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Cardiovascular morbidity associated with nonadherence to statin therapy.
Pharmacotherapy 2005; 25(8):1035-43P

Abstract

STUDY OBJECTIVE

To measure the extent of cardiovascular morbidity associated with nonadherence to 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) therapy.

DESIGN

Retrospective cohort study.

DATA SOURCE

Linked administrative health databases in Saskatchewan, Canada.

PATIENTS

A total of 1221 patients aged 30-70 years who received a new prescription for a statin drug between 1994 and 2001, within 1 year of their first cardiovascular event (i.e., myocardial infarction, unstable angina, ischemic stroke, percutaneous transluminal coronary angioplasty [PTCA], or coronary artery bypass graft [CABG]).

MEASUREMENTS AND MAIN RESULTS

Adherence was measured by the fill frequency (number of prescriptions filled during the observation period divided by months of observation). Patients with a fill frequency of 80% or greater were classified as adherent (661 patients); those with a fill frequency of 60% or less were classified as nonadherent (395 patients). The remaining 165 patients who had adherence rates of 61-79% were excluded from the analysis. The primary end point included a composite of myocardial infarction, unstable angina, PTCA, CABG, and death. Among 1056 patients, adherence was not associated with a reduction of the primary end point. However, patients in the adherent group were half as likely to experience a subsequent myocardial infarction as the patients in the nonadherent group (hazard ratio [HR] 0.45, 95% confidence interval [CI] 0.20-0.99, p=0.047). In patients younger than 65 years (both adherent and not), the associated reduction in myocardial infarction was even more profound (HR 0.14, 95% CI 0.04-0.46, p=0.001) and was accompanied by a trend for a lower frequency of unstable angina (HR 0.37, 95% CI 0.13-1.03, p=0.06). In patients 65 years or older (301 patients), adherence was not associated with significant changes in cardiovascular end points.

CONCLUSION

A detectable excess of cardiovascular morbidity appears to be associated with nonadherence to statin therapy. Our analysis suggests that many occurrences of myocardial infarction could be prevented with improvements in adherence. Larger studies are necessary to determine the association between adherence and other cardiovascular end points.

Authors+Show Affiliations

College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. d.blackburn@usask.caNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16207093

Citation

Blackburn, David F., et al. "Cardiovascular Morbidity Associated With Nonadherence to Statin Therapy." Pharmacotherapy, vol. 25, no. 8, 2005, pp. 1035-43.
Blackburn DF, Dobson RT, Blackburn JL, et al. Cardiovascular morbidity associated with nonadherence to statin therapy. Pharmacotherapy. 2005;25(8):1035-43.
Blackburn, D. F., Dobson, R. T., Blackburn, J. L., & Wilson, T. W. (2005). Cardiovascular morbidity associated with nonadherence to statin therapy. Pharmacotherapy, 25(8), pp. 1035-43.
Blackburn DF, et al. Cardiovascular Morbidity Associated With Nonadherence to Statin Therapy. Pharmacotherapy. 2005;25(8):1035-43. PubMed PMID: 16207093.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cardiovascular morbidity associated with nonadherence to statin therapy. AU - Blackburn,David F, AU - Dobson,Roy T, AU - Blackburn,James L, AU - Wilson,Thomas W, PY - 2005/10/7/pubmed PY - 2005/10/27/medline PY - 2005/10/7/entrez SP - 1035 EP - 43 JF - Pharmacotherapy JO - Pharmacotherapy VL - 25 IS - 8 N2 - STUDY OBJECTIVE: To measure the extent of cardiovascular morbidity associated with nonadherence to 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) therapy. DESIGN: Retrospective cohort study. DATA SOURCE: Linked administrative health databases in Saskatchewan, Canada. PATIENTS: A total of 1221 patients aged 30-70 years who received a new prescription for a statin drug between 1994 and 2001, within 1 year of their first cardiovascular event (i.e., myocardial infarction, unstable angina, ischemic stroke, percutaneous transluminal coronary angioplasty [PTCA], or coronary artery bypass graft [CABG]). MEASUREMENTS AND MAIN RESULTS: Adherence was measured by the fill frequency (number of prescriptions filled during the observation period divided by months of observation). Patients with a fill frequency of 80% or greater were classified as adherent (661 patients); those with a fill frequency of 60% or less were classified as nonadherent (395 patients). The remaining 165 patients who had adherence rates of 61-79% were excluded from the analysis. The primary end point included a composite of myocardial infarction, unstable angina, PTCA, CABG, and death. Among 1056 patients, adherence was not associated with a reduction of the primary end point. However, patients in the adherent group were half as likely to experience a subsequent myocardial infarction as the patients in the nonadherent group (hazard ratio [HR] 0.45, 95% confidence interval [CI] 0.20-0.99, p=0.047). In patients younger than 65 years (both adherent and not), the associated reduction in myocardial infarction was even more profound (HR 0.14, 95% CI 0.04-0.46, p=0.001) and was accompanied by a trend for a lower frequency of unstable angina (HR 0.37, 95% CI 0.13-1.03, p=0.06). In patients 65 years or older (301 patients), adherence was not associated with significant changes in cardiovascular end points. CONCLUSION: A detectable excess of cardiovascular morbidity appears to be associated with nonadherence to statin therapy. Our analysis suggests that many occurrences of myocardial infarction could be prevented with improvements in adherence. Larger studies are necessary to determine the association between adherence and other cardiovascular end points. SN - 0277-0008 UR - https://www.unboundmedicine.com/medline/citation/16207093/Cardiovascular_morbidity_associated_with_nonadherence_to_statin_therapy_ L2 - https://doi.org/10.1592/phco.2005.25.8.1035 DB - PRIME DP - Unbound Medicine ER -