Temporal Trends in Lipid‐Lowering Therapy Use and Adherence in Patients With Premature Coronary Artery Disease

Q: What are the key findings of this study?

Good adherence to lipid-lowering therapy was associated with a 55% lower risk of all-cause death (HR 0.45, 95% CI 0.39-0.55) compared to low adherence in patients with premature CAD.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Premature coronary artery disease (n=11411). Intervention: Good adherence to lipid-lowering therapy (≥80% proportion of days covered) vs. Low adherence (<40% proportion of days covered) or discontinuation. Primary outcome: All-cause death (HR 0.45, 95% CI 0.39-0.55, p=<0.001).

Q: What does this research mean for the field?

Good adherence to lipid-lowering therapy is associated with a 55% lower risk of all-cause mortality and a 47% lower risk of myocardial infarction in patients with premature coronary artery disease. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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

To evaluate temporal trends in lipid-lowering therapy prescription and adherence, identify predictors of treatment persistence, and assess the link between adherence and clinical outcomes in patients with premature coronary artery disease.

D. Vikulova; Danielle Pinheiro-Muller; Simon N. Pimstone; Liam R. Brunham

doi:10.1161/jaha.125.046415

May 6, 2026Journal of the American Heart AssociationOpen Access

Temporal Trends in Lipid‐Lowering Therapy Use and Adherence in Patients With Premature Coronary Artery Disease

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Key result

Good lipid-lowering therapy adherence linked to ~55% lower mortality in premature CAD.

HR 0.45
95% CI 0.39-0.55
P<0.001
n=11,411

Figures

Why the study?

Patients with premature CAD have high rates of recurrent events and death, but information on long-term adherence to LLT and trends in medication-taking behavior is limited.

Does good adherence to lipid-lowering therapy improve long-term cardiovascular outcomes and reduce mortality in patients with premature coronary artery disease?

Key Points

To evaluate temporal trends in lipid-lowering therapy prescription and adherence, identify predictors of treatment persistence, and assess the link between adherence and clinical outcomes in patients with premature coronary artery disease.
Analyzed 11,411 patients discharged alive after index presentation for premature coronary artery disease between 2000 and 2017 using a provincial cardiovascular registry and administrative health databases.
Tracked temporal changes across presentation eras (2000–2003, 2004–2007, 2008–2012, and 2013–2017) for initial prescription intensity, 1- to 3-year adherence levels, and multivariable predictors of adherence.
Evaluated the association between first-year medication adherence and recurrent major adverse cardiovascular events including all-cause death and myocardial infarction.
Initial dispensing of high-intensity lipid-lowering therapy rose from 9.8% in 2000–2003 to 87.1% in 2013–2017 (P for trend <0.001), while first-year good adherence increased from 54.9% to 71.4%.
Good adherence dropped substantially over time to 53.3% in year two and 48.2% by year three, with 40.0% demonstrating low adherence or discontinuation by the third year.
Good treatment adherence was associated with a lower risk of all-cause mortality (hazard ratio [HR], 0.45 [95% CI, 0.39–0.55]) and recurrent myocardial infarction (HR, 0.53 [95% CI, 0.45–0.63]).

Study Design

Type

Cohort (n=11,411)

Structured PICO

Does good adherence to lipid-lowering therapy improve long-term cardiovascular outcomes and reduce mortality in patients with premature coronary artery disease?

P

Population

11,411 young adults (mean age 46.1 years, 27.6% female) with premature coronary artery disease, discharged alive after their first presentation and followed for a median of 8.5 years.

E

Exposure

Good adherence to lipid-lowering therapy (LLT), defined as a proportion of days covered (PDC) of ≥80% during the first year after the index presentation.

C

Comparator

Low adherence to lipid-lowering therapy (LLT), defined as a PDC of <40%, or treatment discontinuation during the first year.

O

Outcome

Recurrent major adverse cardiovascular events (MACEs) and specifically all-cause death and myocardial infarction over a median follow-up of 8.5 years.hard clinical

Main Result

Hazard Ratio: 0.45 (95% CI 0.39–0.55)

Absolute Event Rate: 7.1% vs 17.11%

p-value: p=<0.001

In young patients with premature coronary artery disease, maintaining high adherence to lipid-lowering therapy significantly reduces the long-term risk of mortality and recurrent myocardial infarction.

Limitations

Patients residing outside the province of British Columbia were not included.
Generalizability is limited to patients with angiographically confirmed disease, excluding those managed noninvasively.
Race and ethnicity data were not captured in the administrative databases.
Treatment adherence assessed by pharmacy records may overestimate actual medication taking.
Lack of laboratory data prevented assessment of lipid target achievement.

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Implication

May support adherence interventions in premature CAD; leaves open causal confirmation in randomized trials.

Abstract

BACKGROUND: Patients with premature coronary artery disease (CAD) have high rates of recurrent events and death. Information on long-term adherence to lipid-lowering therapy (LLT) and trends in medication-taking behavior in premature CAD is limited. We assessed temporal trends in LLT, factors associated with adherence to LLT, and the consequences of low adherence in a longitudinal cohort of patients with premature CAD. METHODS: Using a cardiovascular registry and administrative databases, we analyzed temporal changes in rates and predictors of adherence to LLT as well as the association between adherence and cardiovascular outcomes in patients with premature obstructive CAD from 2000 to 2017. More severe presentation, revascularization at presentation, absence of chronic kidney disease, and nonsmoking were consistently associated with better adherence across the study time frame. Rural residence, female sex, and substance use disorder were associated with poor adherence only in later years. Good adherence was associated with a lower risk of cardiovascular outcomes, including death (hazard ratio [HR], 0.45 [95% CI, 0.39-0.55]) and myocardial infarction (HR, 0.53 [95% CI, 0.45-0.63]). CONCLUSIONS: Use of high-intensity LLT and short-term adherence are improving in patients with premature CAD, but different strategies are needed to increase long-term adherence to prevent recurrent cardiovascular events.

Discussion

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Cite This Study

Vikulova et al. (2026) conducted a cohort in Premature coronary artery disease (n=11,411). Good adherence to lipid-lowering therapy (≥80% proportion of days covered) vs. Low adherence (<40% proportion of days covered) or discontinuation was evaluated on All-cause death (HR 0.45, 95% CI 0.39-0.55, p=<0.001). Good adherence to lipid-lowering therapy was associated with a 55% lower risk of all-cause death (HR 0.45, 95% CI 0.39-0.55) compared to low adherence in patients with premature CAD.

synapsesocial.com/papers/69fd7f65bfa21ec5bbf07f89 https://doi.org/10.1161/jaha.125.046415

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Temporal Trends in Lipid‐Lowering Therapy Use and Adherence in Patients With Premature Coronary Artery Disease

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Temporal Trends in Lipid‐Lowering Therapy Use and Adherence in Patients With Premature Coronary Artery Disease

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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