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Adherence to secondary prevention medications and four-year outcomes in outpatients with atherosclerosis

Dharam J Kumbhani1, Ph Gabriel Steg, Christopher P Cannon

  • 1Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.

The American Journal of Medicine
|June 27, 2013
PubMed

Insights

Nonadherence to secondary prevention medications in atherothrombosis patients significantly increases long-term risks of cardiovascular events and death. Maintaining medication adherence is crucial for better patient outcomes.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Public Health

Background:

  • Nonadherence to secondary prevention medications is common in patients with established atherothrombotic disease.
  • Long-term outcome data for nonadherence in this population are limited.
  • The REduction of Atherothrombosis for Continued Health (REACH) registry provides a large international dataset.

Purpose of the Study:

  • To assess the prevalence of nonadherence to secondary prevention medications.
  • To evaluate the long-term outcomes associated with nonadherence.
  • To investigate the impact of adherence on cardiovascular events and mortality.

Main Methods:

  • Analysis of 37,154 stable outpatients with established atherothrombosis from the REACH registry.
  • Assessment of adherence to antiplatelet agents, statins, and antihypertensive agents at baseline and 1-year follow-up.
  • Primary outcome: composite of cardiovascular death, myocardial infarction, or stroke at 4 years.

Main Results:

  • Adherence rates were 46.7% at baseline and 48.2% at 1 year.
  • Nonadherence at baseline (HR 1.18) and 1 year (HR 1.19) significantly increased the risk of the primary composite endpoint.
  • Nonadherence was also associated with elevated all-cause mortality, with numbers needed to treat of 31 and 25, respectively.

Conclusions:

  • Nonadherence to evidence-based secondary prevention therapies significantly increases long-term adverse events in patients with atherothrombosis.
  • Consistent adherence is associated with the lowest incidence of adverse outcomes.
  • Interventions to improve medication adherence are critical for this patient population.
Abstract

Keywords:
AtherosclerosisCardiovascular diseaseCompliance/adherenceRegistrySecondary prevention

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