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Adherence to Lipid-Lowering Therapies and Cardiovascular Outcomes in Patients With Atherosclerotic Cardiovascular
Laney K Jones1, Cara East2, Om P Ganda3
1Department of Genomic Health Research Institute, Geisinger Danville PA USA.
Insights
Adherence to lipid-lowering therapy (LLT) significantly reduces cardiovascular events in patients with atherosclerotic cardiovascular disease (ASCVD). Improving LLT adherence is crucial for better patient outcomes and preventing major adverse cardiovascular events.
Area of Science:
- Cardiology
- Public Health
- Pharmacology
Background:
- Persistently high low-density lipoprotein cholesterol (LDL-C) is a primary risk factor for atherosclerotic cardiovascular disease (ASCVD).
- Despite available lipid-lowering therapies (LLT), many ASCVD patients fail to reach target LDL-C levels.
- Poor adherence to LLT is a significant barrier to achieving LDL-C goals and may worsen cardiovascular outcomes.
Purpose of the Study:
- To systematically review and meta-analyze the relationship between adherence to LLT and cardiovascular outcomes.
- To clarify the impact of LLT adherence on mortality and major adverse cardiovascular events in ASCVD patients.
Main Methods:
- Systematic literature searches were conducted across major databases (PubMed, Embase, Scopus, CINAHL) in March 2023 (updated September 2024).
- Included were observational studies of adults with clinical ASCVD reporting objective LLT adherence measures and cardiovascular outcomes.
- Risk of bias was evaluated using the Clinical Advances Through Research and Information Translation tool.
Main Results:
- The meta-analysis included 39 studies, predominantly focusing on statin adherence measured by proportion of days covered (≥80% threshold).
- Adherence to LLT was associated with a statistically significant reduction in the risk of all-cause death (HR, 0.56) and major adverse cardiovascular events (HR, 0.77).
- Significant reductions were also observed for myocardial infarction (HR, 0.86), with non-significant trends for cardiovascular death and ischemic stroke.
Conclusions:
- Adherence to lipid-lowering therapy is significantly associated with a reduced risk of cardiovascular events in patients diagnosed with clinical ASCVD.
- These findings underscore the importance of strategies to improve LLT adherence for better cardiovascular risk management.
Background:
Persistently elevated low-density lipoprotein cholesterol is a major risk factor for atherosclerotic cardiovascular disease (ASCVD). Despite the availability of lipid-lowering therapy (LLT), most patients with ASCVD do not achieve guideline-recommended low-density lipoprotein cholesterol goals. Poor adherence to LLT is a key barrier to low-density lipoprotein cholesterol lowering and may be associated with adverse cardiovascular outcomes. We conducted a systematic review and meta-analysis to clarify the relationship between adherence to LLT and cardiovascular outcomes in patients with ASCVD.
Methods:
Systematic searches of PubMed, Embase, Scopus, and Cumulative Index to Nursing and Allied Health Literature were performed in March 2023 (updated September 2024). Observational studies in adults with clinical ASCVD reporting objective measures of adherence or persistence to LLT and cardiovascular outcomes, including death, cardiovascular death, and major adverse cardiovascular events, were included. Risk of bias was assessed using the Clinical Advances Through Research and Information Translation tool.
Results:
Of 12 466 unique records identified, 39 met the inclusion criteria. Most studies only reported adherence to statins (33/39), and most measured adherence using proportion of days covered (25/39). Using an adherence threshold of ≥80%, adherence to LLT was shown to statistically significantly reduce risk of death (hazard ratio [HR], 0.56 [95% CI, 0.34-0.92]; P=0.0268; I2 95%), major adverse cardiovascular events (HR, 0.77 [95% CI, 0.68-0.86]; P=0.0007; I2 83%), myocardial infarction (HR, 0.86 [95% CI, 0.79-0.95]; P=0.0147; I2 0%), and non-statistically significant reductions in cardiovascular death (HR, 0.44 [95% CI, 0.12-1.60]; P=0.1528; I2 92%) and ischemic stroke (HR, 0.83 [95% CI, 0.58-1.18]; P=0.1856; I2 52%).
Conclusions:
In this systematic review and meta-analysis, adherence to LLT was associated with reduced risk of cardiovascular events in patients with clinical ASCVD.
Registration:
URL: https://www.crd.york.ac.uk/prospero/; identifier: CRD42023427146.
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