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Published on: September 30, 2020
Adherence with statin therapy in elderly patients with and without acute coronary syndromes
Cynthia A Jackevicius1, Muhammad Mamdani, Jack V Tu
1Department of Health Policy, Management, and Evaluation, Pharmacy Department and Women's Health Program, University Health Network-Toronto General Hospital, 200 Elizabeth St, Toronto, Ontario, Canada M5G 2C4. Cynthia.Jackevicius@uhn.on.ca
Elderly patients show low adherence to statins, with only 40% completing 2-year treatment. This poor adherence limits the survival benefits of statin therapy for many older adults.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Geriatrics
Background:
- Statin therapy offers survival benefits, typically observed after 1-2 years.
- Previous studies on older lipid-lowering drugs indicated low 1-year adherence rates.
Purpose of the Study:
- To compare 2-year statin adherence in elderly patients with recent acute coronary syndrome (ACS), chronic coronary artery disease (CAD), and primary prevention.
- To assess the impact of adherence on the effectiveness of statin therapy.
Main Methods:
- A cohort study utilized linked population-based administrative data from Ontario, Canada.
- Included were 66+ year-old patients initiated on statins between 1994-1998, with no prior statin use in the preceding year.
- Follow-up was for 2 years, defining adherence as dispensing a statin every 120 days.
Main Results:
- Two-year adherence rates were low: 40.1% (ACS), 36.1% (chronic CAD), and 25.4% (primary prevention).
- Patients with chronic CAD (RR 1.14) and primary prevention (RR 1.92) were significantly more likely to be nonadherent compared to the ACS cohort.
Conclusions:
- Elderly patients, regardless of recent ACS, exhibit low adherence to statin therapy.
- Premature discontinuation of statins suggests many patients may not achieve full therapeutic benefits.
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