Association of Treatment Intensity and Adherence to Lipid-Lowering Therapy with Major Adverse Cardiovascular Events Among Post-MI Patients in Germany.
Cardiovascular disease
Lipid-lowering therapy
Myocardial infarction
Statins
Treatment adherence
Treatment intensity
Journal
Advances in therapy
ISSN: 1865-8652
Titre abrégé: Adv Ther
Pays: United States
ID NLM: 8611864
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
received:
07
01
2021
accepted:
03
03
2021
pubmed:
9
4
2021
medline:
22
5
2021
entrez:
8
4
2021
Statut:
ppublish
Résumé
Patients with a history of myocardial infarction (MI) are at very high risk of subsequent cardiovascular events. This study evaluated the association of treatment intensity and adherence to lipid-lowering therapies (LLT) with major adverse cardiovascular events (MACE) among post-MI patients in Germany. We carried out a retrospective cohort study using German health claims data (2010-2015). We included patients ≥ 18 years, with a history of MI and who started an LLT (statin and/or ezetimibe), between 2011 and 2013. The follow-up period started 1 year after the second LLT prescription and continued until MACE, all-cause death or December 31, 2015, whichever occurred first. Treatment intensity was classified based on expected low-density lipoprotein cholesterol reduction; adherence was measured by the proportion of days covered using prescription data. A combined adherence-adjusted intensity variable was created by multiplying intensity and adherence. We used Cox proportional hazards models to control for age, sex, Charlson Comorbidity Index and other cardiovascular risk factors at baseline. A total of 14,944 patients were included. Mean age was 66.7 (SD = 13.0) years; 68.7% of patients were men. Each 10% increase in treatment intensity, adherence, or adherence-adjusted intensity was associated with a decrease in the risk of MACE of 17% (HR = 0.83, 95% CI 0.79-0.87), 5% (HR = 0.95, 95% CI 0.94-0.97), and 14% (HR = 0.86, 95% CI 0.83-0.90), respectively. Higher treatment intensity and/or adherence of LLT was associated with significantly lower risk of MACE in post-MI patients. Strategies to tailor intensity to patient profiles and improve adherence could reduce the risk of cardiovascular events.
Identifiants
pubmed: 33830461
doi: 10.1007/s12325-021-01697-8
pii: 10.1007/s12325-021-01697-8
pmc: PMC8107155
doi:
Substances chimiques
Hydroxymethylglutaryl-CoA Reductase Inhibitors
0
Lipids
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Pagination
2532-2541Références
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