Abstract
BackgroundA decade ago, statin persistence was < 50% after 1 year, and recent short-term analyses have revealed very little progress in improving statin persistence, even in patients with a prior cardiovascular (CV) event. Data on longer-term statin persistence are lacking. We measured long-term statin persistence in patients with high CV risk.MethodsThis retrospective administrative claims analysis of the Optum Research Database included patients aged ≥ 45 years with diabetes and/or atherosclerotic CV disease (ASCVD) who had a statin prescription filled in 2010. It included an elevated triglycerides (TG) cohort of patients with index date in 2010 and TG ≥ 150 mg/dL (n = 23,181) and a propensity-matched comparator cohort with TG < 150 mg/dL and high-density lipoprotein cholesterol > 40 mg/dL (n = 23,181). Both cohorts were followed for ≥ 6 months up to March 2016.ResultsThe probability of remaining on a prescription fill for index statin therapy was 47% after 1 year and 19% after 5 years in both cohorts. Statin persistence was worse among women than men, and among younger versus older patients (P < 0.001 for all comparisons). After 5 years, the probability of remaining on a prescription fill for index statin was < 25% across all subgroups assessed including patients with and without baseline revascularization, heart failure, peripheral artery disease and renal disease. Similar results were observed in a subcohort analysis of patients with TG 200–499 mg/dL.ConclusionsLong-term statin persistence after 5 years is alarmingly low (< 25%) and is a public health concern.
Highlights
Statin therapy forms the cornerstone of both primary and secondary prevention and treatment of atherosclerotic cardiovascular disease (ASCVD) [1]
There was no difference in statin persistence between those with elevated TG and propensity-matched comparators in these subgroups. Results from this 5-year retrospective administrative claims analysis indicate that persistence with index statin therapy is poor in patients with elevated TG (≥ 150 mg/ dL) or high TG (200–499 mg/dL), diabetes, and/or ASCVD. This result is consistent with a number of previous studies over the past two decades, and confirms that poor long-term statin persistence remains an issue of concern for patients with high CV disease risk, including those with elevated TG who may be at increased risk of CV events and patients with diabetes [4,5,6, 8, 10, 16, 17]
In a Danish population study of nearly 675,000 individuals, early statin discontinuation increased with negative reports about statins in the news media and was associated with increased risk of myocardial infarction and death from CV disease, whereas early statin discontinuation decreased with positive news media reports about statin [18]
Summary
Statin therapy forms the cornerstone of both primary and secondary prevention and treatment of atherosclerotic cardiovascular disease (ASCVD) [1]. Adherence and persistence to statin therapy are low, and this has been shown to negatively impact clinical outcomes and residual cardiovascular (CV) risk [2, 3]. Statin persistence was reported to be less than 50% after 1 year [4]. A more recent study found that the proportion of days covered with a statin after a median follow-up of 2.2 years was 76%, with 40.5% of patients having poor adherence after 2 years [5]. A decade ago, statin persistence was < 50% after 1 year, and recent short-term analyses have revealed very little progress in improving statin persistence, even in patients with a prior cardiovascular (CV) event. We measured long-term statin persistence in patients with high CV risk
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