Markedly increased healthcare costs after being diagnozed with peripheral artery disease

Lars Pål Hasvold has used big data from Swedish healthcare registries to compare risks associated with medications for high blood pressure and hypercholesterolemia. He has also looked at the healthcare costs of patients with peripheral artery disease.


  1. Patients with hypertension who receive candesartan have lower risk of type 2 diabetes than patients who receive enalapril.
  2. Reduction in HDL-cholesterol is relatively common following statin inititation and associated with indreased risk of major adverse cardiovascular events.
  3. Patient-related healthcare costs increase substantially the first year after a diagnosis of peripheral artery disease.


Thesis: Cardiovascular Disease and the Use of Swedish Health Care Registries and Electronic Medical Data From Primary Care: Disease Reality, Risk Factors, Comparative Effectiveness and Outcomes
Candidate: Lars Pål Hasvold
Time: February 13, 2018 at 13:15
Place: Oslo University Hospital, Ullevaal, Midtblokken (Building 6): Large Auditorium
Link to university website (in Norwegian)


(1) Candesartan might be more protective against type 2 diabetes than enalapril. Both drugs reduced blood pressure equally, but the incidence rate of new-onset diabetes was 19 % lower in patients initiated on candesartan. The results might indicate that angiotensin-II receptor blockers in general are better than ACE inhibitors when it comes to preventing type 2 diabetes in patients with hypertension.

Registry data from more than 16 000 Swedish patients was used in the analyses, and the mean follow-up time was almost two years. No difference between the groups was observed in risk of cardiovascular disease.

(2) HDL-cholesterol levels decrease more than 0.1 mmol/L in 20 % of the patients initiated on statins. Compared with a propensity score-matched group of patients with unchanged HDL-cholesterol following statin initiation, the risk of a major adverse cardiovascular event during follow-up was increased by 56 %.

This study includes more than 15 000 Swedish patients from 76 primary care centers, treated for hypercholesterolemia between 2004 and 2009. 96 % of them received simvastatin.

(3) 26 % of the total healthcare costs the year before a patient was diagnosed with peripheral artery disease was related to cardiovascular disease. Both the total costs and the costs related to cardiovascular diseases more or less doubled the year after the diagnosis. The increased costs were mainly driven by costs related to follow-up of the peripheral artery disease.

This study includes 66,189 patients from the Swedish National Patient Register. All were diagnosed with peripheral artery disease between 2006 and 2014.


(1) Hasvold, L. P., Bodegård, J., Thuresson, M., Stålhammar, J., Hammar, N., Sundström, J., Russell, D., & Kjeldsen, S. E. (2014). Diabetes and CVD risk during angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker treatment in hypertension: a study of 15 990 patientsJournal of human hypertension28(11), 663.

(2) Hasvold, P., Thuresson, M., Sundström, J., Hammar, N., Kjeldsen, S. E., Johansson, G., Holme, I., & Bodegård, J. (2016). Association between paradoxical HDL cholesterol decrease and risk of major adverse cardiovascular events in patients initiated on statin treatment in a primary care settingClinical drug investigation36(3), 225-233.

(3) Hasvold, P., Nordanstig, J., Kragsterman, B., Kristensen, T., Falkenberg, M., Johansson, S., Thuresson, M., & Sigvant, B. (2017). Long-term cardiovascular outcome, use of resources, and healthcare costs in patients with peripheral artery disease: results from a nationwide Swedish studyEuropean Heart Journal-Quality of Care and Clinical Outcomes4(1), 10-17.

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