Available online 15 April 2024, 117550

Less than 70% of patients with coronary heart disease used high-intensity statin therapy with only small changes over time

Only one in four patients used additional treatment with ezetimibe

More than one in five had poor long-term adherence to lipid lowering drugs

There is a major potential for improving long-term lipid management in secondary prevention

Proper prescription and high adherence to intensive lipid lowering drugs (LLD) in patients with coronary heart disease (CHD) is crucial and strongly recommended. The aim of this study is to investigate long-term treatment patterns and adherence to LLD following hospitalization for a CHD event.

Patients admitted to two Norwegian hospitals with a CHD event from 2011-2014 (N=1094) attended clinical examination and completed a questionnaire, median 16 months later. Clinical data were linked to pharmacy dispensing data from 2010-2020. The proportions using high-intensity statin therapy (atorvastatin 40/80 mg or rosuvastatin 20/40 mg) and non-statin LLD after the CHD event were assessed. Adherence was evaluated by proportion of days covered (PDC) and gaps in treatment.

Median age at hospitalization was 63 (IQR 12) years, 21% were female. Altogether, 1054 patients (96%) were discharged with a statin prescription, while treatment was dispensed in 85% within the following 90 days. During median 8 (SD 2.5) years follow-up, the proportion using high-intensity statin therapy ranged 62-68%, whereas the use of ezetimibe increased from 4-26 %. PDC <0.8 was found in 22% of statin users and 26% of ezetimibe users. The proportions with a treatment gap exceeding 180 days were 22% for statins and 28% for ezetimibe. Smoking at hospitalization and negative affectivity were significantly associated with reduced statin adherence, regardless of adherence measure.

In this long-term follow-up of patients with CHD, less than 70% used high-intensity statin therapy with only small changes over time, and only 25% used additional treatment with ezetimibe. We identified factors associated with reduced statin adherence that may be target for interventions.

Statins

adherence

prescription registry

coronary heart disease

psychosocial

lipid-lowering treatment

© 2024 The Authors. Published by Elsevier B.V.