol from the blood. However, there is a receptor
What are the most popular statins and how much do they cost per 30 days
Lipitor: $559 (generic Atorvastin: $20)
Lescol XL: $401 (generic Fluvastatin: $128)
Livalo: $339 patent expires 2024
Pravachol: $371 (generic Pravastatin $20)
Crestor: $294 (generic Rosuvastatin: $15)
Zocor: $173 (generic Simvastatin: $13)
What percentage of people experience side-effects with statins?
5%-10% or less when compared to a placebo. This varies from study to study. A meta analysis of 176 studies and over 4m patients found the prevalance of statin intollerance at 9.1%, (Banach et 2022). However as many as 30% stop taking statins due to percieved side-effects (usually muscle aches) and up to 50% stop, reduce dose, or take infrequently due to percieved side-effects (the nocebo effect)
What percentage of people are on statins?
According to an NHANES survey from 2012:
40-59 yrs old: 17%
60-74 yrs old: 43%
75+: 47%
Cost of a cardiac event
Downstream conditions
Hypertension > further damage to arteries
Stenosis > angina, peripheral vascular disease
Plaque rupture > thrombis > heart attack / stroke
How much did Lipitor make in its prime? How does that compare to other blockbuster drugs from other years?
Lipitor made $13 billion in its biggest year in 2006. It was the top selling drug from 2001 - 2011 when it came off patent. Humira took over and grew from 7B to 21B in 2022. It goes off-patent in 2023.
In 2006 when Lipitor made the most money, what percentage of people in the US and World were 65+? What will that number be by 2030? 2040 (I’m assuming when the patent runs out)?
12.4% (36.8 million people) were over 65 in 2005
17% (73 million people) will be over 65 in 2030
21.6% (80.8 million people) will be over 65 in 2040
https://acl.gov/sites/default/files/aging%20and%20Disability%20In%20America/2020Profileolderamericans.final_.pdf
Hyperlipidemia
High levels of LDL or triglycerides
Dyslipidemia
An imbalance or abnormal amount of lipids in the blood. This includes triglycerides, cholesterol, and/or fat phospholipids in the blood. Dyslepidemia is a risk factor for athersclerotic cardiovascular disease, cerebrovascular disease, and peripheral artery disease.
Pharmacoeconomics and Pharmacoeconomic benefits
Pharmacoeconomics is the measuring of outcomes associated with the use of pharamceuticals in healthcare delivery.
Pharmacoeconomic benefits are the improvements in costs that a pharmaceutical causes in the delivery of healthcare
Direct medical costs for patients with established cardiovascular diseasees
$18,953 mean with stdev of $39,036 in the US (2010 study that tracked 12,000 patients in Kaiser Permanented Northwest from 2000-2008). Inpatient costs accounted for 42.8% ($8,114). And the biggest cost difference were between people who had a second hospitalization vs those that didn’t ($62,755 vs $13,509) https://europepmc.org/article/med/20205493
What would treatment with Cyclarity’s drug look like?
3-5 injections over 2-3 weeks, then not again for several years /decades