HighCholesterol and Hypertension Have the Greatest Economic Impact Across theAsia-Pacific

HONG KONG, CHINA - Media OutReach - 5 December 2018- Amgen and The Economist Intelligence Unit (EIU) today released acomprehensive new report entitled, "The Cost of Silence: Cardiovascular diseasein Asia." The report, which was developed by EIU and sponsored by Amgen,estimates that in the eight Asian economies studied, US$53bn of the total costsof primaryischaemic heart disease (IHD) and stroke are attributable to four modifiablerisk factors: smoking, hypertension, obesity and high cholesterol.

Amgen's Ms. Penny Wan, RegionalVice-President and General Manager, JAPAC (left) and The Economist IntelligenceUnit's Ms. Rashmi Dalai, Managing Editor (right), present the report "The Costof Silence: Cardiovascular disease in Asia."

Amgen's Ms. Penny Wan, Regional Vice-Presidentand General Manager, JAPAC shares the findings of the report.

The white paper, which examines China,Japan, South Korea, Australia, Taiwan, Hong Kong, Singapore and Thailand, waslaunched over a media roundtable presented by The Economist's Rashmi Dalai,Managing Editor; and Amgen's Penny Wan, Regional Vice-President and GeneralManager, JAPAC.

"Silent" risk factors -- high cholesteroland hypertension --  are costinggovernments and health agencies across Asia billions of dollars every year,which together with smoking and obesity, threaten the sustainability ofhealthcare systems. The biggest challenge with these silent risk factors isthat individuals often have little knowledge of their underlying risks untilsymptoms become more pronounced, and the illnesses more advanced.

In addition, the risks of cardiovasculardisease (CVD), the general term for conditions affecting the heart or bloodvessels, are more elevated among older populations; as a result, countries withaging demographics face even greater challenges. This is a major issue in Asia,which is rapidly aging: in2016 approximately 12.4% of Asia's population was 60 years of age or older.[i] This proportion is projected to increase to more than a quarter by 2050.[ii] How countries in the region address the CVD burden has enormous economic andhuman implications. For example, the recurrence rates for people suffering froma CVD event are high. Prioritising at-risk groups, where the cost for treatmentcan be significant, will help drive positive impact on CVD cost management.

CVD is already the leading cause ofdeath globally and it is estimated that half the cases of CVD occur in Asia[iii].The economic burdens of these conditions are rising dramatically, as the reportfound:

• Thecost of ischemic heart disease and stroke is USD 24.3 billion in Japan and USD21.7 billion in China, top 2 amongst the 8 markets.
• Chinahas the highest stroke incidence rate at 403 cases per 100,000, according tothe latest WHO data from 2016. IHD incidence is highest in Japan and Hong Kong,with approximately 396 cases and 365 cases per 100,000 respectively in 2016.
• Asianheart failure patients spend between 5 and 12.5 days in hospital, with 3% to15% readmitted within 30 days.
• Earlyretirement and disability caused by CVD has the potential to erode tax basesand put pressure on national budgets.
• Hypertensionis the risk factor that contributes the highest cost, with an estimated totalof US$18bn annually. Across the other estimated annual risk factor costs, highcholesterol contributes US$15bn.

In addition, the report found a lack ofawareness among Asian populations of the risks and symptoms of CVD, an issuethat has serious health and economic consequences. The danger from lack of awarenessand poor information can lead patients to make bad decisions, such asdiscontinuing treatments.

Theconsequences of insufficient awareness are also reflected by patients failingto take steps to treat CVD in its early stages. If early warning signs wereaddressed, treatments would be easier and cheaper. Lifestyle changes andmedications are convenient and cost-effective ways to manage CVD, and theyreduce the chance of life threatening incidences. However, most importantly, bycreating more awareness of early symptoms and diagnosing silent risks, it is possibleto prevent illnesses such as CVD. Penny Wan, Regional VP and General Manager,JAPAC at Amgen, explained further:

"As a leadingglobal biopharmaceutical company, understanding the healthcare landscape anddemographic trends in Asia are critical to Amgen's mission to serve patients.Looking at this part of the world, we see how aging populations are puttingpressure on economies and amplifying risk factors for illnesses such as CVD. Weare dedicated to changing the trajectory of healthcare, and our innovativemedicines make a difference to ensure people live healthier, longer lives.

However, as wesee in this report, more needs to be done to improve awareness of CVD risks,while shifting away from treating illnesses, towards predicting and preventingconditions before they become life-threatening. Through multi-stakeholdercollaborations, we can change behavior and transform healthcare systems tocreate a new 'predict and prevent paradigm' that is a better, safer and morecost-effective way to address CVD in the face of demographic headwinds."

Speaking on thereport, and the silent CVD risks it highlights, Rohan Greenland, President ofthe Asia Pacific Heart Network (APHN), said: "The Asia-Pacific is facing acardiovascular crisis on an immense scale. All governments need to do much moreto prevent and control CVD, starting with national action plans as a key partof a comprehensive response to tackle non-communicable disease. Modifiable riskfactors including smoking, physical inactivity and overweight/obesity need tobe aggressively addressed. Alarming rates of high blood cholesterol and highblood pressure - silent killers - also need to be countered through appropriaterisk assessment, treatment and on-going management."

Singapore

There areseveral key takeaways specific for Singapore. Of the four risk factors, thepopulation attributable fractions (PAFs) for hypertension in men and highcholesterol in women indicate that eliminating these risk factors in thepopulation would reduce CVD incidence by 11% and 13% respectively.

CVDs levy$8.1bn in direct and indirect costs on individuals, their households and thepublic finances, with the four modifiable risk factors accounting for anestimated US$4.9bn or 60% of the total.

Japan

A rise in theprevalence of hypercholesterolemia, widely linked with changing diets andincreasingly sedentary lifestyles, also suggests a gradual increase inincidence of ischaemic heart disease over a longer time frame.^[iv] While stroke's mortality rate hasdecreased over recent decades, it remains one of the leading causes of deathand disability. The incidence of CVD in men could be reduced by over 20% ifhypertension and smoking were eliminated. Eliminating hypertension and highcholesterol in women would have a similar effect on their CVD incidence rate.

CVDs levy$24.3bn in direct and indirect costs on individuals, their households and thepublic finances, with the four modifiable risk factors accounting for US$15.9bnor approximately 65% of the total.

Hong Kong

Ischemic heartdisease is the third leading cause of death in Hong Kong, and while mortalityrates are falling, incidence rates are not. Ischemic heart disease is on therise due to growing proportion of older people, diminished physical activityand susceptibility to obesity from dietary causes. In 2016, 11 people died fromcoronary heart disease per day with a male/female ratio of 1.5:1.[v]The incidence of CVD in men could be reduced by 15% if hypertension waseliminated. For women, this would reduce their CVD incidence by 10%.

CVDs levy$4.8bn in direct and indirect costs on individuals, their households and thepublic finances, with the four modifiable risk factors accounting for anestimated US$3.1bn or approximately 65% of the total.

Thailand

Ischaemic heartdisease is the number one cause of mortality in Thailand, according to WHOestimates.[vi]  Hypertension is the most prevalent riskfactor for both genders.

CVDs levy$1.3bn in direct and indirect costs on individuals, their households and thepublic finances, with the four modifiable risk factors accounting for anestimated US$1.0bn or approximately 77% of the total.

Australia

CVD remains thenumber one cause of death in the country and the leading cause of prematuredeath. High cholesterol is the leading modifiable risk factor in terms ofprevalence in Australia for men and women respectively. Of the four riskfactors, high cholesterol has the highest PAF for both genders.

These diseasesimpose US$12.3bn in direct and indirect costs on individuals, their householdsand the public finances, with the four modifiable risk factors accounting forUS$7.5bn or 61% of the total.

China

Ischaemic heartdisease has, over the last thirty years, been the single fastest riser amongcauses of premature death in China, from seventh in 1990 to second, behindstroke, by 2010.[vii]  Stroke is the leading cause of family povertyin rural China.[viii]

Risk factors,including age and obesity, have combined with environmental issues such asambient particulate air pollution to drive ischaemic heart disease-relatedhospital admissions, particularly in urban centres. Hypertension is ofparticular concern for both genders, reducing this risk factor would reduce CVDincidence by 13% for men and 12% for women.

CVDs levy$21.7bn in direct and indirect costs on individuals, their households and thepublic finances, with the four modifiable risk factors accounting for US$13.6bnor approximately 63% of the total.

South Korea

Stroke is thedominant CVD nationally with limited reduction in risk factors over recentdecades. According to EIU, high cholesterol has the highest PAF amongst women.

CVDs levy$7.2bn in direct and indirect costs on individuals, their households and thepublic finances, with the four modifiable risk factors accounting for US$4.0bnor approximately 56% of the total.

Taiwan

Low levels ofphysical activity, associated with risks of high blood pressure andcholesterol, and a higher sodium intake due to a contemporary diet, are allbroader trends of concern. Stroke was the leading cause of death in Taiwan in2014. Of the four risk factors, hypertension's PAF is highest for both genders;reducing this risk factor would decrease CVD incidence by around 10% for menand women.

CVDs levyUS$4.7bn in direct and indirect costs on individuals, their households and thepublic finances, with the four modifiable risk factors accounting for US$2.7bnor approximately 57% of the total.

The fullreport, "The Cost of Silence: Cardiovascular disease in Asia", can bedownloaded here: https://eiuperspectives.economist.com/healthcare/cost-silence/white-paper/cost-silence-cardiovascular-disease-asia

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Amgenfocuses on areas of high unmet medical need and leverages its expertise tostrive for solutions that improve health outcomes and dramatically improve people'slives. A biotechnology pioneer since 1980, Amgen has grown to be one of theworld's leading independent biotechnology companies, has reached millions ofpatients around the world and is developing a pipeline of medicines withbreakaway potential.

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