Clinical impact and room for improvement of intensity and adherence to lipid lowering therapy: Five years of clinical follow-up from 164,565 post-myocardial infarction patients

Background: In patients at risk of cardiovascular (CV) events, the effectiveness of lipid-lowering therapies (LLT) is affected by both intensity and adherence. Our study evaluated the association between LLT intensity (statin and/ or ezetimibe) and adherence, and CV events in patients with a history of myocardial infarction (MI) in France. Methods: Using the French national healthcare database (SNDS), we included patients with a history of MI, an initial LLT prescription in 2011 & ndash;2013, and a second prescription within one year. LLT intensity was defined using the expected percent reduction in low-density lipoprotein cholesterol; adherence was measured as the proportion of days covered. Cox proportional hazards models were used to assess associations between intensity and/or adherence, and the risk of major adverse CV event (MACE). Results: 164,565 patients were included; mean (SD) age, 66 & middot;3 (13 & middot;8) years; 73 & middot;6% men. Following an MI, only half of patients were treated with high-intensity LLT and approximately 40% of those on LLT remained non adherent during follow-up (mean (SD) follow-up, 2 & middot;6 (1 & middot;4) years). Each 10% increase in treatment intensity, adherence, or adherence-adjusted intensity was respectively associated with a 16% (HR 0.84, 95%CI 0.84 & ndash;0.85), 7% (HR 0.93, 95%CI 0.93 & ndash;0.94), and 15% (HR 0.85, 95%CI 0.84 & ndash;0.86) decrease in the risk of MACE. Conclusions: Among patients with a history of MI, prescriptions of high-intensity LLT were limited and adherence to LLT was low. Higher intensity and/or adherence to statins was associated with a significantly lower risk of MACE, highlighting the importance of compliance with clinical guidelines to improve patient outcomes. (c) 2021 Published by Elsevier B.V.