Treatment patterns and adherence to lipid-lowering drugs during eight-year follow-up after a coronary heart disease event

Abstract

Background and aimsProper prescription and high adherence to intensive lipid lowering drugs (LLD) in patients with coronary heart disease (CHD) is crucial and strongly recommended. The aim of this study is to investigate long-term treatment patterns and adherence to LLD following hospitalization for a CHD event. MethodsPatients admitted to two Norwegian hospitals with a CHD event from 2011-2014 (N=1094) attended clinical examination and completed a questionnaire, median 16 months later. Clinical data were linked to pharmacy dispensing data from 2010-2020. The proportions using high-intensity statin therapy (atorvastatin 40/80 mg or rosuvastatin 20/40 mg) and non-statin LLD after the CHD event were assessed. Adherence was evaluated by proportion of days covered (PDC) and gaps in treatment. ResultsMedian age at hospitalization was 63 (IQR 12) years, 21% were female. Altogether, 1054 patients (96%) were discharged with a statin prescription, while treatment was dispensed in 85% within the following 90 days. During median 8 (SD 2.5) years follow-up, the proportion using high-intensity statin therapy ranged 62-68%, whereas the use of ezetimibe increased from 4-26 %. PDC <0.8 was found in 22% of statin users and 26% of ezetimibe users. The proportions with a treatment gap exceeding 180 days were 22% for statins and 28% for ezetimibe. Smoking at hospitalization and negative affectivity were significantly associated with reduced statin adherence, regardless of adherence measure. ConclusionsIn this long-term follow-up of patients with CHD, less than 70% used high-intensity statin therapy with only small changes over time, and only 25% used additional treatment with ezetimibe. We identified factors associated with reduced statin adherence that may be target for interventions.