The burden of a widespread disease
Cardiovascular diseases—such as heart attacks, strokes and peripheral arterial disease—are the leading cause of death globally. Cardiovascular disease (CVD) accounts for 17.3 million deaths per year globally1, and it accounts for about one in every three deaths in the United States.2 Unfortunately, after decades of a steady decline, mortality in the U.S. due to CVD has plateaued, and is increasing for some demographics.3 Approximately every 40 seconds, an American will have a heart attack.4 Few aren’t touched by the disease in some way, either personally or through friends, family and colleagues who have the disease. Due to improved survival after acute cardiovascular events such as heart attacks, cardiovascular disease is increasingly a chronic disease. Living with CVD has profound, lifelong negative consequences for people, their families and caregivers.
In addition to the impact that cardiovascular diseases have on individuals’ lives, the costs of CVD to society continue to rise. The disease accounts for $1 trillion in direct healthcare spending globally and more than $350 billion in the U.S.5, or about $1 out of every $6 spent on healthcare.6
At The Medicines Company, we have a singular and relentless focus on the greatest global healthcare challenge and burden today – atherosclerotic cardiovascular disease (ASCVD).
The link between ASCVD and LDL-C (bad cholesterol)
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of CVD morbidity and death. Cumulative exposure to low-density lipoprotein (LDL) cholesterol, also known as LDL-C or bad cholesterol, over a lifetime causes ASCVD and is the most readily modifiable risk factor.7 LDL-C is a waxy substance that accumulates in artery walls over time. Accumulation of LDL-C in the walls of arteries causes atherosclerosis. In the early stages of ASCVD, this process occurs silently without people experiencing any symptoms. Over time, as the disease progresses, people may develop symptoms as a result of reduced blood flow. Often, however, people do not experience any symptoms until the atherosclerotic plaque unexpectedly ruptures and causes a heart attack or stroke.
According to the American Heart Association, about one in three American adults has high levels of LDL-C.8 Overwhelming evidence demonstrates that lower LDL-C is simply better. It’s not only the level of LDL-C that matters; LDL-C needs to be consistently low over time to reduce the risk of a heart attack or stroke.9 This is particularly important in people who have already had a heart attack or stroke because they are at an even higher risk of another event.
Unmet medical need for lowering LDL-C
Lifestyle adjustments, such as modifying diet and exercise can improve cardiovascular health. However, many people struggle to maintain a healthy lifestyle, and lifestyle improvements alone may not be enough – particularly for people with a high risk of CVD. In addition, despite available therapies proven to be safe and effective at lowering LDL-C, many people don’t receive appropriate or sufficient treatment. This is partly because people may not know their LDL-C levels.
In addition, many people do not take prescribed therapies as directed. Poor adherence to therapies that require frequent administration undermines treatment success. Even when people take their oral therapies as prescribed, not all reach their LDL-C goals. For example, in patients with ASCVD, high-dose oral combination therapies leave about one out of six people in need of additional therapy to bring down their LDL-C to adequate levels.10
Missed opportunities in CVD
- Failure to make risk factor modifications (e.g., a 10% increase in treating LDL-C or in preventive aspirin could prevent 8,000 deaths annually)
- Failure to elicit and follow people’s goals
- Failure to diagnose (e.g., 20-40% of heart attacks occur in undiagnosed patients)
- Failure to use proven first-line treatments (43-67% of patients are non-adherent to statins after one year)
For information about LDL-C or bad cholesterol, and what can be done to more effectively manage it and lower risk of cardiovascular disease, learn more from these resources:
- 1 McClellan M et al, AHA Presidential Advisory, Call to Action: Urgent Challenges in Cardiovascular Disease, January 2019.
- 2 American Heart Association. Heart Disease and Stroke Statistics, 2019 update.
- 3 McClellan M et al, AHA Presidential Advisory, Call to Action: Urgent Challenges in Cardiovascular Disease, January 2019.
- 4 American Heart Association. Heart Disease and Stroke Statistics, 2019 update.
- 5 American Heart Association. Heart Disease and Stroke Statistics, 2019 update.
- 6 McClellan M et al, AHA Presidential Advisory, Call to Action: Urgent Challenges in Cardiovascular Disease, January 2019.
- 7 Goldstein J et al, A century of cholesterol and coronaries: From plaques to genes to statins, Cell, March 2015.
- 8 American Heart Association. Heart Disease and Stroke Statistics, 2019 update.
- 9 Baigent C et al, Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins, Lancet, October 2005.
- 10 Cannon C et al, Simulation of lipid-lowering therapy intensification in a population with atherosclerotic cardiovascular disease, JAMA Cardiology, September 2017.