Association of Statin Adherence With Mortality in Patients With Atherosclerotic Cardiovascular Disease

作者：Fátima Rodríguez, David Joel Maron, Joshua W. Knowles, Salim S. Virani, Shoutzu Lin, Paul A. Heidenreich · 发表于：JAMA Cardiology · 年份：2019 · DOI：10.1001/jamacardio.2018.4936 · 被引用次数：353 · 研究领域：Lipoproteins and Cardiovascular Health、Medication Adherence and Compliance、Cancer, Lipids, and Metabolism

Importance: Statins decrease mortality in those with atherosclerotic cardiovascular disease (ASCVD), but statin adherence remains suboptimal. Objective: To determine the association between statin adherence and mortality in patients with ASCVD who have stable statin prescriptions. Design, Setting, and Participants: This retrospective cohort analysis included patients who were between ages 21 and 85 years and had 1 or more International Classification of Diseases, Ninth Revision, Clinical Modification codes for ASCVD on 2 or more dates in the previous 2 years without intensity changes to their statin prescription who were treated within the Veterans Affairs Health System between January 1, 2013, and April 2014. Exposures: Statin adherence was defined by the medication possession ratio (MPR). Adherence levels were categorized as an MPR of less than 50%, 50% to 69%, 70% to 89%, and 90% or greater. For dichotomous analyses, adherence was defined as an MPR of 80% or greater. Main Outcomes and Measures: The primary outcome was death of all causes adjusted for demographic and clinical characteristics, as well as adherence to other cardiac medications. Results: Of 347 104 eligible adults with ASCVD who had stable statin prescriptions, 5472 (1.6%) were women, 284 150 (81.9%) were white, 36 208 (10.4%) were African American, 16 323 (4.7%) were Hispanic, 4093 (1.2%) were Pacific Islander, 1293 (0.4%) were Native American, 1145 (0.3%) were Asian, and 1794 (0.5%) were other races. Patient...