Rodriguez F, et al. - In patients with atherosclerotic cardiovascular disease (ASCVD) with stable statin prescriptions, researchers assessed if there was any correlation between statin adherence and mortality. Investigators discovered that low adherence to statin therapy was related to a higher risk of death. It was less likely for women, minorities, younger adults and older adults to adhere to statin therapy. Finding ways to improve adherence is important.

Methods

• It was a retrospective cohort analysis.
• This investigation involved subjects who were between ages 21 and 85 years and had 1 or more International Classification of Diseases, Ninth Revision, Clinical Modification codes for ASCVD on two or more dates in the previous 2 years without intensity changes to their statin prescription who were treated within the Veterans Affairs Health System between January 1, 2013 and April 2014.
• By the medication possession ratio (MPR), statin adherence was defined.
• Investigators categorized adherence levels as an MPR of less than 50%, 50% to 69%, 70% to 89%, and 90% or greater; adherence was defined as an MPR of 80% or greater for dichotomous analyses.
• The primary outcome was death of all causes adjusted for demographic and clinical characteristics and adherence to other cardiac medications.

Results

• Of the 347,104 adults eligible for ASCVD, 5,472 (1.6%) were women, 284,150 (81.9%) were white, 36,208 (10.4%) were African Americans, 16,323 (4.7%) were Hispanic, 4,093 (1.2%) were Pacific Islanders, 1,293 (0.4%) were Native Americans, 1,145 (0.3%) were Asians, and 1,794 (0.5%) were other races.
• Compared to patients taking high-intensity statin therapy (odds ratio [OR], 1.18; 95% CI, 1.16-1.20), those taking moderate-intensity statin therapy were more adherent.
• Like minority groups, women were less adherent (OR, 0.89; 95% CI, 0.84-0.94).
• Compared to adults aged 65 to 74 years, younger and older patients were less likely to be adherent.
• There were 85,930 deaths (24.8%) during a mean (SD) of 2.9 (0.8) years of follow-up.
• Patients with an MPR of less than 50% had a hazard ratio (HR; adjusted for clinical characteristics and adherence to other cardiac medications) of 1.30 (95% CI, 1.27-1.34), those with an MPR of 50% to 69% had an HR of 1.21 (95% CI, 1.18-1.24), and those with an MPR of 70% to 89% had an HR of 1.08 (95% CI, 1.06-1.09) compared to the most adherent patients (MPR ≥ 90%).