High
Cholesterol and Hypertension Have the Greatest Economic Impact Across the
Asia-Pacific

HONG KONG, CHINA -�Media OutReach�- 5 December 2018
- Amgen and The Economist Intelligence Unit (EIU) today released a
comprehensive new report entitled, "The Cost of Silence: Cardiovascular disease
in 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 costs
of primary
ischaemic heart disease (IHD) and stroke are attributable to four modifiable
risk factors: smoking, hypertension, obesity and high cholesterol.

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Amgen's Ms. Penny Wan, Regional
Vice-President and General Manager, JAPAC (left) and The Economist Intelligence
Unit's Ms. Rashmi Dalai, Managing Editor (right), present the report "The Cost
of Silence: Cardiovascular disease in Asia."

Amgen's Ms. Penny Wan, Regional Vice-President
and 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, was
launched over a media roundtable presented by The Economist's Rashmi Dalai,
Managing Editor; and Amgen's Penny Wan, Regional Vice-President and General
Manager, JAPAC.

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"Silent" risk factors -- high cholesterol
and hypertension --� are costing
governments and health agencies across Asia billions of dollars every year,
which together with smoking and obesity, threaten the sustainability of
healthcare systems. The biggest challenge with these silent risk factors is
that individuals often have little knowledge of their underlying risks until
symptoms become more pronounced, and the illnesses more advanced.

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In addition, the risks of cardiovascular
disease (CVD), the general term for conditions affecting the heart or blood
vessels, are more elevated among older populations; as a result, countries with
aging demographics face even greater challenges. This is a major issue in Asia,
which is rapidly aging:
in
2016 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 and
human implications. For example, the recurrence rates for people suffering from
a CVD event are high. Prioritising at-risk groups, where the cost for treatment
can be significant, will help drive positive impact on CVD cost management.

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CVD is already the leading cause of
death 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 report
found:

• The
  cost of ischemic heart disease and stroke is USD 24.3 billion in Japan and USD
  21.7 billion in China, top 2 amongst the 8 markets.
• China
  has the highest stroke incidence rate at 403 cases per 100,000, according to
  the 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.
• Asian
  heart failure patients spend between 5 and 12.5 days in hospital, with 3% to
  15% readmitted within 30 days.
• Early
  retirement and disability caused by CVD has the potential to erode tax bases
  and put pressure on national budgets.
• Hypertension
  is the risk factor that contributes the highest cost, with an estimated total
  of US$18bn annually. Across the other estimated annual risk factor costs, high
  cholesterol contributes US$15bn.

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

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The
consequences of insufficient awareness are also reflected by patients failing
to take steps to treat CVD in its early stages. If early warning signs were
addressed, treatments would be easier and cheaper. Lifestyle changes and
medications are convenient and cost-effective ways to manage CVD, and they
reduce the chance of life threatening incidences. However, most importantly, by
creating more awareness of early symptoms and diagnosing silent risks, it is possible
to prevent illnesses such as CVD. Penny Wan, Regional VP and General Manager,
JAPAC at Amgen, explained further:

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"As a leading
global biopharmaceutical company, understanding the healthcare landscape and
demographic 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 putting
pressure on economies and amplifying risk factors for illnesses such as CVD. We
are dedicated to changing the trajectory of healthcare, and our innovative
medicines make a difference to ensure people live healthier, longer lives.

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

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

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Singapore

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

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

Japan

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

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

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Hong Kong

Ischemic heart
disease is the third leading cause of death in Hong Kong, and while mortality
rates are falling, incidence rates are not. Ischemic heart disease is on the
rise due to growing proportion of older people, diminished physical activity
and susceptibility to obesity from dietary causes. In 2016, 11 people died from
coronary 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 was
eliminated. For women, this would reduce their CVD incidence by 10%.

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

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Thailand

Ischaemic heart
disease is the number one cause of mortality in Thailand, according to WHO
estimates.[vi] �Hypertension is the most prevalent risk
factor for both genders.

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

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Australia

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

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

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China

Ischaemic heart
disease has, over the last thirty years, been the single fastest riser among
causes of premature death in China, from seventh in 1990 to second, behind
stroke, by 2010.[vii]� Stroke is the leading cause of family poverty
in rural China.[viii]

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Risk factors,
including age and obesity, have combined with environmental issues such as
ambient particulate air pollution to drive ischaemic heart disease-related
hospital admissions, particularly in urban centres. Hypertension is of
particular concern for both genders, reducing this risk factor would reduce CVD
incidence by 13% for men and 12% for women.

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

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South Korea

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

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

Taiwan

Low levels of
physical activity, associated with risks of high blood pressure and
cholesterol, and a higher sodium intake due to a contemporary diet, are all
broader trends of concern. Stroke was the leading cause of death in Taiwan in
2014. 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 men
and women.

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

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

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About Amgen

Amgen is
committed to unlocking the potential of biology for patients suffering from
serious illnesses by discovering, developing, manufacturing and delivering
innovative human therapeutics. This approach begins by using tools like
advanced human genetics to unravel the complexities of disease and understand
the fundamentals of human biology.

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

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For
more information, visit�
www.amgen.com

�and follow us on�
www.twitter.com/amgen

.

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