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IMPRES: Statin adherence low at 3 years in atherosclerotic CVD
ANAHEIM, Calif. — Fewer than one-third of patients with atherosclerotic CVD who were prescribed statin therapy from a discharge medication protocol were on the therapy at 3 years, according to data presented at the American Heart Association Scientific Sessions.
“Although long-term statin use was significantly higher among the atherosclerotic cardiovascular disease patients with coronary artery disease patients who participated in a special program emphasizing statin prescription upon discharged, compared to patients with strokes or peripheral artery disease, still a large treatment gap remained in all groups, including our patients who we made sure that they got started on a statin,” Joseph B. Muhlestein, MD, co-director of cardiovascular research at the Intermountain Medical Center Heart Institute in Salt Lake City, said during the presentation.
Atherosclerotic CVD
Researchers for the IMPRES study analyzed data from 62,070 patients (mean age, 66 years; 65% men) who were diagnosed with atherosclerotic CVD, including cerebrovascular disease (n = 11,541), CAD (n = 43,046) and peripheral artery disease (n = 7,483), from 1999 to 2013.
A discharge medication protocol was initiated at the start of the study. Through this, patients with CAD, HF and atrial fibrillation were discharged with guideline-based medications. Patients with CAD received statin therapy when discharged.
Information on prescribed medications, medical history and demographics were collected throughout the study. Researchers also reviewed electronic medical records for the number of patients initially discharged with statin therapy and those who were still on the therapy at 1 year and 3 years, which was categorized by the type of atherosclerotic CVD.
Patients were followed up for at least 3 years or until death.
Patients with CAD were more likely to be discharged with a statin prescription through the discharge medication protocol (83%) compared with those with cerebrovascular disease (53%) and PAD (28%; P < .0001); patients in the latter two categories were not part of the discharge protocol.
“We think that the discharge medication protocol implemented for coronary artery disease patients was beneficial,” Muhlestein said.
Continued statin therapy
At 1 year, 45.4% of patients with CAD, 22.5% of those with cerebrovascular disease and 14.2% of patients with PAD were still on statin therapy (P < .0001). Adherence rates were lower at 3 years in patients with CAD (37.5%), cerebrovascular disease (15.5%) and PAD (10.2%; P < .0001).
“It was similar among all the groups no matter how many got started on it to begin with, which resulted in the total patients still on statins at 1 and 3 years was less than desirable,” Muhlestein said.
At 3 years, the strongest predictor of statin continuation was no major adverse CV events during follow-up (OR = 4.17; P < .0001).
“When you think about it from a clinician’s standpoint, they might say, ‘Well, I’m doing fine, so I’m going to stop this medicine,’” Muhlestein said. “If they had another heart attack, then you’d say, ‘You better stay on that statin because even with the statin, you’re not doing well, so for heaven’s sakes, don’t stop it.’ It made sense in that regard.”
Another independent predictor was no follow-up LDL (OR = 3.13; P < .0001).
“Some of our physicians thought the new guidelines said, ‘Well, don’t necessarily look for targets, so therefore, fire and forget and just start them on a statin and forget about it,’” Muhlestein said. “That led patients to decide, ‘Maybe I don’t need to keep taking it.’” – by Darlene Dobkowski
Reference:
Muhlestein JB, et al. Ancel Keys Memorial Lecture: Lifestyle and Medical Therapy for CVD Prevention. Presented at: American Heart Association Scientific Sessions; Nov. 11-15, 2017; Anaheim, Calif.
Disclosures: The study was funded by an institutional grant from The Medicines Company. The authors report no relevant financial disclosures.