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Statin adherence is lower in primary than secondary prevention: A national follow-up study of new users

Finn Sigglekow1, Simon Horsburgh1,2, Lianne Parkin1,2

  • 1Department of Preventive and Social Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand.

Plos One
|November 19, 2020
PubMed

Insights

Patients receiving statins for secondary cardiovascular disease (CVD) prevention show higher adherence and lower discontinuation rates than those in primary prevention. Statin adherence is crucial for reducing cardiovascular events in high-risk individuals.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Public Health

Background:

  • Statin therapy is essential for preventing initial (primary prevention) and subsequent (secondary prevention) cardiovascular disease (CVD) events.
  • Patient adherence significantly impacts the effectiveness of statin treatment for CVD risk reduction.
  • A nationwide study was conducted to compare statin adherence and discontinuation between primary and secondary prevention cohorts.

Purpose of the Study:

  • To compare medication adherence and discontinuation rates of statin therapy in patients undergoing primary versus secondary prevention for cardiovascular disease.
  • To identify factors influencing statin adherence and discontinuation in different patient groups.

Main Methods:

  • Utilized nationwide dispensing data from New Zealand community pharmacies (2006-2011).
  • Identified new statin users and categorized them into primary (n=238,855) and secondary (n=50,811) prevention groups based on previous CVD history.
  • Calculated Medication Possession Ratio (MPR ≥ 0.8 for adherence) and discontinuation rates within one year of first dispensing, controlling for demographic and treatment variables using logistic regression.

Main Results:

  • Secondary prevention patients were 1.55 times more likely to be adherent and 0.67 times as likely to discontinue statin treatment compared to primary prevention patients.
  • Out of 289,666 new statin users, 82.5% were in the primary prevention group and 17.5% in the secondary prevention group.
  • An early gap in statin coverage was associated with increased odds of treatment discontinuation.

Conclusions:

  • Statin medication adherence is demonstrably higher in patients receiving treatment for secondary prevention of CVD compared to primary prevention.
  • Adherence patterns are influenced by a variety of demographic and treatment-related factors within both primary and secondary prevention groups.
  • Optimizing statin adherence in both primary and secondary prevention is critical for maximizing cardiovascular event risk reduction.
Abstract

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