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Association of Treatment Intensity and Adherence to Lipid-Lowering Therapy with Major Adverse Cardiovascular Events Among Post-MI Patients in Germany
Association of Treatment Intensity and Adherence to Lipid-Lowering Therapy with Major Adverse Cardiovascular Events Among Post-MI Patients in Germany
- Source :
- Advances in Therapy
- Publication Year :
- 2021
- Publisher :
- Springer Healthcare, 2021.
-
Abstract
- Introduction Patients with a history of myocardial infarction (MI) are at very high risk of subsequent cardiovascular events. This study evaluated the association of treatment intensity and adherence to lipid-lowering therapies (LLT) with major adverse cardiovascular events (MACE) among post-MI patients in Germany. Methods We carried out a retrospective cohort study using German health claims data (2010–2015). We included patients ≥ 18 years, with a history of MI and who started an LLT (statin and/or ezetimibe), between 2011 and 2013. The follow-up period started 1 year after the second LLT prescription and continued until MACE, all-cause death or December 31, 2015, whichever occurred first. Treatment intensity was classified based on expected low-density lipoprotein cholesterol reduction; adherence was measured by the proportion of days covered using prescription data. A combined adherence-adjusted intensity variable was created by multiplying intensity and adherence. We used Cox proportional hazards models to control for age, sex, Charlson Comorbidity Index and other cardiovascular risk factors at baseline. Results A total of 14,944 patients were included. Mean age was 66.7 (SD = 13.0) years; 68.7% of patients were men. Each 10% increase in treatment intensity, adherence, or adherence-adjusted intensity was associated with a decrease in the risk of MACE of 17% (HR = 0.83, 95% CI 0.79–0.87), 5% (HR = 0.95, 95% CI 0.94–0.97), and 14% (HR = 0.86, 95% CI 0.83–0.90), respectively. Conclusions Higher treatment intensity and/or adherence of LLT was associated with significantly lower risk of MACE in post-MI patients. Strategies to tailor intensity to patient profiles and improve adherence could reduce the risk of cardiovascular events. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01697-8.
- Subjects :
- Male
030213 general clinical medicine
medicine.medical_specialty
Statin
medicine.drug_class
Myocardial Infarction
Lipid-lowering therapy
Lower risk
Medication Adherence
03 medical and health sciences
0302 clinical medicine
Ezetimibe
Risk Factors
Internal medicine
Germany
Medicine
Treatment adherence
Humans
Pharmacology (medical)
Myocardial infarction
Medical prescription
Original Research
Aged
Retrospective Studies
business.industry
Proportional hazards model
Statins
Retrospective cohort study
General Medicine
medicine.disease
Cardiovascular disease
Lipids
030220 oncology & carcinogenesis
Female
Hydroxymethylglutaryl-CoA Reductase Inhibitors
business
Mace
Treatment intensity
medicine.drug
Subjects
Details
- Language :
- English
- ISSN :
- 18658652 and 0741238X
- Volume :
- 38
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- Advances in Therapy
- Accession number :
- edsair.doi.dedup.....c5f874050a1f81d6b5dcbf2eae709094