What is the clinical evidence from this study?

Study design: Cohort. Population: Myocardial infarction or atherosclerotic disease (n=16991). Intervention: Full medication adherence (≥80%) to statins and ACE inhibitors vs. Nonadherence (<40%). Primary outcome: Composite of all-cause death, MI, stroke, or coronary revascularization (HR 0.73, p=0.0004).

What question did this study set out to answer?

This study aims to determine the relationship between medication adherence and long-term cardiovascular outcomes in patients after myocardial infarction or with atherosclerotic disease.

June 17, 2026

Assessing the Impact of Medication Adherence on Long-Term Cardiovascular Outcomes

Q: What are the key findings of this study?

Full adherence (≥80%) to statins and ACE inhibitors was associated with a lower rate of MACE compared to nonadherence in post-MI (HR 0.73, p=0.0004) and atherosclerotic patients (HR 0.56, p<0.0001).

Q: What question did this study set out to answer?

This study aims to determine the relationship between medication adherence and long-term cardiovascular outcomes in patients after myocardial infarction or with atherosclerotic disease.

Key Result

Full adherence (≥80%) to statins and ACE inhibitors was associated with a lower rate of MACE compared to nonadherence in post-MI (HR 0.73, p=0.0004) and atherosclerotic patients (HR 0.56, p<0.0001).

Key Points

This study aims to determine the relationship between medication adherence and long-term cardiovascular outcomes in patients after myocardial infarction or with atherosclerotic disease.
Analyzed claims data from a large health insurer for patients with myocardial infarction or atherosclerotic disease.
Categorized patients based on adherence: fully adherent (≥80%), partially adherent (≥40% to ≤79%), nonadherent (<40%).
Estimated per-patient annual direct medical costs using unit costs from national databases.
The fully adherent post-MI group had significantly lower MACE rates than the nonadherent (18.9% vs. 26.3%; HR: 0.73; p = 0.0004) and partially adherent (18.9% vs. 24.7%; HR: 0.81; p = 0.02) groups.
The fully adherent ATH cohort exhibited lower MACE rates than the nonadherent (8.42% vs. 17.17%; HR: 0.56; p < 0.0001) and partially adherent (8.42% vs. 12.18%; HR: 0.76; p < 0.0001) groups.
Full adherence led to cost savings of $369 and $440 for MI hospitalizations when compared with partially and nonadherent groups respectively.

Study Design

Type

Cohort (n=16,991)

Structured PICO

Does full adherence to statins and ACE inhibitors reduce the composite of death, MI, stroke, or coronary revascularization in patients post-MI or with atherosclerotic disease?

Population

16,991 patients hospitalized for myocardial infarction or with atherosclerotic disease, evaluated for medication adherence and followed for 2 years.

Exposure

Full adherence (≥80% proportion of days covered) to statins and angiotensin-converting enzyme inhibitors

Comparator

Partial adherence (≥40% to ≤79%) or nonadherence (<40%) to statins and angiotensin-converting enzyme inhibitors

Outcome

Composite of all-cause death, MI, stroke, or coronary revascularization at 2 yearscomposite

Full adherence to statins and ACE inhibitors is associated with significantly lower rates of major adverse cardiovascular events and reduced medical costs in patients post-MI or with atherosclerotic disease.

Main Result

Hazard Ratio: 0.73

Absolute Event Rate: 18.9% vs 26.3%

p-value: p=0.0004

Abstract

BACKGROUND: Although guideline-recommended therapies reduce major adverse cardiovascular events (MACE) in patients after myocardial infarction (MI) or those with atherosclerotic disease (ATH), adherence is poor. OBJECTIVES: The goal of this study was to determine the association between medication adherence levels and long-term MACE in these patients. METHODS: We queried the claims database of a large health insurer for patients hospitalized for MI or with ATH. The primary outcome measure was a composite of all-cause death, MI, stroke, or coronary revascularization. Using proportion of days covered for statins and angiotensin-converting enzyme inhibitors, patients were stratified as fully adherent (≥80%), partially adherent (≥40% to ≤79%), or nonadherent (80% adherence in the post-MI population; at least a 40% level of long-term adherence needs to be maintained to continue to accrue benefit. Novel approaches to improve adherence may significantly reduce cardiovascular events.

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