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
Rannanheimo, P; Tiittanen, P; Hartikainen, J; Helin-Salmivaara, A; Huupponen, R; Vahtera, J; Korhonen, MJ (2015)
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Rannanheimo, P
Tiittanen, P
Hartikainen, J
Helin-Salmivaara, A
Huupponen, R
Vahtera, J
Korhonen, MJ
2015
Value in Health : 6
Tiivistelmä
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 cali-
bration, were used. Results: During the first year of follow-up,53%
displayed good (PDC Z80%), 26% had intermediate (PDC40%–79%),
and 21% exhibited poor (PDC o40%) adherence. After adjust-
ment 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%CI0.49–0.65) and acute cerebrovascular disease
events (HR0.67;95%CI0.60–0.76). 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
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 cali-
bration, were used. Results: During the first year of follow-up,53%
displayed good (PDC Z80%), 26% had intermediate (PDC40%–79%),
and 21% exhibited poor (PDC o40%) adherence. After adjust-
ment 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%CI0.49–0.65) and acute cerebrovascular disease
events (HR0.67;95%CI0.60–0.76). 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
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