OBJECTIVES: To document incidence, patient characteristics, and treatments of high-risk vascular disease (HRVD, defined as history of acute coronary syndrome [hACS], cerebrovascular disease [CVD], peripheral artery disease [PAD], or coronary artery disease w/diabetes [CADD]) in an employed Japanese population.
METHODS: A retrospective analysis was conducted using the Japan Medical Data Center (JMDC) database, which comprises multiple employer-sourced insurance societies in Japan, with inpatient, outpatient, and pharmacy claims of ~800,000 lives from 2006–2011. HRVD incidence was estimated based on diagnoses for CVD, PAD, CADD, and hACS (defined as another ACS claim >30–≤365 days after an ACS-related hospitalization) occurring between January 1, 2008 to December 31, 2009. Population denominators for this period were provided by JMDC. A subcohort with insurance coverage for ≥12 months before and ≥24 months after first/index HRVD claim during January 1, 2008 to December 31, 2009 were analyzed on demographics, comorbidities, and treatments.
RESULTS: HRVD incidence was 2,238 per 100,000 population. By subtype (non-mutually exclusive), incidence was 73 hACS, 1,289 CVD, 897 PAD, and 591 CADD per 100,000; 22% had ≥2 HRVD subtypes. hACS and CADD incidence per 100,000 was markedly higher in males (111 and 730, respectively) versus females (35 and 409). In total, 10,400 patients met the inclusion criteria for analyses of patient characteristics, comorbidities, treatments. Mean [SD] age at index was 52.8 [10.9] years and 57% were male. Comorbid hypertension and dyslipidemia were common (24% and 17%, respectively). Pre-index use of antihypertensives and lipid-altering drugs was 22% and 15%, respectively. During 24 months post-index, use of these agents increased to 53% and 42%. Post-index use of antiplatelets (including prescription aspirin), anticoagulants, and NSAIDs was 30%, 15%, and 66%, respectively, with substantially higher use in hACS patients.
CONCLUSIONS: HRVD was not rare in the employed Japanese population analyzed, and a high proportion of cases involved multiple HRVDs. Pharmacotherapy after HRVD diagnosis appeared suboptimal, particularly for non-hACS patients.
