Lipid therapy intensity and adherence: more is better for CVD risk

  • JAMA Netw Open

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Across 3 cohorts, patients with atherosclerosis, chronic kidney disease (CKD), or diabetes had 40% reduced risk for cardiovascular disease (CVD) event with high-intensity, high-adherence regimens vs 5% with low-intensity regimens combined and nonadherence.

Why this matters

  • Low-density lipoprotein cholesterol (LDL) reduction appears to mediate the risk reduction.

Key results

  • In CVD cohort, adherence at years 1 and 6 with high- vs low-intensity therapy: 
    • Year 1, high vs low: 84.1% and 57.4%.
    • Year 6, high vs low: 72.3% and 48.4%.
    • With each 10% increase in combination of high-intensity and good adherence, risk dropped by 10%. 
    • Vs no treatment, lowest CVD risk seen with high-intensity therapy plus best adherence: HR, 0.60; 95% CI, 0.54-0.68.
  • CKD, diabetes cohorts had similar outcomes.
  • If all CVD cohort patients adhered optimally to optimal therapy, events would have decreased from 3086 to 2069 (difference: –1017); similar results for other 2 cohorts.

Study design

  • Retrospective study, 3 UK cohorts, n=29,797 (16,701 CVD; 12,422 type 2 diabetes; 674 CKD) patients receiving first cholesterol-lowering drug prescription, January 1, 2010 through December 31, 2013.
  • Intensity: expected LDL reduction
  • Outcome: Composite CVD event endpoint.
  • Funding: Amgen Europe GmbH. 

Limitations

  • Possible confounding underlying adherence behaviors.

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