Key result
Each 10% increase in post-MI statin adherence links to ~14% lower all-cause mortality.
Why the study?
Post-MI cardioprotective medication adherence is commonly assessed via a binary 80% threshold, prompting evaluation of adherence as a continuous measure using restricted cubic splines.
Does increasing adherence to cardioprotective medications as a continuous measure reduce the risk of death and MACE in older MI survivors?
Cohort (n=5,938)
Does increasing adherence to cardioprotective medications as a continuous measure reduce the risk of death and MACE in older MI survivors?
Hazard Ratio: 0.861 (95% CI 0.76–0.976)
p-value: p=0.019
In older MI survivors, increasing adherence to statins, RASI, and clopidogrel (but not beta-blockers) above 60% is associated with progressively lower risks of death and MACE, suggesting adherence should be evaluated as a continuous measure rather than a binary threshold.
Higher adherence above 60% was associated with lower post-MI mortality; leaves open whether continuous targets should guide care or trials.
Adherence to cardioprotective medications following myocardial infarction (MI) is commonly assessed using a binary threshold of 80%. We investigated the relationship between medication adherence as a continuous measure and outcomes in MI survivors using restricted cubic splines (RCS). We identified all patients aged ≥65 years hospitalised for MI from 2003-2008 who survived one-year post-discharge (n = 5938). Adherence to statins, beta-blockers, renin angiotensin system inhibitors (RASI) and clopidogrel was calculated using proportion of days covered to one-year post-discharge (landmark date). Outcomes were 1-year all-cause death and major adverse cardiac events (MACE) after the landmark date. Adherence-outcome associations were estimated from RCS Cox regression models. RCS analyses indicated decreasing risk for both outcomes above 60% adherence for statins, RASI and clopidogrel, with each 10% increase in adherence associated with a 13.9%, 12.1% and 18.0% decrease respectively in adjusted risk of all-cause death (all p < 0.02). Similar results were observed for MACE (all p < 0.03). Beta-blockers had no effect on outcomes at any level of adherence. In MI survivors, increasing adherence to statins, RASI, and clopidogrel, but not beta blockers, is associated with a decreasing risk of death/MACE with no adherence threshold beyond 60%. Medication adherence should be considered as a continuous measure in outcomes analyses.
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Greenland et al. (2020) conducted a cohort in Myocardial infarction (MI) survivors (n=5,938). Adherence to cardioprotective medications (statins, RASI, clopidogrel, beta-blockers) vs. Lower adherence levels was evaluated on All-cause death (per 10% increase in statin adherence for PDC 60-100%) (HR 0.861, 95% CI 0.760-0.976, p=0.019). In MI survivors, each 10% increase in adherence above 60% for statins, RASI, and clopidogrel was associated with a 13.9%, 12.1%, and 18.0% decrease in the adjusted risk of all-cause death, respectively.
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