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

Introduction: Intraoperative hypotension (IOH) is a common issue in surgeries, associated with severe postoperative complications and increased healthcare costs. Previous studies have identified various risk factors for IOH, but the role of biological age remains underexplored.
Aims: This study aimed to evaluate the association between accelerated biological aging and the risk of IOH in surgical patients.
Methods: A multicenter-based retrospective cohort study was conducted using electronic health records and anesthetic management system from three hospitals from April 2016 to December 2022. Patients undergoing major surgeries under general anesthesia were included. Biological age was determined using the phenotypic age (PA) approach. PA acceleration (PhenoAgeAccel) was also assessed. The primary endpoint was the occurrence of IOH, defined by mean arterial pressure (MAP) below 60 mmHg.
Results: Out of 19,475 patients included in the study, IOH was detected in 2750 (14.1%). Patients exhibiting biological aging had a higher risk of IOH after adjusting for age, sex, and surgery type (adjusted odds ratio [aOR], 1.08, 95% confidence interval [CI] 1.03-1.13, P<0.001). More significant PhenoAgeAccel were associated with longer cumulative duration of IOH (aOR 0.44, 95% CI 0.25-0.62, P<0.001) and greater area under the MAP threshold curve (aOR 3.00, 95% CI 0.86-5.14, P=0.006). Subgroup analysis confirmed these findings, particularly in patients aging between 0-39 (aOR 1.13, 95% CI 1.03-1.24, P=0.008), males (aOR 2.75, 95% CI 2.55-2.96, P<0.001), and those undergoing non-cardiac surgery (aOR 1.11, 95% CI 1.04-1.17, P=0.001), while an inverse association was observed in cardiac surgeries (aOR 0.69, 95% CI 0.58-0.82, P<0.001).
Discussion: The study suggested that accelerated biological aging may serve as a predictor for IOH, with higher biological aging linked to an increased risk and severity of IOH. Targeting preemptive measures and careful monitoring in patients identified with accelerated aging could potentially reduce the occurrence and impact of IOH.

Aim/Objective: To evaluate whether the risk of hospitalization for cardiovascular diseases (CVDs) in elderly populations declined following influenza vaccination.

Methods: This retrospective cohort study with target trial emulation framework utilized Taiwan’s National Health Insurance Research Database. Study subjects were the people aged ≥65 year from a flu season of 2019/2020. The vaccinated group was study subjects receiving an influenza vaccination in October-December 2019. Vaccinated elderly were matched with unvaccinated individuals within the same month using propensity score matching (PSM) on a series of patient baseline characteristics. Cox proportional hazard model was employed to assess the CVD risk with vaccination status.

Results: Among 500,000 elderly individuals sampled from the season of 2019/2020, 157,272 PSM pairs of vaccinated and unvaccinated elderly were identified, with a mean age of 73.3 years old and 45.9% of male subjects. Compared with non-vaccination, having an influenza vaccination reduced risks of various CVDs by 4%-34%, including ischemic heart disease (hazard ratio [95% confidence interval: 0.96 [0.92-1.02]), hypertensive heart disease (0.85 [0.79-0.91]), cerebrovascular disease (0.84 [0.77-0.91]), heart disease (0.84 [0.80-0.89]), pulmonary heart diseases (HR [95% CI]: 0.80 [0.64-1.01]), and other heart diseases (0.66 [0.43-0.99]). Results of series of sensitivity analyses (e.g., restricting influenza events to those confirmed by principal diagnoses, negative control outcome analyses, restricting the follow-up to different peak flu months) and interaction tests for various patient characteristics (e.g., age, gender, frailty status) are consistent with primary findings, supporting study robustness.

Conclusion: Vaccine effectiveness on CVD-related hospitalizations among the general elderly populations in real-world settings was well-corroborated.

Introduction: Antipsychotic medications are prescribed for various psychotic and non-psychotic disorders. Few studies have examined the cardiometabolic outcomes of antipsychotic use in a national cohort.
Aims: To generate real-world evidence on the cardiometabolic health of patients exposed to antipsychotics in this country in 2022.
Methods: Using a 10% representative sample of a national medication dispensing dataset, patients dispensed an antipsychotic in 2022 (exposed group) and patients without any current or previous antipsychotic dispensings (unexposed group) were identified. Their cardiometabolic burden was estimated as the proportion of subjects with dispensings for medicines to treat hyperglycemia, dyslipidemia, hypertension and thrombosis in 2022. Age, categorised into three groups (<18, 18–64, >/=65 years), and sex characteristics were compared between the two groups using Pearson’s chi-square test. Logistic regression analyses estimated the odds ratios (aOR) and 95% confidence intervals (CI) for cardiometabolic medication use, adjusted for baseline differences.
Results: Nearly 1.64 million subjects were chosen from the dataset, with 38,420 being dispensed an antipsychotic (2.4%) and the rest being unexposed. Both groups were significantly different in their baseline characteristics for age and sex (P <0.0001). The proportion of patients with any cardiometabolic outcome was 44.5% in the exposed cohort and 36.5% in the unexposed, yielding an aOR of 1.30 (95% CI 1.27–1.33). Similar results were observed for hyperglycemia (17.1% versus 9%, aOR 1.97), dyslipidemia (26% versus 21.3%, aOR 1.23) and thrombosis (9.6% versus 7.2%, aOR 1.35), while hypertension was lower in the exposed (27.1% versus 27.2%, aOR 0.87, 95% CI 0.84–0.89).
Discussion: Antipsychotic exposure is associated with a higher likelihood of the use of medications to treat hyperglycemia, dyslipidemia and thrombosis. These findings highlight the need for metabolic monitoring of patients prescribed antipsychotics, with careful consideration in non-psychotic disorders.

Introduction. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) significantly reduce risks of re-hospitalisations and deaths in people with heart failure (HF). While initially used for treating type 2 diabetes (T2D), accumulating evidence of cardiovascular benefits in people with HF regardless of T2D has resulted in expanded indications for HF. Little is known about the use of SGLT2i in Australian routine clinical practice among people with HF.
Aims. To quantify and characterise temporal trends in SGLT2i use following hospitalisation for HF.
Methods. Using linked administrative data, we identified adults hospitalised with HF in New South Wales during 2014-2021. We estimated the quarterly prevalence of SGLT2i use during the study period defined as having ≥1 SGLT2i dispensing in the 90 days following discharge. We assessed the sociodemographic and clinical characteristics of people with a post-discharge dispensing of SGLT2i in 2020-2021.
Results. We identified 57,496 people hospitalised with HF during 2014-2021 (median age 80.0 years, 51.6% male, 34.8% with T2D). We observed a ~8-fold increase in the prevalence of SGLT2i use over this period, reaching 7.8% by the end of 2021 (Figure). This increase was primarily driven by increased use in people with T2D, with a 16-fold increase, up to 16.5% by the end of 2021. There was almost no use among people without T2D from 2014-2020, but this increased to 1.8% by the end of 2021. 1,057 (5.7%) people were prescribed SGLT2i in 2020-2021, with key characteristics as follows: median age 72.0 years, 67.2% male, high comorbidities prevalence (94.0% T2D, 46.8% chronic kidney disease, 36.5% obesity), 66.9% SGLT2i prevalent users, and 65.2% used ≥10 medicines.
Discussion. SGLT2i use has increased among people hospitalised with HF, primarily in people with T2D. However, this use remains relatively low, with only one in six people hospitalised with HF with T2D in 2021 filling a prescription. Continued monitoring is required with the expanding indication for HF, to ensure clinical benefits are realised within this high-risk population.

Introduction. Clinical trials have shown that levels of active metabolites of prasugrel in the body were higher in East Asian populations, which may lead to an increased risk of bleeding in patients receiving standard doses of prasugrel. Whether a low-dose regimen of prasugrel provides the same treatment effect but reduces the risk of bleeding in East Asian populations is under discussion.
Aims. To compare the effectiveness and safety of low-dose and standard-dose prasugrel in East Asian populations by an anchored matching-adjusted indirect comparison using patient-level data from Taiwan and published aggregate data from Korea.
Methods. Using claims data from the National Health Insurance Research Database, we matched the population of Taiwan to the population of the Korean study and then adjusted 7 important covariates to balance the baseline characteristics between two study cohorts. Effectiveness outcomes were MACE, composite of cardiovascular death, non-fatal MI, stroke and vessel revascularization, and their individual components. Safety outcome was bleeding event. Fatal outcomes were all-cause death and cardiovascular death.
Results. After matching and adjusting, no significant differences were observed between two groups across all effectiveness and fatal outcomes, either during hospital admissions or in 6 months following DAPT initiation. However, the bleeding risk of the low-dose prasugrel group was significantly lower than that in the standard-dose prasugrel group (adjusted OR, 0.34; 95% CI, 0.13-0.94). The results were consistent with the main analysis in the sensitivity analyses adjusting different covariates.
Discussion. Due to diverse patient characteristics across studies, it is essential to account for these differences to ensure a more accurate comparison. Adjusting for cross-study differences, our results suggested similar treatment effectiveness between the low-dose and standard-dose prasugrel regimens for AMI patients, but low-dose prasugrel provided preferable for reducing bleeding events in East Asian populations.