June 17, 2026Journal of the American College of Cardiology
Assessing the Impact of Medication Adherence on Long-Term Cardiovascular Outcomes
Key result
Full adherence to statins and ACE inhibitors linked to ~27% lower MACE risk post-MI.
- HR 0.73
- P=0.0004
- n=16,991
Why the study?
Guideline-recommended therapies reduce MACE in patients after MI or with atherosclerotic disease, but adherence is poor, prompting evaluation of the association between adherence levels and long-term MACE.
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
4,015 post-MI patients and 12,976 patients with ATH from a health insurer claims database
Comparison
Fully adherent (≥80%) vs partially adherent (≥40% to ≤79%) vs nonadherent (<40%)
Design
Retrospective database cohort study
Follow-up
2 years
Authors
Discussion
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Implication
Supports adherence monitoring in secondary prevention; extends observational data but leaves causal effects open for trials.
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?
P
Population
16,991 patients hospitalized for myocardial infarction or with atherosclerotic disease, evaluated for medication adherence and followed for 2 years.
E
Exposure
Full adherence (≥80% proportion of days covered) to statins and angiotensin-converting enzyme inhibitors
C
Comparator
Partial adherence (≥40% to ≤79%) or nonadherence (<40%) to statins and angiotensin-converting enzyme inhibitors
O
Outcome
Composite of all-cause death, MI, stroke, or coronary revascularization at 2 yearscomposite
Main Result
Hazard Ratio: 0.73
Absolute Event Rate: 18.9% vs 26.3%
p-value: p=0.0004
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.
Cite This Study
Bansilal et al. (2016) conducted a cohort in Myocardial infarction or atherosclerotic disease (n=16,991). Full medication adherence (≥80%) to statins and ACE inhibitors vs. Nonadherence (<40%) was evaluated on Composite of all-cause death, MI, stroke, or coronary revascularization (HR 0.73, p=0.0004). 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).