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Long-term statin persistence is poor among high-risk patients with dyslipidemia: a real-world administrative claims
Peter P Toth1,2, Craig Granowitz3, Michael Hull4
1CGH Medical Center, 101 East Miller Road, Sterling, IL, 61081, USA. Peter.Toth@cghmc.com.
Insights
Long-term statin use remains low, with less than 25% of patients persisting with therapy after five years. This highlights a significant public health concern regarding cardiovascular disease management.
Area of Science:
- Cardiovascular Medicine
- Pharmacoeconomics
- Public Health
Background:
- Statin persistence rates have remained below 50% after one year for a decade, with little recent improvement.
- Long-term data on statin persistence, especially in high-risk populations, are scarce.
- This study addresses the need for understanding longer-term statin adherence patterns.
Purpose of the Study:
- To evaluate long-term statin persistence in patients with high cardiovascular risk.
- To compare statin persistence between patients with elevated triglycerides and a matched control group.
- To identify factors influencing long-term statin adherence.
Main Methods:
- Retrospective analysis of administrative claims data (Optum Research Database).
- Inclusion of patients aged ≥45 years with diabetes and/or atherosclerotic cardiovascular disease (ASCVD).
- Comparison of an elevated triglycerides cohort (TG ≥150 mg/dL) with a propensity-matched control cohort (TG <150 mg/dL, HDL-C >40 mg/dL).
Main Results:
- Statin persistence was 47% after 1 year and 19% after 5 years in both cohorts.
- Persistence was significantly lower in women and younger patients compared to men and older patients.
- After 5 years, persistence remained below 25% across all assessed subgroups, including those with comorbidities.
Conclusions:
- Long-term statin persistence is alarmingly low, with less than 25% of patients remaining on therapy after five years.
- The findings indicate a significant public health concern regarding the management of cardiovascular risk.
- Strategies to improve long-term statin adherence are crucial for effective cardiovascular disease prevention.
Background:
A decade ago, statin persistence was < 50% after 1 year, and recent short-term analyses have revealed very little progress in improving statin persistence, even in patients with a prior cardiovascular (CV) event. Data on longer-term statin persistence are lacking. We measured long-term statin persistence in patients with high CV risk.
Methods:
This retrospective administrative claims analysis of the Optum Research Database included patients aged ≥ 45 years with diabetes and/or atherosclerotic CV disease (ASCVD) who had a statin prescription filled in 2010. It included an elevated triglycerides (TG) cohort of patients with index date in 2010 and TG ≥ 150 mg/dL (n = 23,181) and a propensity-matched comparator cohort with TG < 150 mg/dL and high-density lipoprotein cholesterol > 40 mg/dL (n = 23,181). Both cohorts were followed for ≥ 6 months up to March 2016.
Results:
The probability of remaining on a prescription fill for index statin therapy was 47% after 1 year and 19% after 5 years in both cohorts. Statin persistence was worse among women than men, and among younger versus older patients (P < 0.001 for all comparisons). After 5 years, the probability of remaining on a prescription fill for index statin was < 25% across all subgroups assessed including patients with and without baseline revascularization, heart failure, peripheral artery disease and renal disease. Similar results were observed in a subcohort analysis of patients with TG 200-499 mg/dL.
Conclusions:
Long-term statin persistence after 5 years is alarmingly low (< 25%) and is a public health concern.
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