Abstract
BackgroundCardiovascular disease (CVD) is a group of disorders of the heart and blood vessels, such as coronary heart disease (CHD), cerebrovascular disease, and peripheral artery disease. CVD is the leading threat to global health, whether measured by mortality, morbidity, or economic cost. Long-term administration of aspirin, statins, beta-blockers, and angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers improves survival in patients with stablished coronary heart disease. Nevertheless, adherence to prescribed medication is poor for long-term drug treatment.ObjectiveWe aim to assess the relationship between adherences to the four pharmacological groups recommended for secondary prevention and the clinical outcomes of cardiovascular morbidity and mortality in patients with established CHD according to the level of adherence to these drugs in a population of incident cases of acute coronary syndrome (ACS).MethodsPopulation-based cohort study of patients with a first episode of ACS during 2006-2015 in the Information System for Research in Primary Care (SIDIAP) database. We will estimate adherence to these drugs. The primary endpoint is a composite of all-cause mortality, ACS, and ischaemic stroke. Bivariate analyses will be performed estimating odds ratios for categorical variables and mean differences for continuous variables. Hazard ratios for adherences will be calculated for outcome events using Cox proportional hazard regression models, and proportionality of hazards assumption will be tested.ResultsWe expect to estimate adherence to all four study treatments, the incidence of MACE, and to analyze if this incidence is associated with the level of drug adherence.ConclusionsWe expect to find that adherent patients have a lower risk of the primary endpoints compared with nonadherent patients.Trial RegistrationThis study protocol was classified as EPA-OD by the AEMPS (IJG-EST-2017-01-2017-01, 07/04/2017) and registered in the EU PAS register (EUPAS19017, 09/05/2017).
Highlights
Cardiovascular disease (CVD) is a group of disorders of the heart and blood vessels, such as coronary heart disease (CHD), cerebrovascular disease, and peripheral artery disease
The primary endpoint is a composite of all-cause mortality, acute coronary syndrome (ACS), and ischaemic stroke
We expect to estimate adherence to all four study treatments, the incidence of major cardiovascular events (MACE), and to analyze if this incidence is associated with the level of drug adherence
Summary
Cardiovascular disease (CVD) is a group of disorders of the heart and blood vessels, such as coronary heart disease (CHD), cerebrovascular disease, and peripheral artery disease. CVD was responsible for the largest proportion of deaths for noncommunicable diseases under the age of 70 years, 37% of 16 million deaths [2]. Despite these numbers, the incidence of CVD death has decreased dramatically over the last four decades due to both population-level lifestyle changes in diet, smoking, and physical activity, and the development of effective interventions to treat individuals. The incidence of CVD death has decreased dramatically over the last four decades due to both population-level lifestyle changes in diet, smoking, and physical activity, and the development of effective interventions to treat individuals The latter includes invasive procedures and effective drugs to tackle modifiable CVD risk factors [3]. Adherence to prescribed medication is poor for long-term drug treatment
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