Impact of Statin Adherence on Cardiovascular Morbidity and All-Cause Mortality in the Primary Prevention of Cardiovascular Disease: A Population-Based Cohort Study in Finland
Abstract Objectives To assess the extent to which adherence to statins is associated with the incidence of cardiovascular (CV) events and all-cause mortality in the primary prevention of CV diseases and whether different analytical approaches influence the observed associations. Methods This populat...
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| Veröffentlicht in: | Value in health 2015-09, Vol.18 (6), p.896-905 |
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| creator | Rannanheimo, Piia K., MSc(Pharm) Tiittanen, Pekka, MSc Hartikainen, Juha, MD Helin-Salmivaara, Arja, MD, PhD Huupponen, Risto, MD Vahtera, Jussi, MD Korhonen, Maarit Jaana, LicSc(Pharm), PhD |
| description | Abstract Objectives To assess the extent to which adherence to statins is associated with the incidence of cardiovascular (CV) events and all-cause mortality in the primary prevention of CV diseases and whether different analytical approaches influence the observed associations. Methods This population-based cohort study used data from Finnish registers. The cohort included 97,575 new statin users aged 45 to 75 years in 2001 to 2004 with no CV diseases at baseline. Exposure was defined as adherence to statins (proportion of days covered [PDC]). The primary outcome was any CV event or death during a 3-year follow-up. Different analytical approaches, including multivariable-adjusted Cox regression, inverse probability weighting with time-varying adherence, and propensity score calibration, were used. Results During the first year of follow-up, 53% displayed good (PDC ≥80%), 26% had intermediate (PDC 40%–79%), and 21% exhibited poor (PDC |
| doi_str_mv | 10.1016/j.jval.2015.06.002 |
| format | Article |
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Methods This population-based cohort study used data from Finnish registers. The cohort included 97,575 new statin users aged 45 to 75 years in 2001 to 2004 with no CV diseases at baseline. Exposure was defined as adherence to statins (proportion of days covered [PDC]). The primary outcome was any CV event or death during a 3-year follow-up. Different analytical approaches, including multivariable-adjusted Cox regression, inverse probability weighting with time-varying adherence, and propensity score calibration, were used. Results During the first year of follow-up, 53% displayed good (PDC ≥80%), 26% had intermediate (PDC 40%–79%), and 21% exhibited poor (PDC <40%) adherence. After adjustment for sociodemographic and clinical covariates, a 25% relative risk reduction (hazard ratio [HR] 0.75; 95% confidence interval [CI] 0.71–0.79) was observed in the rate of any CV event or death among good versus poor adherers. Good adherers also had a lower incidence than poor adherers of acute coronary syndrome (HR 0.56; 95% CI 0.49–0.65) and acute cerebrovascular disease events (HR 0.67; 95% CI 0.60–0.76). The different analytical approaches achieved comparable results for all the outcomes. Conclusions The incidence of CV events and mortality was higher in poor versus good adherers. Different analytical methods that took into account changes in adherence and confounding at baseline did not appreciably affect the results.</description><identifier>ISSN: 1098-3015</identifier><identifier>EISSN: 1524-4733</identifier><identifier>DOI: 10.1016/j.jval.2015.06.002</identifier><identifier>PMID: 26409618</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; cardiovascular disease ; Cardiovascular Diseases - diagnosis ; Cardiovascular Diseases - mortality ; Cardiovascular Diseases - prevention & control ; Cause of Death ; Dyslipidemias - diagnosis ; Dyslipidemias - drug therapy ; Dyslipidemias - mortality ; Female ; Finland - epidemiology ; healthy adherer effect ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use ; Incidence ; Internal Medicine ; Male ; Medication Adherence ; Middle Aged ; Multivariate Analysis ; Primary Prevention - methods ; Propensity Score ; Proportional Hazards Models ; Registries ; Retrospective Studies ; Risk Assessment ; Risk Factors ; statins ; Time Factors ; Treatment Outcome</subject><ispartof>Value in health, 2015-09, Vol.18 (6), p.896-905</ispartof><rights>2015</rights><rights>Copyright © 2015. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5062-567f4981600a727698f316184cddd4a6f42c727f34a335078b9be37df76c67d23</citedby><cites>FETCH-LOGICAL-c5062-567f4981600a727698f316184cddd4a6f42c727f34a335078b9be37df76c67d23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jval.2015.06.002$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,45974</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26409618$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rannanheimo, Piia K., MSc(Pharm)</creatorcontrib><creatorcontrib>Tiittanen, Pekka, MSc</creatorcontrib><creatorcontrib>Hartikainen, Juha, MD</creatorcontrib><creatorcontrib>Helin-Salmivaara, Arja, MD, PhD</creatorcontrib><creatorcontrib>Huupponen, Risto, MD</creatorcontrib><creatorcontrib>Vahtera, Jussi, MD</creatorcontrib><creatorcontrib>Korhonen, Maarit Jaana, LicSc(Pharm), PhD</creatorcontrib><title>Impact of Statin Adherence on Cardiovascular Morbidity and All-Cause Mortality in the Primary Prevention of Cardiovascular Disease: A Population-Based Cohort Study in Finland</title><title>Value in health</title><addtitle>Value Health</addtitle><description>Abstract Objectives To assess the extent to which adherence to statins is associated with the incidence of cardiovascular (CV) events and all-cause mortality in the primary prevention of CV diseases and whether different analytical approaches influence the observed associations. Methods This population-based cohort study used data from Finnish registers. The cohort included 97,575 new statin users aged 45 to 75 years in 2001 to 2004 with no CV diseases at baseline. Exposure was defined as adherence to statins (proportion of days covered [PDC]). The primary outcome was any CV event or death during a 3-year follow-up. Different analytical approaches, including multivariable-adjusted Cox regression, inverse probability weighting with time-varying adherence, and propensity score calibration, were used. Results During the first year of follow-up, 53% displayed good (PDC ≥80%), 26% had intermediate (PDC 40%–79%), and 21% exhibited poor (PDC <40%) adherence. After adjustment for sociodemographic and clinical covariates, a 25% relative risk reduction (hazard ratio [HR] 0.75; 95% confidence interval [CI] 0.71–0.79) was observed in the rate of any CV event or death among good versus poor adherers. Good adherers also had a lower incidence than poor adherers of acute coronary syndrome (HR 0.56; 95% CI 0.49–0.65) and acute cerebrovascular disease events (HR 0.67; 95% CI 0.60–0.76). The different analytical approaches achieved comparable results for all the outcomes. Conclusions The incidence of CV events and mortality was higher in poor versus good adherers. Different analytical methods that took into account changes in adherence and confounding at baseline did not appreciably affect the results.</description><subject>Aged</subject><subject>cardiovascular disease</subject><subject>Cardiovascular Diseases - diagnosis</subject><subject>Cardiovascular Diseases - mortality</subject><subject>Cardiovascular Diseases - prevention & control</subject><subject>Cause of Death</subject><subject>Dyslipidemias - diagnosis</subject><subject>Dyslipidemias - drug therapy</subject><subject>Dyslipidemias - mortality</subject><subject>Female</subject><subject>Finland - epidemiology</subject><subject>healthy adherer effect</subject><subject>Humans</subject><subject>Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use</subject><subject>Incidence</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medication Adherence</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Primary Prevention - methods</subject><subject>Propensity Score</subject><subject>Proportional Hazards Models</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>statins</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1098-3015</issn><issn>1524-4733</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9ks1u1DAUhSMEoqXwAiyQl2wS_Bc7QQhpCBQqFVGpsLY89o3GQyae2slI81I8IzdMYdEFK1vH537X18dF8ZLRilGm3myr7cEOFaesrqiqKOWPinNWc1lKLcRj3NO2KQUenxXPct5SSpXg9dPijCtJW8Wa8-LX1W5v3URiT24nO4WRrPwGEowOSBxJZ5MP8WCzmwebyNeY1sGH6Ujs6MlqGMrOzhkWfbLDoiNg2gC5SWFn0xFXOMA4BURhhwe0jyGDzfCWrMhN3KO0-MoPKHnSxQ0y8U6z_wO9DOOAPZ8XT3o7ZHhxv14UPy4_fe--lNffPl91q-vS1VTxsla6l23DFKVWc63aphcM55XOey-t6iV3qPdCWiFqqpt1uwahfa-VU9pzcVG8PnH3Kd7NkCezC9nBgHeAOGfDNNNS81YotPKT1aWYc4Le7E_DG0bNkpPZmiUns-RkqDKYExa9uufP6x34fyV_g0HDu5MBcMpDgGSyC0sqPiRwk_Ex_J___kG5G8IYnB1-whHyNs5pxPczzGRuqLldfsryUVhNWdtQKX4DNXe6NQ</recordid><startdate>20150901</startdate><enddate>20150901</enddate><creator>Rannanheimo, Piia K., MSc(Pharm)</creator><creator>Tiittanen, Pekka, MSc</creator><creator>Hartikainen, Juha, MD</creator><creator>Helin-Salmivaara, Arja, MD, PhD</creator><creator>Huupponen, Risto, MD</creator><creator>Vahtera, Jussi, MD</creator><creator>Korhonen, Maarit Jaana, LicSc(Pharm), PhD</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20150901</creationdate><title>Impact of Statin Adherence on Cardiovascular Morbidity and All-Cause Mortality in the Primary Prevention of Cardiovascular Disease: A Population-Based Cohort Study in Finland</title><author>Rannanheimo, Piia K., MSc(Pharm) ; Tiittanen, Pekka, MSc ; Hartikainen, Juha, MD ; Helin-Salmivaara, Arja, MD, PhD ; Huupponen, Risto, MD ; Vahtera, Jussi, MD ; Korhonen, Maarit Jaana, LicSc(Pharm), PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5062-567f4981600a727698f316184cddd4a6f42c727f34a335078b9be37df76c67d23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>cardiovascular disease</topic><topic>Cardiovascular Diseases - diagnosis</topic><topic>Cardiovascular Diseases - mortality</topic><topic>Cardiovascular Diseases - prevention & control</topic><topic>Cause of Death</topic><topic>Dyslipidemias - diagnosis</topic><topic>Dyslipidemias - drug therapy</topic><topic>Dyslipidemias - mortality</topic><topic>Female</topic><topic>Finland - epidemiology</topic><topic>healthy adherer effect</topic><topic>Humans</topic><topic>Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use</topic><topic>Incidence</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medication Adherence</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Primary Prevention - methods</topic><topic>Propensity Score</topic><topic>Proportional Hazards Models</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>statins</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rannanheimo, Piia K., MSc(Pharm)</creatorcontrib><creatorcontrib>Tiittanen, Pekka, MSc</creatorcontrib><creatorcontrib>Hartikainen, Juha, MD</creatorcontrib><creatorcontrib>Helin-Salmivaara, Arja, MD, PhD</creatorcontrib><creatorcontrib>Huupponen, Risto, MD</creatorcontrib><creatorcontrib>Vahtera, Jussi, MD</creatorcontrib><creatorcontrib>Korhonen, Maarit Jaana, LicSc(Pharm), PhD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Value in health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rannanheimo, Piia K., MSc(Pharm)</au><au>Tiittanen, Pekka, MSc</au><au>Hartikainen, Juha, MD</au><au>Helin-Salmivaara, Arja, MD, PhD</au><au>Huupponen, Risto, MD</au><au>Vahtera, Jussi, MD</au><au>Korhonen, Maarit Jaana, LicSc(Pharm), PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Statin Adherence on Cardiovascular Morbidity and All-Cause Mortality in the Primary Prevention of Cardiovascular Disease: A Population-Based Cohort Study in Finland</atitle><jtitle>Value in health</jtitle><addtitle>Value Health</addtitle><date>2015-09-01</date><risdate>2015</risdate><volume>18</volume><issue>6</issue><spage>896</spage><epage>905</epage><pages>896-905</pages><issn>1098-3015</issn><eissn>1524-4733</eissn><abstract>Abstract Objectives To assess the extent to which adherence to statins is associated with the incidence of cardiovascular (CV) events and all-cause mortality in the primary prevention of CV diseases and whether different analytical approaches influence the observed associations. Methods This population-based cohort study used data from Finnish registers. The cohort included 97,575 new statin users aged 45 to 75 years in 2001 to 2004 with no CV diseases at baseline. Exposure was defined as adherence to statins (proportion of days covered [PDC]). The primary outcome was any CV event or death during a 3-year follow-up. Different analytical approaches, including multivariable-adjusted Cox regression, inverse probability weighting with time-varying adherence, and propensity score calibration, were used. Results During the first year of follow-up, 53% displayed good (PDC ≥80%), 26% had intermediate (PDC 40%–79%), and 21% exhibited poor (PDC <40%) adherence. After adjustment for sociodemographic and clinical covariates, a 25% relative risk reduction (hazard ratio [HR] 0.75; 95% confidence interval [CI] 0.71–0.79) was observed in the rate of any CV event or death among good versus poor adherers. Good adherers also had a lower incidence than poor adherers of acute coronary syndrome (HR 0.56; 95% CI 0.49–0.65) and acute cerebrovascular disease events (HR 0.67; 95% CI 0.60–0.76). The different analytical approaches achieved comparable results for all the outcomes. Conclusions The incidence of CV events and mortality was higher in poor versus good adherers. Different analytical methods that took into account changes in adherence and confounding at baseline did not appreciably affect the results.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26409618</pmid><doi>10.1016/j.jval.2015.06.002</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged cardiovascular disease Cardiovascular Diseases - diagnosis Cardiovascular Diseases - mortality Cardiovascular Diseases - prevention & control Cause of Death Dyslipidemias - diagnosis Dyslipidemias - drug therapy Dyslipidemias - mortality Female Finland - epidemiology healthy adherer effect Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use Incidence Internal Medicine Male Medication Adherence Middle Aged Multivariate Analysis Primary Prevention - methods Propensity Score Proportional Hazards Models Registries Retrospective Studies Risk Assessment Risk Factors statins Time Factors Treatment Outcome |
| title | Impact of Statin Adherence on Cardiovascular Morbidity and All-Cause Mortality in the Primary Prevention of Cardiovascular Disease: A Population-Based Cohort Study in Finland |
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