Medication adherence among persons with coronary heart disease and associations with blood pressure and low-density-lipoprotein-cholesterol

Elisabeth Pedersen,Anne Elise Eggen,Beate Hennie Garcia,Kjell H Halvorsen,Raul Primicerio,Henrik Schirmer,Marit Waaseth

doi:10.1007/s00228-022-03276-4

Abstract

PurposeTo describe medication adherence to lipid-lowering drugs (LLDs), antihypertensive drugs, and acetylsalicylic acid (ASA) among persons with coronary heart disease (CHD) and explore its association with low-density-lipoprotein (LDL)-cholesterol, and systolic and diastolic blood pressure.MethodsBased on record linkage between the seventh wave of the Tromsø Study and the Norwegian Prescription Database, medication adherence was calculated as the proportion of days covered (PDC) for persistent prevalent users in the period of 365 days before the attendance date. Multivariable linear regression models were used to assess the association between systolic and diastolic blood pressure and medication nonadherence to antihypertensive drugs, age, sex, lifestyle, body mass index (BMI), current and previous diabetes, and between LDL-cholesterol and medication nonadherence to LLDs, age, sex, lifestyle, BMI, and current and previous diabetes.ResultsMean PDC was 0.94 for LLDs and antihypertensive drugs and 0.97 for ASA. Among persons with PDC ≥ 0.80 for LLDs, 12.0% had an LDL-cholesterol < 1.8 mmol/L. Blood pressure < 140/90 mmHg (< 140/80 mmHg if diabetes patient) was reached by 55.1% of those with a PDC ≥ 0.80 for antihypertensive drugs. Adherence to LLDs was associated with lower LDL-cholesterol, while neither systolic nor diastolic blood pressure was associated with adherence to antihypertensive drugs.ConclusionAdherence to antihypertensive drugs, LLDs, and ASA among persons with CHD were high despite low achievement of treatment goals for blood pressure and LDL-cholesterol. There was a statistically significant association between adherence to LLDs and LDL-cholesterol, but not between adherence to antihypertensive drugs and blood pressure.

Highlights

Adherence to medications for secondary prevention of coronary heart disease (CHD) is important to achieve the full effect of lipid-lowering drugs (LLDs), antihypertensive drugs, and low-dose acetylsalicylic acid (ASA) and thereby avoid new cardiovascular events [1,2,3,4].Lowering low-density-lipoprotein (LDL)-cholesterol and blood pressure reduce the risk of further morbidity and mortality of coronary heart disease [5, 6]
We applied three multivariable linear regression models to assess the association between systolic and diastolic blood pressure and medication nonadherence to antihypertensive drugs, age, sex, lifestyle, body mass index (BMI), current and previous diabetes, and between LDL-cholesterol and medication nonadherence to LLDs, age, sex, lifestyle, BMI, and current and previous diabetes
We found that adherence to LLDs was significantly associated with a lower LDL-cholesterol, but no significant association was identified between adherence to antihypertensive drugs and lower blood pressure

Summary

Introduction

Adherence to medications for secondary prevention of coronary heart disease (CHD) is important to achieve the full effect of lipid-lowering drugs (LLDs), antihypertensive drugs, and low-dose acetylsalicylic acid (ASA) and thereby avoid new cardiovascular events [1,2,3,4]. Lowering low-density-lipoprotein (LDL)-cholesterol and blood pressure reduce the risk of further morbidity and mortality of coronary heart disease [5, 6]. European guidelines for prevention of cardiovascular disease have recommended that patients with established CHD should have a blood pressure of < 140/90 mmHg (< 140/80 mmHg in patients with diabetes) and an LDL-cholesterol of < 1.8 mmol/l (< 70 mg/dL) [7, 8]. Several studies have found an association between being adherent and achieving LDL-cholesterol or blood pressure control [15,16,17,18,19]

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