Medication persistence trajectories among individuals prescribed lipid-lowering therapy in primary care settings: A...

This study aimed to identify distinct trajectories of lipid-modifying medication (LMM) persistence over time and to explore characteristics associated with each pattern.

Using primary care data from IQVIA, we conducted a retrospective cohort study of adults prescribed LMMs between January 2015 and December 2017, with 5 years of follow-up. Persistence was defined as ≥1 prescription every 6 months. Group-based trajectory modelling identified medication persistence patterns; characteristics were compared using 1-way ANOVA and chi-squared tests.

Among 51 504 individuals (mean age 62 years, 53% male), 4 distinct trajectories were identified: persistent use (PU, 20%), gradual decline (10%), rapid decline (29%) and early discontinuation (41%). Compared to those who discontinued early, individuals in the rapid decline, gradual decline and PU groups were older by 1.18 (95% confidence interval: 0.82-1.55), 2.61 (2.08-3.13) and 3.71 (3.30-4.12) years, respectively. Persistent users were more likely to have cardiovascular risk factors: a higher proportion of smokers (44.4 vs. 39.6%), elevated systolic blood pressure (≥140 mmHg: 36.9 vs. 32.9%) and reduced renal function (estimated glomerular filtration rate >45 mL/min/m²: 14.4 vs. 11.7%) compared to those who discontinued LMMs early. In contrast, the early discontinuation group had a greater proportion of metropolitan residents (76.1 vs. 69.2%) and individuals with elevated total cholesterol ratios (>4: 60.8 vs. 53.8%) than the PU group.

Distinct profiles across trajectories highlight the need for tailored interventions to improve long-term medication use, particularly among younger, healthier individuals and those residing in metropolitan areas.