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Adherence to high-intensity statins decreases CV risk
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Patients with hypercholesterolemia who were treated with high-intensity statin therapy had a lower CV risk compared with those who were nonadherent to low-intensity statin therapy, according to a study published in JAMA Network Open.
“It doesn’t matter how patients get to this point — through obesity, smoking, genetic risk factors — what we know is that once you have one heart attack or other cardiovascular event, you are at much higher risk of more events in the future and that lowering your LDL cholesterol levels is key to improving outcomes,” Kausik Ray, MBChB, MD, MPhil, FRCP, professor at Imperial College London School of Public Health, said in a press release. “For these patients, taking the right medication at the right dose at the right time — and sticking to the regimen — is critical in lowering their risk of future cardiovascular events.”
Primary care in the U.K.
Kamlesh Khunti, MD, head of the department and professor of primary care, diabetes and vascular medicine at University of Leicester in the United Kingdom, and colleagues analyzed data from 29,797 patients with hypercholesterolemia who were newly treated, defined as receipt of the first statin and/or ezetimibe prescription between 2010 and 2013 and at least one additional prescription during the following year. Patients were categorized as having CVD (n = 16,701; mean age, 68 years; 61% men), type 2 diabetes without chronic kidney disease or CVD (n = 12,422; mean age, 59 years; 55% men) and chronic kidney disease without CVD (n = 674; mean age, 67 years; 47% men).
LDL levels were measured on or before the therapy was prescribed. Adherence and treatment intensity were calculated annually during follow-up, which was conducted until CV event of interest, death, last known record of the patient in the primary care practice, change in therapy other than a statin or ezetimibe or Feb. 29, 2016, whichever occurred first.
Statin therapy was categorized as low intensity (< 30% reduction), moderate intensity (30% to < 50% reduction) or high intensity ( 50% reduction) based on the American College of Cardiology/American Heart Association guidelines.
The primary outcome was a composite endpoint of CV death or hospitalization for unstable angina, MI, ischemic stroke, revascularization or HF.
Adherence, treatment effects
Patients in the CVD cohort who received high-intensity statin therapy were more likely to be adherent over time (84.1% in the first year and 72.3% in the sixth year) compared with patients who received low-intensity therapy (57.4% to 48.4%). Those in the diabetes and chronic kidney disease cohorts had similar rates of adherence across intensity groups.
There was a graded association between a combined measure of adherence and treatment intensity and outcomes. Each 10% increase in the combined measure for patients in the CVD cohort was linked to a 10% decreased risk for CV events (HR = 0.9; 95% CI, 0.86-0.94). Compared with patients who were untreated for at least 1 year, those who adhered to a high-intensity statin therapy regimen had a 40% lower risk for CV events (HR = 0.6; 95% CI, 0.54-0.68). Similar results were seen in the chronic kidney disease and diabetes cohorts.
“The lowest cardiovascular risk was observed among adherent patients receiving high-intensity therapy, and the highest cardiovascular risk was observed among nonadherent patients receiving low-intensity therapy,” Khunti and colleagues wrote. “Strategies that optimize LDL-C reduction through better use of high-intensity statins and improved adherence could potentially reduce the risk of CVD in high-risk populations.” – by Darlene Dobkowski
Disclosures: The study was funded by Amgen Europe GmbH. Khunti reports he received personal fees from Amgen, AstraZeneca, Bayer, Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Roche, Sanofi and Servier; received grants from AstraZeneca, Boehringer Ingelheim, Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Pfizer, Roche and Sanofi; consulted for Abbott, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Sanofi and Servier; and spoke for AstraZeneca, Boehringer Ingelheim, Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk and Sanofi. Ray reports he received personal fees from Algorithm, Amgen, AstraZeneca, Boehringer Ingelheim, Cipla, Kowa, Novo Nordisk, Regeneron, Sanofi, Takeda and The Medicines Company; served as a consultant for AbbVie, Akcea, Amgen, Cerenis, Esperion, Ionis Pharma, Lilly, Regeneron, Sanofi and The Medicines Company; and received grants through his instruction from Amgen, Merck Sharpe & Dohme, Pfizer, Regeneron and Sanofi. Please see the study for all other authors’ relevant financial disclosures.
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Khunti K, et al. JAMA Netw Open. 2018;doi:10.1001/jamanetworkopen.2018.5554.
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