Factors and outcomes associated with adherence to statins among patients with newly diagnosed cardiovascular disease

Abstract

Background

Statin use is proven to be effective in lowering low-density lipoprotein cholesterol (LDL-C) levels and reducing risk of recurrent myocardial infarction, stroke, and mortality in individuals with established cardiovascular disease (CVD). We used medication dispensed data (e.g., SureScripts), which has been integrated with the electronic health record (EHR) to examine the factors and outcomes associated with adherence to statins.

Methods

This study is a secondary data analysis using longitudinal data between 1/1/2010–10/31/2021 (n = 1486,286 over nearly 12 years) from a large community-based health system on all primary care patients aged 35 years or older when diagnosed with the first CVD two years after their first primary care visit and had new statin prescriptions on or after CVD diagnosis. Multivariable logistic regression models were used to identify the factors associated with filling the prescription and statin adherence, respectively. Survival analysis was used to assess the association between statin adherence and LDL-C control.

Results

Of the 5155 patients with newly prescribed statins, a total of 3553 (68.9 %) were adherent, with insurance type, online patient portal use, race, age, statin intensity, and cardiologist visits emerging as significant predictors. Specifically, patients with PPO/FFS were less likely to fill statin prescriptions compared to those with HMO. Infrequent online patient portal use is associated with lower adherence. There is a disparity between patients race categories (Non-Hispanic Black (NHB) vs. Non-Hispanic White (NHW)) in filling the prescription and adhering to the filled prescription. Medication adherence is defined as proportion of days covered (PDC) of 80 % or greater. Adherence was positively associated with older age, high-intensity statins, and cardiologist visits. Having a visit with a cardiologist showed better adherence to the prescription and lowering of LDL values. Additionally, adhering to statins has shown a better outcome of lowering patients LDL values.

Conclusions

The findings emphasize demographic and healthcare factors in medication adherence and LDL control, suggesting tailored interventions for diverse populations, addressing disparities in insurance type, race, and online portal use, and involving cardiologists in medication management for improved medication adherence and clinical outcomes.