Long-term statin persistence is poor among high-risk patients with dyslipidemia: a real-world administrative claims analysis

Abstract

Background: A decade ago, statin persistence was < 50% after 1 year, and recent short-term analyses have revealed very little progress in improving statin persistence, even in patients with a prior cardiovascular (CV) event. Data on longer-term statin persistence are lacking. We measured long-term statin persistence in patients with high CV risk. Methods: This retrospective administrative claims analysis of the Optum Research Database included patients aged ≥ 45 years with diabetes and/or atherosclerotic CV disease (ASCVD) who had a statin prescription filled in 2010. It included an elevated triglycerides (TG) cohort of patients with index date in 2010 and TG ≥ 150 mg/dL (n = 23,181) and a propensity-matched comparator cohort with TG < 150 mg/dL and high-density lipoprotein cholesterol > 40 mg/dL (n = 23,181). Both cohorts were followed for ≥ 6 months up to March 2016. Results: The probability of remaining on a prescription fill for index statin therapy was 47% after 1 year and 19% after 5 years in both cohorts. Statin persistence was worse among women than men, and among younger versus older patients (P < 0.001 for all comparisons). After 5 years, the probability of remaining on a prescription fill for index statin was < 25% across all subgroups assessed including patients with and without baseline revascularization, heart failure, peripheral artery disease and renal disease. Similar results were observed in a subcohort analysis of patients with TG 200-499 mg/dL. Conclusions: Long-term statin persistence after 5 years is alarmingly low (< 25%) and is a public health concern.

Adherence to lipid-lowering therapy and risk for cardiovascular disease and death in type 1 diabetes mellitus: a population-based study from the Swedish National Diabetes Register

“…In a study on adherence to statin guidelines in patients with type 1 diabetes and with over 50 years of diabetes duration, 72% of the patients self-reported adherence to statins, but fewer in primary than in secondary intervention, 68.5 vs 84.4% respectively 36. In the general population and in type 2 diabetes, adherence to statins tends to deteriorate over time and has been reported to be below 25% in high-risk patients after 5 years of treatment 14 37 38. In our study of individuals with type 1 diabetes, 27% had discontinued LLT after 18 months.…”

Low‐density lipoprotein cholesterol lowering in real‐world patients treated with evolocumab

“…However, observational studies indicate that patients infrequently achieve these guideline‐recommended LDL‐C goals in daily clinical practice, 17‐21 with a recent analysis of US adults with health insurance in the MarketScan ® database reporting that 67% of patients with VHR ASCVD had LDL‐C ≥ 70 mg/dL (≥ 1.8 mmol/L) 21 . Multiple factors are thought to underpin this unmet treatment need, with suboptimal dosing, high rates of treatment discontinuation, and low rates of lipid‐lowering therapy (LLT) adherence commonly observed 22‐27 …”

“…Within the context of personalized medicine, these data suggest that it is reasonable to target evolocumab therapy to higher‐risk patients following a recent MI 12,29 . However, there are limited data on LDL‐C lowering with evolocumab in real‐world healthcare settings, where patient‐, physician‐, and payer‐related treatment hurdles are common 17,22‐27,30‐33 . Historically, these hurdles have included treatment discontinuation, educational needs for providers, prior authorization requirements, costs, and formulary restrictions 30‐33 …”

Risk of cardiovascular events in patients with hypertriglyceridaemia: A review of real‐world evidence

“…LDL cholesterol also did not change substantially during follow-up, despite the fact that persistence with statin therapy was poor, with~20% continuing therapy after 5 years in both the elevated-TG group and the control group. 46 After controlling for patient characteristics, there was also a higher rate of inpatient hospital stay per unit time (all P < 0.001; Table 2, Figure 1B). 44,45 The total healthcare cost ratio was higher in the TG ≥1.69 mmol/L cohort versus the comparator cohort as well as the hypertriglyceridaemia (TGs 2.26-5.64 mmol/L) subcohort versus the comparator cohort (all P < 0.001; Table 2, Figure 1B).…”

“…The mean TG level initially decreased, then increased during the first year, before stabilizing at a concentration slightly below baseline in the TG ≥1.69 mmol/L cohort; TG levels increased in the comparison group. LDL cholesterol also did not change substantially during follow‐up, despite the fact that persistence with statin therapy was poor, with ~20% continuing therapy after 5 years in both the elevated‐TG group and the control group …”