Association between statin intensity and adherence, and MACE in post-STEMI patients: A cohort study.

Q: What are the key findings of this study?

Low statin adherence and non-high statin intensity independently increased major cardiovascular events odds by 8% and 12%, respectively, in post-STEMI patients.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Post-ST-elevated myocardial infarction (STEMI) (n=549). Intervention: Non-high intensity statin therapy and low statin adherence vs. High-intensity statin therapy (persistent 40-80 mg atorvastatin) and high statin adherence. Primary outcome: Major adverse cardiovascular events (MACE: composite of non-fatal MI, non-fatal stroke, unstable angina, stent thrombosis, and heart failure) (OR 1.12, 95% CI 1.04, 1.28, p=0.03).

Q: What does this research mean for the field?

Low statin adherence and non-high statin intensity independently increase the risk of major adverse cardiovascular events (MACE) in post-STEMI patients. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Masoumeh Sadeghi; Mohadeseh Arefian; Elham Ramezannezhad; Amirhossein Ebrahimi; Kiarash Kavianian; Safoura Yazdekhasti; Zahra Teimouri-Jervekani; Hamidreza Roohafza

doi:10.48305/arya.2026.46165.3145

January 1, 2026Open Access

Association between statin intensity and adherence, and MACE in post-STEMI patients: A cohort study.

View Full Paper

Ask AI

Bookmark

Share

Key result

Non-high statin intensity post-STEMI is linked to ~12% higher major cardiovascular events odds.

OR 1.12
95% CI 1.04, 1.28
P=0.03
n=549

Figures

Why the study?

Although cardiovascular disease management emphasizes both statin intensity and patient adherence, observations show that both remain inadequate. This study measured statin adherence and intensity in post-STEMI patients and evaluated their association with MACE.

Does high statin intensity and high medication adherence reduce major adverse cardiovascular events (MACE) in post-STEMI patients?

Key Points

To assess statin adherence and therapy intensity in post-ST-elevation myocardial infarction patients and evaluate their association with major adverse cardiovascular events.
Analyzed data from an Isfahan cohort of post-STEMI patients, evaluating statin intensity in 549 individuals and adherence in 455 individuals via the Morisky Medication Adherence questionnaire.
Assessed demographic, clinical, and behavioral factors influencing adherence alongside multivariable models evaluating major adverse cardiovascular events (MACE).
In fully adjusted models, the chance of experiencing MACE increased 8% (95% CI = 1.02, 1.20) for low statin adherents and 12% (95% CI = 1.04, 1.28) for patients on non-high statin intensity regimens.
Statin adherence was significantly higher with increasing age among patients aged 50-70 years (P = 0.014), fewer daily medications (P = 0.045), and physician counseling on the consequences of discontinuation (P = 0.019).
Statin non-adherence was significantly associated with experiencing drug side effects (P = 0.028) and depressed mood (P ≤ 0.0001), while no measured clinical or demographic factor was associated with statin intensity.

Study Design

Type

Cohort (n=549)

Multicenter

No

Structured PICO

Does high statin intensity and high medication adherence reduce major adverse cardiovascular events (MACE) in post-STEMI patients?

P

Population

549 post-STEMI patients in Iran (mean age 60.6 years, 17.9% female; 455 with adherence data), excluding in-hospital post-procedural STEMI, evaluated at 3 years of follow-up.

E

Exposure

High-intensity statin therapy (persistent consumption of guideline-recommended 40-80 mg atorvastatin daily during follow-up) and high/medium statin adherence (measured via the 8-item Persian Morisky Medication Adherence scale, where score 8 is highly adherent and 6-7 is moderately adherent).

C

Comparator

Non-high intensity statin therapy (patients who refused 40-80 mg atorvastatin for personal reasons, intolerance, initial physician nonprescription, or contraindication) and low statin adherence (Morisky score < 6).

O

Outcome

Major adverse cardiovascular events (MACE), defined as a composite of atherosclerotic cardiovascular diseases in coronary and cerebral vessels including non-fatal MI, non-fatal stroke, unstable angina, stent thrombosis, and heart failure at the third year of follow-up, obtained via telephone call and confirmed by a cardiology panel.composite

Main Result

Odds Ratio: 1.12 (95% CI 1.04–1.28)

Absolute Event Rate: 19% vs 10.3%

p-value: p=0.03

Limitations

Statin side effects were patient-reported and not clinically verified for causality
Depression was assessed subjectively via patient self-report of mood
Recall bias associated with the use of questionnaires and checklists
Potential overestimation of adherence due to social desirability bias during telephone interviews
Affordability analysis did not account for socioeconomic status, income, and health insurance coverage
Statin side effects were patient-reported and not investigated for clinical relevance to statin therapy
Depression was labeled subjectively by asking patients about their mood, introducing possible response bias
Existence of recall bias associated with the use of questionnaires and checklists
Potential overestimation of adherence due to participants feeling pressured to provide positive responses to the questioner
Lack of detailed evaluation of socioeconomic status, income, and health insurance coverage when assessing affordability

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

In post-STEMI patients, both low statin adherence and non-high statin intensity independently increase the risk of MACE, highlighting the critical need for prescribing guideline-recommended high-intensity statins and providing physician education on the consequences of discontinuation.

Abstract

BACKGROUND: Statins are among secondary preventive cardiovascular medications that adherence is critical to their effectiveness. Although, the management of cardiovascular diseases emphasize both intensity and patient adherence, observations show that statin adherence and intensity is not adequate. This study aimed to measure statin adherence and intensity in post-ST elevated myocardial infarction patients and its association with major adverse cardiovascular events (MACE). METHODS: Of 867 patients in the ST-elevated myocardial infarction cohort study in Isfahan, 549 individuals had data on the intensity of statin therapy. 455 of these patients tended to fill out the adherence questionnaire. Morisky Medication Adherence questionnaire and a checklist consisting potential adherence, and intensity-associated factors were filled out. RESULTS: In the age group of 50-70 years, increasing age (P = 0.014), receiving physician's support on the consequences of statin discontinuation (P = 0.019), taking lower number of medications (P = 0.045) were significantly associated with statin adherence. Besides, the experience of side effects (P = 0.028) and depressed mood (P ≤ 0.0001) were negatively associated with adherence. None of the measured factors were associated with statin intensity. Statin adherence and statin intensity independently affect MACE, such that even after full adjustment, the chance of experiencing MACE increases 8% (95% CI = 1.02, 1.20) for low-statin adherents and 12% (1.04, 1.28) for patients on non-high statin intensity. CONCLUSION: Statins have a significant role in the prediction of MACE, based on their intensity and adherence. Educational support from the physician, considering patients' mood and number of medications could improve patients' adherence.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Sadeghi et al. (2026) conducted a cohort in Post-ST-elevated myocardial infarction (STEMI) (n=549). Non-high intensity statin therapy and low statin adherence vs. High-intensity statin therapy (persistent 40-80 mg atorvastatin) and high statin adherence was evaluated on Major adverse cardiovascular events (MACE: composite of non-fatal MI, non-fatal stroke, unstable angina, stent thrombosis, and heart failure) (OR 1.12, 95% CI 1.04, 1.28, p=0.03). Low statin adherence and non-high statin intensity independently increased major cardiovascular events odds by 8% and 12%, respectively, in post-STEMI patients.

synapsesocial.com/papers/6af0dba03c845ca7837ced9c https://doi.org/10.48305/arya.2026.46165.3145

View Full Paper

Ask AI

Bookmark

Share

Association between statin intensity and adherence, and MACE in post-STEMI patients: A cohort study.

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Association between statin intensity and adherence, and MACE in post-STEMI patients: A cohort study.

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading