Patterns Of Statin Use Research Articles

Evaluation of LDL goal achievement in statin consumption, south east of Iran

Lipid goal achievement and statin consumption were estimated at extreme/very-high/high/moderate and low cardiovascular risk categories. In the cross-sectional study, 585 patients treated with statin therapy referring to the heart clinic of Birjand were recruited. Patients were classified and examined LDL-C values and the proportion reaching targets according to the American Association of Clinical Endocrinologists guideline. Three patterns of statin use (high/moderate/low-intensity statin therapy) in all patients were examined and attainments of LDL-C goal in cardiovascular risk groups have been demonstrated. Over half the populations (57.6%) were in the very-high CVD risk group. The results showed that the proportion of patients meeting total LDL-C goal values according to the guidelines was 43.4%. The frequency of patient had achievement LDL goal lower in high-intensity pattern (N = 13, 2.3%), compared with moderate (N = 496, 86.1%) and low-intensity patterns (N = 67, 11.6%). In general, LDL-C goal achievement was greatest with moderate-intensity statin use. LDL-C reduction after statin consumption was estimated about one-third of the studied population. It seems likely that the achievement of a therapeutic target for serum lipids such as LDL-C improved is far more cost-effective and would be able to reach the target LDL as well changing the type and intensity of statins.

Whether statin use improves the survival of patients with glioblastoma?: A meta-analysis.

Background:Glioblastomas are malignant brain tumors associated with high mortality and poor prognosis. Evidence from preclinical studies suggests that statins have an antitumor role, but their effects on the survival of patients with glioblastoma remain controversial. This meta-analysis attempts to assess the association between statins and glioblastoma.Methods:We searched 4 databases (PubMed, Web of Science, Embase, and Cochrane Library) for articles that evaluate the effect of statins on the survival of patients with glioblastoma. Two reviewers were asked to assess the quality of the studies and extract the data regarding progression-free survival (PFS) and overall survival (OS).Result:A total of 5 studies met the inclusion criteria with 430 statin users and 2089 nonstatin users. All 5 studies were retrospectively analyzed. The pooled hazard ratio (HR) and 95% confidence intervals (CIs) were calculated. There was no benefit of statins found pertaining to the survival of glioblastoma patients in both PFS (HR, 0.97; CI, 0.84–1.13) and OS (HR, 0.98; CI, 0.87–1.11). In a subgroup defined by the patterns of statin use, it was determined that usage before glioblastoma diagnosis favored the OS of patients (HR, 0.85). The result, however, failed to demonstrate a statistically significant difference.Conclusion:Use of statins was not associated with prolonged survival of patients with glioblastoma. Further well-designed randomized controlled trials are needed to confirm.

Prevalence and Incidence of Statin Use and 3-Year Adherence and Discontinuation Rates Among Older Adults With Dementia.

To examine the patterns of statin use and determine the 3-year adherence and discontinuation rates among a cohort of Australians aged ≥65 years with dementia. The yearly prevalence and incidence of statin use were compared via Poisson regression modeling using 2007 as the reference year. People with dementia were identified according to dispensing of antidementia medications. A cohort of 589 new statin users was followed longitudinally. Adherence was estimated via the proportion of days covered (PDC). Discontinuation was defined as ≥90 days without statin coverage. The annual prevalence of statin use among older Australians with dementia increased from 20.6% in 2007 to 31.7% in 2016 (aged-sex adjusted rate ratio: 1.51, 95% confidence interval: 1.35-1.69). Among the new users, the proportion adherent (PDC ≥ 0.80) decreased from 60.3% at 6 months to 31.0% at 3 years. During the 3-year follow-up, 58.7% discontinued their statin. Despite increased use of statins among older Australians with dementia, adherence is low and discontinuation is high, which may point to intentional cessation.

Statin-associated myopathy. Assessment of frequency based on data of all statutory health insurance funds in Germany.

Aim of the study was to assess the incidence of statin‐associated myopathy (SAM) under real‐life conditions in Germany. Database: Administrative data (master data, diagnoses, prescriptions) for all individuals in Germany insured with the Statutory Health Insurance. Basic population: individuals 18 years and older who have been insured continually from 2009 to 2011 (52.9 million; 29.9 million men, 23.9 million women). Data access is provided by the German Institute of Medical Documentation and Information, DIMDI) according to the Data Transparency Regulation of 2012. Statins: identification with the ATC–Codes: C10AA, C10BA and C10BX. Study population: incident statin users in 2010 with a diagnosis of lipid disorders (ICD‐10‐GM E78, excluding patients with: E78.1, E78.3, E78.6 in eight quarters before index prescription. Definition of SAM: documentation of myopathy (ICD‐10‐GM G72.0, G72.8; G72.9, M60.8, M60.9, M79.1) in the first statin prescription quarter or in one of the three following quarters. The first event is considered for the incidence estimate. The daily doses included in a package were classified as “days under therapy” (by assuming one DDD) and taken as exposition time. SAM was found in 1.9% of 531 672 incident statin users. The percentage differs according to the patterns of statin use: the lowest incidence is observed in those with only one prescription (1.3%), the highest incidence with 5.0% is observed in those who not only stopped the treatment within 365 days, but who also had their statin changed. Administrative data including diagnoses from ambulatory care provide a realistic estimate of SAM frequency in every day practice.

Patterns of statin use and long‐term adherence and persistence among older adults with diabetes

Statins reduce the risk of cardiovascular disease in patients with diabetes. This study examined the prevalence of statin use and assessed long-term adherence and persistence among people aged ≥65 years with diabetes. Pharmaceutical Benefits Scheme data covering a 10% random sample of the Australian population were analyzed. Among older adults with diabetes, the yearly prevalence of statin use was compared via Poisson regression modeling using 2006 as the reference year. A cohort of 7400 new statin users (mean age 72.9 years; 46.2% female) was followed longitudinally. Adherence was assessed via the proportion of days covered (PDC). Statin discontinuation was defined as the first ≥90 days without statin coverage. The prevalence of statin use increased from 52.0% in 2006 to 71.2% in 2016 (age and sex-adjusted rate ratio 1.37; 95% confidence interval 1.33-1.41). No gender differences in statin use were observed, but the likelihood of being dispensed statin decreased with increasing age. Among the longitudinal cohort, the proportion adherent (PDC ≥0.80) decreased from 54.0% at 6 months to 37.0% at 9 years. Over a mean follow-up of 4.9 years, 66.8% discontinued, and the likelihood of stopping statin medication within the first year was 42.7%. No age or gender differences in statin discontinuation were evident. Statin use has increased among older adults with diabetes. However, adherence is low and discontinuation is high. Further investigations into the factors associated with non-adherence or discontinuation of statins are important so as to optimize statin use towards achieving the intended cardiovascular benefits among older people with diabetes.

Persistencia con estatinas en prevención primaria de enfermedad cardiovascular: resultados en una cohorte de trabajadores españoles

Introduction and objectivesThe aim of this study was to assess patterns of treatment persistence in a cohort of male Spanish workers receiving statin therapy for primary prevention of cardiovascular disease. MethodsThis descriptive study was conducted within the framework of the prospective longitudinal Aragon Workers’ Health Study (N = 5400). Incident male statin users were identified based on data collected from the regional government's medication consumption information system. Patterns of treatment persistence with statins prescribed for primary cardiovascular disease prevention were assessed and the relevance of potential predictors explored. ResultsAmong the 725 new statin users, less than one third remained persistent during the 1 year of follow-up. About 15% of nonpersistent users discontinued statin therapy after dispensation of the first prescription; of these, 42.1% did not recommence treatment within the following year. Factors reducing the likelihood of treatment discontinuation were older age (HR, 0.55; 95%CI, 0.39-0.77) and cotreatment with antihypertensive drugs (HR, 0.68; 95%CI, 0.56-0.82). No association was observed between treatment persistence and cotreatment with antidiabetic or antithrombotic drugs, baseline low-density lipoprotein levels, or total cholesterol levels. However, persistence was influenced by the type of statin first prescribed. ConclusionsOur analysis of a cohort of healthy male workers revealed poor statin persistence. These findings underscore the need for a better understanding of patterns of statin use, especially in apparently healthy individuals, and for the incorporation of patient behavior into prescribing decisions.Full English text available from:www.revespcardiol.org/en

Patterns of Statin Use in Older Medicare Beneficiaries With Traumatic Brain Injury.

In addition to lowering lipids, statins also may be beneficial for older adults sustaining a traumatic brain injury (TBI), as statin use prior to and following trauma may decrease mortality following injury. However, despite statins' potential to reduce mortality, there is limited research regarding statin use among older adults. To characterize and investigate factors associated with statin use among older adults with TBI. A retrospective drug utilization study was used to characterize statin use among Medicare beneficiaries 65 and older hospitalized with a TBI during 2006 to 2010 and with continuous Medicare Parts A, B, and D coverage 6 months prior and 12 months following TBI. Logistic regression was used to investigate the factors associated with statin use. The exposure of interest was statin use prior to and following TBI. Of the 75 698 beneficiaries included in the study, 37 874 (~50%) of beneficiaries used a statin at least once during the study period. The most common statin used was simvastatin, while fluvastatin was the least used statin. Statin users were more likely to have cardiovascular diseases when compared to nonusers. Hyperlipidemia was a major factor associated with statin use and had the greatest impact on statin use compared to nonuse (odds ratio = 9.54; 95% confidence interval = 9.07, 10.03). This national sample of older adults with TBI suggests that statins are commonly used. Future studies must next examine the impact of statin use on mortality and secondary injury in order to shape pharmacological therapy guidelines following TBI.

Persistence With Statins in Primary Prevention of Cardiovascular Disease: Findings From a Cohort of Spanish Workers

Introduction and objectivesThe aim of this study was to assess patterns of treatment persistence in a cohort of male Spanish workers receiving statin therapy for primary prevention of cardiovascular disease. MethodsThis descriptive study was conducted within the framework of the prospective longitudinal Aragon Workers’ Health Study (N = 5400). Incident male statin users were identified based on data collected from the regional government's medication consumption information system. Patterns of treatment persistence with statins prescribed for primary cardiovascular disease prevention were assessed and the relevance of potential predictors explored. ResultsAmong the 725 new statin users, less than one third remained persistent during the 1 year of follow-up. About 15% of nonpersistent users discontinued statin therapy after dispensation of the first prescription; of these, 42.1% did not recommence treatment within the following year. Factors reducing the likelihood of treatment discontinuation were older age (HR, 0.55; 95%CI, 0.39-0.77) and cotreatment with antihypertensive drugs (HR, 0.68; 95%CI, 0.56-0.82). No association was observed between treatment persistence and cotreatment with antidiabetic or antithrombotic drugs, baseline low-density lipoprotein levels, or total cholesterol levels. However, persistence was influenced by the type of statin first prescribed. ConclusionsOur analysis of a cohort of healthy male workers revealed poor statin persistence. These findings underscore the need for a better understanding of patterns of statin use, especially in apparently healthy individuals, and for the incorporation of patient behavior into prescribing decisions.

Patterns of Statin Use in a Real-World Population of Patients at High Cardiovascular Risk.

Widespread use of statins has improved hypercholesterolemia management, yet a significant proportion of patients remain at risk for cardiovascular (CV) events. Analyses of treatment patterns reveal inadequate intensity and duration of statin therapy among patients with hypercholesterolemia, and little is known about real-world statin use, specifically in subgroups of patients at high risk for CV events. To examine patterns of statin use and outcomes among patients with high-risk features who newly initiated statin monotherapy. Adult patients (aged > 18 years) at high CV risk who received > 1 prescription for statin monotherapy and who had not received lipid-modifying therapy during the previous 12 months were identified from the Truven MarketScan Commercial and Medicare Supplemental databases (from January 2007 to June 2013). Patients with atherosclerotic cardiovascular disease (ASCVD) or diabetes were hierarchically classified into 5 mutually exclusive CV risk categories (listed here in order from highest to lowest risk): (1) recent CV event (subcategorized by hospitalization for acute coronary syndrome [ACS] or other non-ACS CV event within 90 days of index); (2) coronary heart disease (CHD); (3) history of ischemic stroke; (4) peripheral artery disease (PAD); and (5) diabetes. Outcomes of interest included changes in therapy, proportion of days covered (PDC), time to discontinuation, and proportion of patients with ASCVD-related inpatient visit during the follow-up period. Statin therapy was subdivided into high-intensity treatment (atorvastatin 40 mg or 80 mg, rosuvastatin 20 mg or 40 mg, or simvastatin 80 mg) or moderate- to low-intensity treatment (all other statins and statin dosing regimens). Follow-up data were obtained from the index date (statin initiation) until the end of continuous enrollment. A total of 541,221 patients were included in the analysis. The majority of patients were stratified in the diabetes cohort (61.1%), followed in frequency by recent ACS event (15.8%), recent non-ACS CV event (9.9%), PAD (4.7%), CHD (4.4%), and history of ischemic stroke (4.1%). Only 15.0% of the population initiated therapy with a high-intensity statin, and 22.5% of these high-intensity statin initiators switched to a moderate- to low-intensity regimen during the follow-up period. Median time to statin discontinuation was approximately 15 months. Duration of treatment was longer among those who were treated with a high-intensity versus a moderate- to low-intensity statin regimen (21 and 15 months, respectively). The PDC was highest in the recent ACS hospitalization cohort (66.4%) and lowest in the diabetes cohort (55.5%). The PDC was significantly greater among patients who initiated treatment with a high-intensity statin regimen than with a moderate- to low-intensity statin regimen (62.1% vs. 57.5%, respectively; P< 0.001). At 1 year, Kaplan-Meier estimates of the cumulative rates for ASCVD-related hospitalizations ranged from 3.5% (diabetes) to 21.8% (recent ACS hospitalization). Patients at high risk for CV events are suboptimally dosed with statins, have high rates of discontinuation, and have low rates of adherence. Despite the use of statin therapy, ASCVD-related inpatient visit rates were high, particularly among those patients at highest risk because of a recent ACS hospitalization. Future interventions are required to ensure that high-risk patients are effectively managed to reduce subsequent morbidity and mortality. Support for this research was provided by Regeneron Pharmaceuticals, Tarrytown, New York, and Sanofi US, Bridgewater, New Jersey. Menzin and Lin are employees of Boston Health Economics, which received consulting fees from Sanofi. Friedman is a consultant to Boston Health Economics. Lin, Friedman, and Menzin have received research support from Sanofi US. Sung, Mallya, Panaccio, and Koren are employees of Sanofi US and also have ownership interest in Sanofi US. Sanchez is an employee of and has ownership interest in Regeneron Pharmaceuticals. Neumann has served on advisory boards for Merck & Co, Takeda Pharmaceutical Company, Genentech, Novartis, Bayer AG, UCB, Sanofi US, Robert Wood Johnson Foundation, and Cubist and serves as consultant for Boston Health Economics, Forrest, P urdue, and Smith and Nephew. This research has been presented in part at the International Society for Pharmacoeconomics and Outcomes Research, 20th Annual International Meeting, May 16-20, 2015, Philadelphia, Pennsylvania. All authors contributed to the study design, protocol development, and results interpretation. Lin and Menzin were responsible for conducting the study analyses. All authors were involved in manuscript development and approved the submitted version.

Patterns of statin use and cholesterol goal attainment in a high-risk cardiovascular population: A retrospective study of primary care electronic medical records

To describe real-life patterns of statin use and cholesterol goal attainment in a retrospective cohort of patients with high cardiovascular risk. Retrospective cohort study of 21,636 individuals, 18.34% women, mean age 63.30 years (standard deviation 6.29). New statin users aged 35 to 74 years at high cardiovascular risk and with no previous cardiovascular disease in primary care electronic medical records (2006-2011). Patterns of statin use were based on statin type, potency, and 1-year statin switches. Relative mean reductions over 1 year and probability of goal attainment (<3.3 mmol/L). Natural patterns of statin use were identified using multiple correspondence analysis; general linear and logistic models were used to estimate low-density lipoprotein cholesterol (LDL-C) reductions and goal attainment probability. Three patterns of statin use were defined: low (3.82% of the population), moderate (71.94%), and high intensity (24.24%). After 1 year, potency decreased 42.74%, 64.16%, and 50.94%, respectively, and 37.41%, 29.47%, and 30.16% of the population stopped taking statins in low, moderate, and high patterns, respectively. Relative reductions in LDL-C: low intensity, 15.7% (95% confidence interval [CI]: -22.96 to 54.36); moderate intensity, 29.72% (95% CI: 29.12-30.32); and high intensity, 24.20% (95% CI: -8.08 to 40.32). There was a direct relationship between higher intensity patterns and greater probability of goal attainment. Three real-life patterns of statin use were identified. Lipid management strategies in primary care should focus on improving adherence to treatment. People starting at low potency should switch to a moderate pattern; more intensive therapies should be considered in who require a larger LDL-C reduction to reach therapeutic targets, patients with good treatment adherence who do not achieve the goal with a moderate pattern of therapy or patients at very high risk.

Changing patterns of statin use following media coverage of statin side effects

Changing patterns of statin use following media coverage of statin side effects

Use of statins by medicare beneficiaries post myocardial infarction: poor physician quality or patient-centered care?

Even though guidelines strongly recommend that patients receive a statin for secondary prevention after an acute myocardial infarction (MI), many elderly patients do not fill a statin prescription within 30 days of discharge. This paper assesses whether patterns of statin use by Medicare beneficiaries post-discharge may be due to a mix of high-quality and low-quality physicians. Our data come from the Centers for Medicare & Medicaid Services (CMS) Chronic Condition Data Warehouse (CCW) and include 100% of Medicare beneficiaries hospitalized for an acute myocardial infarction in 2008 or 2009. Our study sample included physicians treating at least 10 Medicare fee-for-service beneficiaries during their MI institutional stay. Physician-specific statin fill rates (the proportion of each physician’s patients with a statin within 30 days post-discharge) were calculated to assess physician quality. We hypothesized that if the observed statin rates reflected a mix of high-quality and low-quality physicians, then physician-specific statin fill rates should follow a u-shaped or bimodal distribution. In our sample, 62% of patients filled a statin prescription within 30 days of discharge. We found that the distribution of statin fill rates across physicians was normal, with no clear distinctions in physician quality. Physicians, especially cardiologists, with relatively younger and healthier patient populations had higher rates of statin use. Our results suggest that physicians were engaging in patient-centered care, tailoring treatments to patient characteristics.

Statin utilisation patterns in older Australians living in residential care: 1-year prevalence study.

Despite controversy over the risks and benefits of statin therapy, statins continue to be commonly used medicines by older people. In a cohort study of participants aged ≥70 years (n = 540) living in residential care, Sydney, we found that the proportion of statin users decreased gradually from the baseline of 33.1% to 31.3% at 6 months (P = 0.13) and to 28.7% over 1 year (P = 0.002). Prevalence of statin use decreased with increasing age, with individuals aged ≥90 years being more likely to discontinue or deprescribe statins. The patterns of statin use did not change according to increasing baseline dose or baseline indication.

Different Patterns of Statin Use in Patients with Acute Myocardial Infarction

Statins have well-established cardiovascular benefits, and recent evidence suggests that discontinuing statin therapy after acute myocardial infarction (AMI) is harmful. Our objective was to assess the association between statin discontinuation post-AMI and 1-year all-cause mortality in a real world setting. Data on survivors of AMI between 2000 and 2007 were extracted from the hospital discharge summary database of Quebec and the provincial physician and drug claims database. Statin prescription filling was used to establish cohort groups. Previous statin use was defined as having filled a statin prescription in the 90 days pre-AMI, while post-AMI statin use was filling a prescription between discharge from hospital post-AMI and 90 days post-discharge. AMI patients who survived 90 days (n=48,229) were divided into 4 groups: i) non-users (n=11,657), did not receive statins pre- or post- AMI (reference group), ii) starters (n=22,452), received statins only post-AMI, iii) stoppers (n=488), received statins pre- but not post-AMI, and, iv) users (n=13,632), received statins pre- and post-AMI. Cox proportional hazards models were used to calculate hazard ratios (HR). Compared with non-users, stoppers had increased 1-year all-cause mortality (adjusted HR 1.36; 95% CI 1.08- 1.70, P=0.008). Starters (HR 0.65; 95% CI 0.59-0.71, P<0.0001) and users (HR 0.81; 95% CI 0.74-0.88, P<0.0001) had lower mortality than non-users. Discontinuation of statins in survivors of AMI was associated with an increase in 1-year all-cause mortality. Physicians should use caution when discontinuing statins post-AMI.

Maintenance of statin use over 3 years following acute coronary syndromes: a national data linkage study (ANZACS-QI-2)

ObjectiveTo describe patterns of statin use and predictors of poor maintenance over a 3-year period following an acute coronary syndrome (ACS).MethodsNational hospitalisation, mortality and pharmaceutical dispensing data were linked for...

Abstract 80: Patterns of Statin Use, Adherence, and Persistence among Elderly Patients with High-Risk Vascular Diseases

BACKGROUND: High-risk vascular diseases (HRVD), including cerebrovascular disease (CVD), coronary artery disease with diabetes (CADD), acute coronary syndrome (ACS), and peripheral artery disease (PAD), are still the leading cause of death in the US, despite progress in treatment. Little research has been done to systematically study statin use patterns, adherence, and persistence for HRVD patients using real-world large claims databases. The objective was to examine statin use patterns, adherence, and persistence in elderly patients with HRVD. METHODS: A large US administrative claims database for over 10 million beneficiaries annually from more than 100 self-insured Fortune 500 companies was used to conduct a retrospective cohort study. Patients with HRVD, defined as CVD, PAD, CADD, or a history of ACS (≥30days through 365 days after discharge for ACS) between 10/01/2008 and 09/30/2009, were ≥65 years of age and identified with minimum 12-month pre-index and 24-month post-index health plan eligibility. Statin use, statin median/mean dose, percent of patients using maximal statin dose (defined as atorvastatin ≥80 mg and rosuvastatin ≥40 mg), and statin adherence (calculated using the medication possession ratio [MPR]) were measured at 6 months, 12 months, and 24 months. Persistence was assessed with survival analysis techniques using a ≥30-day gap to define a discontinuation. RESULTS: A total of 525,893 patients with HRVD were identified; 50.3% used statins during the baseline period (PAD: 44.9%; CVD: 45.2%; CADD: 63.9%; ACS: 61.7%). This number changed slightly to 49.2%, 51.8%, and 54.3% during the 6-month, 12-month, and 24-month follow-up periods, respectively, with PAD and CVD patients having greater increase of statin use (49.7%, 50%, respectively) during the 24-month follow-up period. Simvastatin (41.6%, 42.2%, 42.8%), atorvastatin (31.9%, 30.5%, 28.8%), and rosuvastatin (11.5%, 12.0%, 12.4%) were the most commonly used statins with 4.8%, 4.6%, and 4.3% of patients using maximum statin doses at 6-month, 12-month, and 24-month follow-up periods. There appeared to be few changes in statin doses during the 24-month follow-up period (mean/median dose: simvastatin 34.6/40 mg, 34.8/40 mg, 34.8/40 mg; atorvastatin 29.6/20 mg, 29.8/20 mg, 30.2/20 mg; rosuvastatin 14.1/10 mg, 14.2/10 mg, 14.4/10 mg). The mean/median MPR was 0.66/0.68, 0.67/0.74, and 0.60/0.65 among HRVD patients who used a statin with only 17.4%, 20.9 %, and 20.7% of patients adherent (MPR≥80%) to their statin therapy during the 6-month, 12-month, and 24-month follow-up periods, respectively. The median time to statin discontinuation was 406 days during the 24-month follow-up period. CONCLUSIONS: Statin adherence is suboptimal for elderly patients with HRVD and the patterns of statin adherence persist over time with little titration in doses.

Abstract 123: Patterns of Statin Use, Adherence, and Persistence among Patients in Working Age Patients With High-Risk Vascular Diseases: Findings from a Multi-Employer Claims Database

BACKGROUND: Despite progress in treatment, high-risk vascular diseases (HRVD), including cerebrovascular disease (CVD), coronary artery disease with diabetes (CADD), acute coronary syndrome (ACS), and peripheral artery disease (PAD), account for approximately half of the rates of morbidity and mortality in the US. Limited research has been done to systematically study statin use patterns, adherence, and persistence for HRVD patients using real-world large claims databases. The objective was to examine statin use patterns, adherence, and persistence in patients with HRVD. METHODS: A retrospective cohort study was conducted using a large US administrative claims database for over 10 million beneficiaries annually from more than 100 self-insured Fortune 500 companies. HRVD patients (defined as patients with CVD, PAD, CADD, or a history of ACS [≥30 days through 365 days after discharge for ACS between 10/01/2008 and 09/30/2009]) aged 18 to 64 years, with minimum 12-month pre-index and 24-month post-index health plan eligibility, were identified for this study. Statin use, statin median/mean dose, percent of patients using maximal statin dose (defined as atorvastatin ≥80 mg and rosuvastatin ≥40 mg), and statin adherence (calculated using the medication possession ratio [MPR]) were measured at 6-month, 12-month, and 24-month follow-up periods. Persistence was assessed with survival analysis techniques using a ≥30-day gap to define a discontinuation. RESULTS: Among 516,863 identified HRVD patients, 38.7% used statins during the baseline period (PAD: 31.5%; CVD: 29.2%; CADD: 54.6%; ACS: 65.5%). The number increased to 40.6%, 43.3%, and 45.6% during the 6-month, 12-month, and 24-month follow-up periods, respectively, with greater increase of statin use in PAD and CVD patients (38.3%, 37.9%, respectively, during the 24-month follow-up period). Simvastatin (39.0%, 39.0%, 39.2%), atorvastatin (31.0%, 29.1%, 27.5%), and rosuvastatin (18.0%, 18.6%, 19.2%) were the most commonly used statins with 8.1%, 7.4%, and 7.3% of patients using maximum statin doses at 6-month, 12-month, and 24-month follow-up periods, respectively. There appeared to be little changes in statin doses during the 24-month follow-up period (mean/median dose: simvastatin 44.1/40 mg, 44.3/40 mg, 44.7/40 mg; atorvastatin 36.7/30 mg, 37.2/30 mg, 37.6/40 mg; rosuvastatin 17.2/10 mg, 17.4/10 mg, 17.9/10 mg). The mean/median MPR was 0.64/0.66, 0.60/0.66, and 0.49/0.49 among HRVD patients who used a statin with only 13.8%, 14.0%, and 10.9% of patients adherent (MPR≥80%) to their statin therapy during the 6-month, 12-month, and 24-month follow-up periods, respectively. The mean time to statin discontinuation was 357 days during the 24-month follow-up period. CONCLUSIONS: Nonadherence to statins is common for patients with HRVD, and the patterns of statin adherence persist over time with little titration in doses.

Discontinuation of statin therapy following an acute myocardial infarction: a population-based study

Randomized clinical trials have shown that statins can reduce mortality after acute myocardial infarction (AMI). However, the impact of changes in patterns of statin use, particularly stopping statins, on survival post-AMI is unknown. Our objective was to estimate the extent to which different patterns of statin use are associated with post-AMI mortality. Population-based, cohort study, from 2002 through 2004 in the United Kingdom General Practice Research Database (GPRD), involving patients surviving 90 days after their first AMI. Past statin use was defined as any statin prescription within 90 days before AMI; statin use post-AMI as any statin prescription within 90 days after AMI. Cohort entry was at day 90 post-AMI; subjects were followed for 1 year. Four groups were identified: (i) non-users (patients never on statins); (ii) users (on statins before and continued post-AMI); (iii) starters (started statins after the event); and (iv) stoppers (stopped statins after the event). Hazard ratios (HRs) were estimated using Cox proportional hazards model. The main outcome measure was 1-year all-cause mortality. The cohort included 9939 AMI survivors (mean age: 68.4 ± 12.8 years; 60.3% men), 22.7% of whom were not prescribed a statin post-AMI. When the non-user group (n = 2124) was considered as the reference, the adjusted HRs (95% confidence intervals) of death were 0.84 (0.66-1.09) for users (n = 2026), 0.72 (0.57-0.90) for starters (n = 5652), and 1.88 (1.13-3.07) for stoppers (n = 137). Stoppers of control medications (aspirin, β-blockers, and proton pump inhibitors) were not associated with increased mortality. Discontinuation of statins in survivors of a first AMI was relatively rare in this cohort. However, statin discontinuation was associated with higher total mortality and this may represent a biological rebound or/and a risk-treatment mismatch phenomenon, where treatment is withdrawn from very ill patients. While awaiting further research, at present statin use should only be withdrawn under judicious clinical supervision.