Persistence and determinants of statin therapy among middle‐aged patients for primary and secondary prevention

Abstract

AimsStatins have been shown to significantly reduce morbidity and mortality in patients with coronary artery disease (CAD), and also in patients with dyslipidaemia when statins are taken regularly. Middle-aged patients have the highest level of forecasting benefit and little is known about persistence rate of these therapies in a real-life setting. The objective was to evaluate the persistence rate of middle-aged patients initiating a statin therapy and its relation with several determinants for primary and secondary prevention. MethodsA cohort was reconstructed using the RAMQ databases. All patients aged 50-64 years-old who received at least one statin prescription between 1 January, 1998 and 31 December, 2000 for a new intention of treatment for dyslipidaemia were included in the cohort and followed up until 30 June, 2001. The date of the first prescription of statin was defined as the index date. There were 4316 patients in the secondary prevention (CAD diagnosis) and 13 642 patients in primary prevention cohort. The cumulative persistence rate was estimated using Kaplan-Meier, and Cox regression models were used to estimate the hazard ratio of ceasing statins. ResultsWe found that persistence with statins had fallen to 71% after 6 months of treatment, and had declined to 45% after 3 years in the secondary prevention cohort; the corresponding figures were 65% and 35% in the primary prevention cohort. Our results suggest that patients with dyslipidaemia in primary prevention compared with those in secondary prevention (HR: 1.18; 1.11-1.25) are less likely to be persistent. Patients with other cardiovascular risk factors such as age (H R: 0.99; 0.98-0.99), diabetes (HR: 0.84; hypertension (HR: 0.76; were most likely to be persistent with statins. We observed lower persistence in patients who have used the greatest number of pharmacies and prescribing physicians. ConclusionThis analysis indicates that barriers to persistence occur early in the therapeutic course. Overall persistence with statins is low, and particularly among patients with few other cardiovascular risk factors.Persistence and determinants of statin therapy among middle-aged patients Br J Clin Pharmacol 59 :5 565

Statin adherence and the risk of major coronary events in patients with diabetes: a nested case–control study

“…Poor adherence means lower cumulative statin exposure over time, leading to less effective or even sub-therapeutic drug use, whereas good adherence increases the likelihood of optimal treatment, resembling the situation in RCTs [33][34][35]. In RCTs, statin adherence above 80% is considered optimal but in real life adherence to statins may be lower [16][17][18][19][20]36]. Older age,presence of CHD and comorbidities are associated with optimal statin persistence or adherence [16-18, 20, 36] and were therefore controlled for in our analysis.…”

“…In real life, suboptimal adherence to statin treatment has been noted in many patient groups [16][17][18][19], including patients with diabetes [20], which questions the effectiveness of statins. We performed a nationwide, register-based study to investigate whether good adherence to statins would be associated with a risk reduction of major coronary events (MCEs) in patients with diabetes.…”

Dynamics of long-term statin therapy

“…One quarter to 50% of new statin users discontinue the therapy during the first year [6][7][8][9]. In Finland, 44% of persons initiating statin use in 1995 continued it for 10 years or longer [9].…”

Healthcare Utilization and Statin Re‐Initiation Among Medicare Beneficiaries With a History of Myocardial Infarction

“…Several studies have characterized the problem of statin discontinuation by identifying subgroups of patients who are at high risk for discontinuing treatment 14, 19, 20, 21, 22. Few studies have described opportunities to re‐initiate statins.…”