Key result
Poor lipid-lowering therapy adherence linked to ~78% higher risk of major cardiovascular events.
Why the study?
Adherence to lipid-lowering therapy is essential for survival in atherosclerotic disease, but adherence patterns required investigation in Saxony-Anhalt, the German state with the highest incidence and mortality for coronary heart disease.
Does adherence to statin therapy improve survival in patients with coronary heart disease?
Cohort (n=542)
No
Does adherence to statin therapy improve survival in patients with coronary heart disease?
Adherence to statin therapy significantly declines within 12 months after discharge in CHD patients, and this non-adherence is associated with increased mortality.
Answers are grounded in this paper and cite their sources.
Adherence support may warrant consideration at CHD discharge; extends observational data but leaves open whether interventions reduce events.
OBJECTIVES: Treatment with lipid-lowering therapy (LLT) such as statins, cholesterol absorption inhibitors, or PCSK9 inhibitors is of major importance for the survival of patients with atherosclerotic diseases, and adherence to LLT is essential for treatment success. The intention of this study was to investigate adherence to LLT in patients with coronary heart disease (CHD) in a 12-month follow-up period in Saxony-Anhalt, the state with the highest incidence and mortality for CHD in Germany. PATIENTS AND METHODS: Data were taken from 542 hospitalized patients with angiographically documented CHD who were prospectively included in this study conducted in the Department of Medicine III of the University Clinics (Halle). We collected data concerning medication at discharge and after 3 and 12 months. RESULTS: A total of 542 patients were included in this study. Mean age was 69.2 ± 11.8 years. In all, 68.8% were males, 165 (30.4%) were smokers, 39.7% suffered from diabetes, and 86.9% had arterial hypertension. The follow-up time of this study was 12 months. At discharge, 463 patients (85.4%) were being treated with a statin. After 3 months 409 (75.5%) and after 12 months, 395 patients (72.9%) were still on statin therapy, respectively. In total treatment, adherence for the statin medication decreased by 15.7% in 12 months. Kaplan-Meier analyses showed that survival, taken as freedom of death from any cause, decreased significantly if statin treatment was stopped (p=0.001). This was confirmed by multivariate Cox regression (HR 1.78, p=0.012). Ezetemibe was prescribed for 56 patients at discharge (10.3%). After 3 months, 40 patients (7.4%) were still taking ezetemibe. After 12 months, adherence to ezetemibe treatment decreased to 4.1% (22 patients). CONCLUSION: During follow-up for 3 and 12 months, adherence for statin therapy decreased by 15.7% and for ezetemibe by 46.6%. Here, low adherence to statin therapy was associated with fatal outcome.
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Waßmuth et al. (2019) conducted a cohort in Coronary heart disease (n=542). Negative adherence to lipid-lowering therapy (discontinuation or dose reduction) vs. Adherence to lipid-lowering therapy (unchanged, increased, or newly prescribed) was evaluated on Composite of cardiac mortality, stroke, and myocardial infarction (HR 1.78, 95% CI 1.13-2.79, p=0.012). Negative adherence to lipid-lowering therapy independently increased the risk of the combined endpoint of cardiac mortality, stroke, and myocardial infarction (HR 1.78).
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