Poor statin adherence leads to increased mortality risk in ASCVD

  • Rodriguez F & al.
  • JAMA Cardiol
  • 13 Feb 2019

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • As statin therapy adherence declines, mortality risk climbs in people who have atherosclerotic cardiovascular disease (ASCVD).
  • Specific groups show increased risk for poor adherence, including women, minorities, and the age extremes.

Why this matters

  • The reasons people do not adhere to statins are complex, so different solution options are needed.
  • Editorial: results are a reminder that adherence is a key factor in the success of this therapy; without it, “the full benefit of this investment will never be realized.”

Key results

  • Those on moderate-intensity therapy had better adherence vs high-intensity:
    • OR, 1.18 (95% CI, 1.16-1.20).
  • Mean adherence was 87.7%.
  • Vs highest adherence (≥90%), adjusted mortality HRs (95% CIs) were:
    • 50%-69% score: 1.21 (1.18-1.24).
    • 70%-89%: 1.08 (1.06-1.09).
  • Less adherence was also tied to more stroke, ischemic heart disease hospitalizations.
  • Less adherence was seen among women, minorities, and in the age extremes (adults 74 years). 

Study design

  • Retrospective cohort study of 347,104 people, ages 21-85 years, treated in the US Veterans Affairs (VA) system.
  • Adherence: defined by medication possession ratio (%, higher=better).
  • Primary outcome was all-cause mortality.
  • Funding: VA. 

Limitations

  • Residual confounding possible; causation not established.

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