Temporal Trends in Lipid-Lowering Therapy Use and Adherence in Patients With Premature Coronary Artery Disease.

BACKGROUND

Patients with premature coronary artery disease (CAD) have high rates of recurrent events and death. Information on long-term adherence to lipid-lowering therapy (LLT) and trends in medication-taking behavior in premature CAD is limited. We assessed temporal trends in LLT, factors associated with adherence to LLT, and the consequences of low adherence in a longitudinal cohort of patients with premature CAD.

METHODS

Using a cardiovascular registry and administrative databases, we analyzed temporal changes in rates and predictors of adherence to LLT as well as the association between adherence and cardiovascular outcomes in patients with premature obstructive CAD from 2000 to 2017.

RESULTS

Among 11 411 patients with premature CAD, 27.6% were women and the mean±SD age was 46.1±5.05 years. The proportion with good first-year adherence to LLT increased from 54.9% to 71.4% (P<0.001) over the study period; however, changes in third-year adherence were much smaller (44.4% versus 47.3%; P<0.001). Use of high-intensity LLT increased over the same time period from 26.7% to 92.0% (P<0.001). More severe presentation, revascularization at presentation, absence of chronic kidney disease, and nonsmoking were consistently associated with better adherence across the study time frame. Rural residence, female sex, and substance use disorder were associated with poor adherence only in later years. Good adherence was associated with a lower risk of cardiovascular outcomes, including death (hazard ratio [HR], 0.45 [95% CI, 0.39-0.55]) and myocardial infarction (HR, 0.53 [95% CI, 0.45-0.63]).

CONCLUSIONS

Use of high-intensity LLT and short-term adherence are improving in patients with premature CAD, but different strategies are needed to increase long-term adherence to prevent recurrent cardiovascular events.