Risk of cardiovascular event and mortality in relation to refill and guideline adherence to lipid-lowering medications among patients with type 2 diabetes mellitus in Sweden

Abstract

ObjectiveTo analyze the risk of cardiovascular (CV) events and mortality in relation to adherence to lipid-lowering medications by healthcare centers and patients with type 2 diabetes mellitus (T2DM).Research design and methodsWe included 121 914 patients (12% secondary prevention) with T2DM reported by 1363 healthcare centers. Patients initiated lipid-lowering medications between July 2006 and December 2012 and were followed from cessation of the first filled supply until multidose dispensed medications, migration, CV events, death or December 2016. The study period was divided into 4-month intervals through 2014, followed by annual intervals through 2016. Adherence measures were assessed for each interval. Patients’ (refill) adherence was measured using the medication possession ratio (MPR). Healthcare centers’ (guideline) adherence represented the prescription prevalence of lipid-lowering medications according to guidelines. The risk of CV events and mortality was analyzed for each interval using Cox proportional hazard regression and Kaplan-Meier.ResultsCompared with high-adherent patients (MPR >80%), low-adherent primary prevention patients (MPR ≤80%) showed higher risk of all outcomes: 44%–51 % for CV events, doubled for all-cause mortality and 79%–90% for CV mortality. Corresponding risks for low-adherent secondary prevention patients were 17%–19% for CV events, 88%–97% for all-cause and 66%–79% for CV mortality. Primary prevention patients treated by low-adherent healthcare centers (guideline adherence <48%) had a higher risk of CV events and CV mortality. Otherwise, no difference in the risk of CV events or mortality was observed by guideline adherence level.ConclusionsOur results demonstrate the importance of high refill adherence and thus the value of individualized care among patients with T2DM.

Guideline Adherence and Associated Outcomes in the Treatment of Type 2 Diabetes Mellitus Patients With an Incident Cardiovascular Comorbidity: An Analysis Based on a Large German Claims Dataset

“…In addition, we showed that diabetes is a significant predictor for time to CV hospitalization (HR 1.43; P = 0.022), underscoring the relevance of implementing appropriate CV management in this patient population. The importance of guideline adherence in reducing CV risk in patients with T2DM was also confirmed in a Swedish study on lipid-lowering therapies, with the results demonstrating a 44-51% higher risk of CV events and a doubled risk of all-cause mortality in patients with low adherence to Swedish lipid-lowering prescribing guidelines [38], despite evidence for increased incidence of T2DM due to statin use [36]. Another U.S. claims data study estimated that 1415 major adverse cardiovascular events (MACE) could be prevented over a 3-year period by closing the gap in high-dose statin use in a cohort of patients with T2DM and ASCVD who were currently not adequately treated [34].…”

Per-Treatment Post Hoc Analysis of Clinical Trial Outcomes With Tolvaptan in ADPKD

“…Given the established association of decreased drug compliance with negative health outcomes in chronic conditions, more research on predictors of medication persistence is needed in the context of treatment for ADPKD. 27 , 28 …”

“…Given the established association of decreased drug compliance with negative health outcomes in chronic conditions, more research on predictors of medication persistence is needed in the context of treatment for ADPKD. 27,28 Limitations of the analysis are the post hoc nature of the analyses and the relatively small proportion of noncompleters in each trial arm (ranging from 7.7% to 23.0%). The small number of noncompleters may have decreased the power to detect differential effects of completer versus noncompleter status.…”

Fixed‐dose combination of amlodipine and atorvastatin improves clinical outcomes in patients with concomitant hypertension and dyslipidemia

“…In patients with documented CVD, the lower adherence to statin therapy has been associated with a greater mortality risk 27 . In another health care database study from Sweden, lower refill adherence to lipid‐lowering medications resulted in higher CVD mortality among patients with type 2 DM 28 . Similarly, in newly diagnosed type 2 DM patients, lower anti‐diabetic medication adherence has been associated with higher long‐term all‐cause mortality 29 .…”