Mortality Rate Increases Steeply With Nonadherence to Statin Therapy in Patients With Acute Coronary Syndrome

Abstract

Background: In a prospective cohort of consecutive acute coronary syndrome (ACS) patients, we compared the adherence rate of statin usage and mortality rate during a median follow-up of 23 months. Hypothesis: Adherence to statin therapy after acute coronary syndrome affects mortality rate. Results: At discharge, the rate of statin prescription to patients was 95.4% (n = 1878). When comparing adherent patients (n = 1200; 61.7%), who purchased the medication systematically until the end of the median 23-month follow-up, with nonadherent patients (n = 94; 4.8%), who did not use the medication at all, there was a vast difference in absolute death rate between the groups: 4.9% vs 14.9%, respectively (P < 0.001). We conducted Cox proportional hazards model with ACS type, cerebrovascular attack, diabetes, age, 3-artery disease, and cancer as adjusted confounders. Compared with regular statin users, nonusers were associated with a >2× increased hazard ratio of mortality (hazard ratio: 2.70, 95% confidence interval: 1.49-4.90, P = 0.001).

Evidence of poor adherence to secondary prevention after acute coronary syndromes: possible remedies through the application of new technologies

“…6 7 9-12 Non-adherence, however, translates into poor clinical outcomes. [12][13][14][15] Understanding the reasons for non-adherence, therefore, can inform development of technological methods to improve adherence. Insufficient knowledge about medication regimens, low motivation or forgetfulness, polypharmacy, adverse side effects, increasing age and a lack of practical support have all been implicated and may be borne in mind.…”

“…Increased mortality is associated with poor β-blocker or clopidogrel adherence at 1 year (2.6-fold increased mortality or non-fatal myocardial infarction), and statins and β-blockers in the longer-term (median 2.4 years of follow-up) 512–14 In addition, over median follow-up of 23 months, a prospective cohort study using the Finnish Prescription Register demonstrated a dose–response relationship between (1) regular (2) irregular or (3) no statin use and mortality (4.9%, 9.4% and 14.9%, respectively), and cardiovascular death in particular (2.9%, 5.1% and 7.4%) 14. Non-adherence to dual antiplatelet therapy (aspirin and clopidogrel) after stent implantation also poses the added risk of potentially catastrophic stent thrombosis 15…”

Update on the efficacy of statin treatment in acute coronary syndromes

“…However, good adherence to therapy further reduced mortality risk (4Á9% vs. 14Á9%; P < 0Á001). Moreover, this study has pointed that earlystarted statin therapy (within 7 days from admission) reduces by twofold the mortality risk (HR 2Á34 [95% CI 1Á19-4Á89]; P = 0Á01) [20]. On the other hand, the Platelet Receptor Inhibition in Ischemic Syndrome Management (PRISM) study first investigated the effects of statin therapy discontinuation at 30-day follow-up in patients admitted for ACS [17].…”

“…Table 1 summarizes the results of relevant clinical trials and registries analysis [15][16][17][18][19][20]. The Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study is the first large study investigating the potential clinical benefit of the early use of statins in ACS [15].…”

The problem with non-adherence arising from medical practices

“…[7][8][9][10] There have been fewer studies on unintentional nonadherence caused by doctors. Lopez-Carmona et al performed an epidemiological study in Spain where they found a significant gap between current guidelines on recommended prescriptions and clinical practice to make these prescriptions.…”