Abstract
IntroductionTo compare statin initiation and treatment non-adherence following a first acute myocardial infarction (MI) in patients with inflammatory rheumatic disease (IRD) and the general population.MethodsWe conducted a retrospective cohort study using a population-based linked database. Cases of first MI from July 2001 to June 2009 were identified based on International Classification of Diseases (ICD-10-AM) codes. Statin initiation and adherence was identified based on pharmaceutical claims records. Logistic regression was used to assess the odds of statin initiation by IRD status. Non-adherence was assessed as the time to first treatment gap using a Cox proportional hazards model.ResultsThere were 18,518 individuals with an index MI over the time period surviving longer than 30 days, of whom 415 (2.2%) were IRD patients. The adjusted odds of receiving a statin by IRD status was significantly lower (OR =0.69, 95% CI: 0.55 to 0.86) compared to the general population. No association between IRD status and statin non-adherence was identified (hazard ratio (HR) =1.12, 95% CI: 0.82 to 1.52).ConclusionsStatin initiation was significantly lower for people with IRD conditions compared to the general population. Once initiated on statins, the proportion of IRD patients who adhered to treatment was similar to the general population. Given the burden of cardiovascular disease and excess mortality in IRD patients, encouraging the use of evidence-based therapies is critical for ensuring the best outcomes in this high risk group.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-014-0443-y) contains supplementary material, which is available to authorized users.
Highlights
To compare statin initiation and treatment non-adherence following a first acute myocardial infarction (MI) in patients with inflammatory rheumatic disease (IRD) and the general population
Within the IRD group, patients initiated on statins were significantly more likely to be aged under 70 years, male, have received statins in the month prior to MI, have hypercholesterolaemia or be obese, but were less likely to be indigenous or have certain comorbidities, including dementia, peptic ulcer disease and pulmonary disease when compared to patients not initiated on statins
IRD patients initiated on statins received a significantly higher median number of medications at 1 month post MI than patients not initiated on statins
Summary
To compare statin initiation and treatment non-adherence following a first acute myocardial infarction (MI) in patients with inflammatory rheumatic disease (IRD) and the general population. Clinical trials have demonstrated the efficacy of secondary pharmacological prevention strategies for reducing cardiovascular morbidity and mortality in the general population [15,16,17,18] Based on this evidence, current guidelines advocate the use of secondary prevention medications (anti-thrombotic therapy, oral beta-blockers, angiotensinconverting-enzyme (ACE) inhibitor and statins) following acute MI, where such therapy is not contra-indicated [19,20,21]. Lindharsen et al conducted a population-based study of national registries in Denmark, which included 877 patients with RA after a first MI They found RA patients had significantly lower odds of treatment with aspirin (OR 0.80, 95% CI:0.67, 0.96), β-blockers (OR 0.77, 95% CI 0.65, 0.92) and statins (OR 0.69, 95% CI 0.58, 0.82) [23]
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