Let’s focus on two major types of CVD

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CVD is the leading cause of death in Brazil¹

In 2016, CVD was responsible for 29% of all deaths

Percent of total deaths

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CVD is the leading cause of disability in Brazil¹

In 2016, CVD was responsible for nearly 14% of disability-adjusted life years (DALYs)

Percent total DALYs lost

(Lost years of healthy life)

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Without action, the health and economic burden of CVD in Brazil will grow significantly over the next 20 years.²

• CVD Deaths
• CVD Cases
• Costs

• Projected number of deaths

• Projected number of cases

• Projected costs

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Dyslipidemia—including high LDL-C—is a major modifiable risk factor.

CVD Risk Factors ³

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Reducing LDL-C reduces the risk of heart attacks, strokes and death regardless of LDL level at baseline.⁴

CV events include: heart attack, coronary revascularization (bypass procedure), ischemic stroke

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Two groups of people are at the greatest risk of CVD events due to elevated LDL-C

Secondary Prevention (SP)

People with atherosclerotic cardiovascular disease (ASCVD) who have already experienced a CVD event^{5, 6, 7}

Heterozygous Familial Hypercholesterolemia (HeFH)

Genetic predisposition to very high LDL-C levels⁸

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These high-risk patients often have uncontrolled LDL-C despite treatment with standard of care, and represent a strategic target to reduce CVD burden.

1. SP
2. HeFH

1. 3.9 million people, or 2.7% of the 20+ year old Brazilian population, are Secondary Prevention (SP).

   Of the treated SP population in Brazil, 2.6 million of them (66%) are not at treatment goal and represent a strategic target population.⁹

2. 730,000 people, or 0.5% of the 20+ year old Brazilian population, are Heterozygous Familial Hypercholesterolemia (HeFH).

   Of the treated HeFH population in Brazil, 657,000 of them (90%) are not at treatment goal and represent a strategic target population.⁹

Even though the populations are relatively small, these high-risk groups could benefit the most from lowering LDL-C.

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Repatha® can lower LDL-C in these high risk patients:

Repatha® with optimized statins is shown across multiple studies in 30,000+ patients to reduce LDL-C in high-risk patients whose cholesterol is uncontrolled despite standard treatments.^{10, 11, 12, 13}

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Repatha® plus statins significantly reduced the risk of CVD events compared to statins alone.¹³

1. All Major CV Events
2. CV Death, Heart Attack, or Stroke

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Landmark analysis showed Repatha® risk reduction grows beyond one year.¹³

Longer duration of treatment and follow-up suggests larger risk reduction.

1. Year 1
2. After year 1

Risk reduction in CV death, heart attack and stroke (secondary endpoint) grew from 16% in the first year to 25% beyond one year

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Lowering LDL-C in all high risk patients to target levels could reduce CVD events over the next 20 years in Brazil.⁹

1. SP
2. HeFH

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Lowering LDL-C in all high-risk patients to target levels could reduce CVD costs over the next 20 years in Brazil.

1. SP
2. HeFH

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The World Health Organization (WHO) seeks to reduce the burden of CVD through five modifiable risk factors.¹⁴

WHO 25×25 goals

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Reducing all CVD risk factors is important, but we could make a significant impact by targeting high-risk patients who are not at LDL-C treatment goal.

1. SP
2. HeFH

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By lowering LDL-C in high-risk patients, we could make a significant impact on both health outcomes and costs.¹⁵

The WHO 25×25 goals are an important way to reduce the burden of CVD. Lowering LDL-C to target levels in high risk patients could help further reduce CVD events and associated costs over the next 20 years.

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1. Institute for Health Metrics and Evaluation (IHME). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, 2016. (Accessed Sept 29, 2017)
2. The Economic Burden of Cardiovascular Disease in Brazil; A Status Quo Forecast. The Conference Board of Canada, Sept 2016.
3. Risk Factors. World Heart Federation.
4. Cholesterol Treatment Trialists’ (CTT) Collaboration. Lancet. 2010;376:1670-1681.
5. Mohan et al., 2011.
6. Bhatt et al., 2010.
7. Smolina et al., 2012.
8. Villa et al., submitted.
9. The Health and Economic Impact of Reducing LDL Cholesterol in High Risk Populations in Brazil. The Conference Board of Canada, June 2017.
10. Robinson et al., 2014
11. Raal et al., 2015
12. Nissen SE and Nicholls SJ. Results of GLAGOV Trial – AHA 2016
13. Sabatine et al., 2017
14. WHO Global Monitoring Framework.
15. The Economic Burden of Cardiovascular Disease in Brazil. The Conference Board of Canada, June 2017.

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