Disease burden and treatment patterns of atherosclerotic cardiovascular diseases in Hong Kong

Abstract

<p>Introduction:<br>Evidence on the clinical disease burden and lipid-lowering drug treatment choices among patients<br>with incident atherosclerotic cardiovascular disease (ASCVD) in Hong Kong is limited.<br>Aims:<br>This study aims to describe the disease burden and treatment patterns for secondary prevention of<br>ASCVD in Hong Kong by identifying the incidence of diseases, mortality rates, patients' LDL<br>cholesterol levels, and treatment of lipid-lowering agents, utilising real-world data from the Hong<br>Kong public healthcare system.<br>Methods:<br>All patients with an incident diagnosis or procedure code for ASCVD from 2010 to 2020 in a territorywide<br>clinical database in Hong Kong were identified. We studied the incidence, mortality rates, lowdensity<br>lipoprotein (LDL) cholesterol trends, and treatments stratified by each ASCVD, age and sex<br>groups.<br>Results:<br>A total of 243,201 cases of ASCVD were included. The three most frequent index ASCVD conditions<br>were ischemic stroke (n= 86,251 [35.5%]), myocardial infarction (MI) (n=54,674 [22.5%]), and chronic<br>coronary heart disease (n= 42578 [17.5%]). Incidence of all ASCVD decreased from 326 per 100,000<br>individuals in 2010 to 266 in 2020. Ischaemic stroke had the highest incidence during these 10 years.<br>The all-cause mortality rate at 5 years after the index ASCVD event was the highest for MI and was<br>greater in women than men. Over 80% of patients with ASCVD received statins in Hong Kong, with<br>very low uptake of non-statin lipid-lowering agents (5.2%). Despite most patients starting statin<br>prescriptions after ASCVD diagnosis for over a year, half of patients still had LDL cholesterol levels<br>over 1.8 mmol/L after years of follow-up.<br>Conclusion:<br>The overall incidence of ASCVD decreased from 2010 to 2020. Despite high coverage of statin<br>prescriptions in Hong Kong, the disease burden remained high with an unmet goal of optimal LDL<br>cholesterol levels.<br></p>