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Nonutilization of Statins in a Community-based Population with a History of Coronary Revascularization
Jonathan A Peng1, Benedict P Ancock1, Carol Conell2
1Kaiser Permanente San Francisco Medical Center, San Francisco, California.
Insights
Many patients with coronary revascularization history stop taking statins, often due to patient preference. This highlights a need for improved statin adherence strategies in atherosclerosis management.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Health Services Research
Background:
- Statin therapy is crucial for reducing vascular events in atherosclerosis patients.
- Suboptimal adherence to statin medication is a significant clinical challenge.
- Understanding factors influencing statin use is vital for improving patient outcomes.
Purpose of the Study:
- To determine the rate of statin discontinuation among patients with a history of coronary revascularization.
- To identify demographic and clinical factors associated with statin non-adherence.
- To explore patient and provider reasons for stopping statin therapy.
Main Methods:
- Retrospective cohort study of 17,869 adult members with coronary revascularization history.
- Off-statin status defined as a ≥1-year gap in prescription refills.
- Multivariable logistic regression and chart review to analyze predictors and reasons for discontinuation.
Main Results:
- 18.3% of patients were off-statin status.
- Statin allergy, end-stage renal disease, liver disease, and African-American/Latino race were associated with off-statin status.
- Patient preference, not provider decision, was the primary reason for discontinuation (79%).
Conclusions:
- A significant portion of patients with coronary revascularization history discontinue statin therapy.
- Specific comorbidities and racial/ethnic groups show higher rates of discontinuation.
- Interventions should address patient-reported reasons to improve statin adherence and cardiovascular health.
Purpose:
Statin therapy has been reported to reduce the incidence of vascular events in patients with atherosclerosis, but adherence to statins may be suboptimal. The aims of this study were to quantify the rate of statin use among individuals with a history of coronary revascularization in a large, integrated health care system and to determine which demographic characteristics and clinical factors are associated with statin use.
Methods:
This was a retrospective cohort study using database programming and chart review. The study included adult members of Kaiser Permanente Northern California with a history of coronary revascularization. The study outcome was off-statin status, defined as a ≥1-year gap between filled prescriptions. The predictor variables included age, race, body mass index, dyslipidemia, liver disease, kidney disease, and history of statin allergy. Multivariable logistic regression was used to quantify the associations between the predictor variables and statin status. A chart review of a randomly selected subset was performed to identify reasons why individuals were not taking statins.
Findings:
The study population included 17,869 Kaiser Permanente Northern California members, of which 18.3% had off-statin status. The following variables were associated with off-statin status: statin allergy (odds ratio [OR] = 2.18; 95% CI, 1.89-2.52), end-stage renal disease (OR = 1.55; 95% CI, 1.26-1.91), liver disease (OR = 1.44; 95% CI, 1.08-1.93), African-American race (OR = 1.55 vs white; 95% CI, 1.32-1.81), and Latino race (OR = 1.18; 95% CI, 1.05-1.33). The chart review found that off-statin status typically reflects patient (79%) rather than provider (21%) preference.
Implications:
A significant minority of patients with a history of coronary revascularization are not taking statins. Off-statin status is associated with kidney disease, liver disease, African-American race, and Latino race. At an individual level, off-statin status was usually driven by patient preference, due to minor or undefined reasons. These findings may be useful in guiding strategies to increase statin use in individuals with atherosclerosis.
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