Real‐world evaluation of the impact of statin intensity on adherence and persistence to therapy: A Scottish population‐based study

Abstract

Method: Retrospective cohort study, using linked electronic health records covering a period from January 2009 to December 2016. The study cohort included adult patients (≥18 years) newly initiating statins within Greater Glasgow and Clyde, Scotland. Study outcomes comprised adherence, discontinuation and persistence to treatment, stratified by three exposure groups (high, moderate and low intensity). Discontinuation and persistence were calculated using the refill-gap and anniversary methods, respectively. Proportion of days covered (PDC) was used as a proxy for adherence. Kaplan-Meier survival curves and Cox proportional hazard models were used to evaluate discontinuation, and associations between adherence/persistence and statin intensity were assessed using logistic regression. Results: A total of 73 716 patients with a mean age of 61.4 ± 12.6 years were included; the majority (88.3%) received moderate intensity statins. Discontinuation rates differed between intensity levels, with high-intensity patients less likely to discontinue treatment compared to those on moderate intensity (prior cardiovascular disease [CVD]: HR 0.43 [95% CI 0.34-0.55]; no prior CVD: 0.80 [0.74-0.86]). Persistence declined over time, and high-intensity patients had the highest persistence rates. Overall, 52.6% of patients were adherent to treatment (PDC ≥ 80%), but adherence was considerably higher among high-intensity patients (63.7%). Conclusion: High-intensity statins were associated with better persistence and adherence to treatment, but overall long-term persistence and adherence remain a challenge, particularly among patients without prior CVD. This needs addressing.

Bempedoic Acid: The New Kid on the Block for the Treatment of Dyslipidemia and LDL Cholesterol: A Narrative Review

“…After 6 years of therapy, adherence rates in both groups dropped further to 72% and 48% in the high-and low-intensity cohorts respectively [51]. These results were supported by a more recent study which retrospectively observed patients from 2009 to 2016; overall, approximately 53% of patients were adherent to statin therapy [52]. Adherence and discontinuation were related to intensity levels with patients on high-intensity therapy being more adherent (63.7%) and less likely to discontinue treatment compared to those on moderate-or low-intensity therapy [52].…”

Real-World Effectiveness of Therapy With Rosuvastatin Combined With Fenofibric Acid in a Sample of Colombian Patients With Mixed Dyslipidemia

“…24 For example, in a retrospective cohort study conducted in Scotland, the 62.9% of patients with statins discontinued such therapy during follow-up. 25 However, in our study, a third of patients who discontinued the combination at fixed doses of rosuvastatin + fenofibric acid switched to a single lipid-lowering agent such as rosuvastatin, atorvastatin, or gemfibrozil after having reached the expected goals, especially for triglycerides, which shows the importance of continuing treatment to maintain control of lipid metabolism, which should have a positive impact on long-term cardiovascular risk. 17 It is evident that this cohort of patients had a significant burden of cardiovascular disease: more than 70% had hypertension, slightly more than a third suffered from diabetes mellitus, approximately 20% had a history of established heart disease, and 10% had chronic kidney disease.…”

Editorial: Medication safety and interventions to reduce patient harm in low- and middle-income countries

“…Consequently, medicines should not be over-used or misused as seen with antibiotics in ambulatory care among patients with self-limiting illnesses or in hospitals for patients with COVID-19 ( Godman et al, 2020 ; Langford et al, 2021 ), as this increases antimicrobial resistance (AMR) with its considerable impact on morbidity, mortality, and cost ( Hofer, 2019 ; Antimicrobial Resistance Collaborators, 2022 ; GBD, 2023 ). Similarly, efforts are needed to improve medicine use in patients with chronic non-communicable diseases, including enhancing adherence to prescribed medicines, to improve outcomes and reduce complications ( Kirk et al, 2017 ; Rezende Macedo do Nascimento et al, 2020 ; Chan et al, 2021 ; Nowak et al, 2022 ). Alongside this, reducing the potential for drug-drug interactions (DDIs) especially among patients with multiple co-morbidities.…”