Adherence to Post-MI High-Intensity Statins Wanes By 2 Years

Marcia Frellick

April 21, 2017

BIRMINGHAM, AL — Few Medicare beneficiaries hospitalized for acute MI who filled a prescription for a high-intensity statin continued to maintain a high level of adherence 2 years after discharge, according to a retrospective study published April 19, 2017 in JAMA Cardiology[1].

Despite the generally high coronary risk after an MI, only about 40% of both of two age groups in a Medicare cohort took their high-intensity statin on at least 80% of subsequent covered days over the next 2 years, according to the authors, led by Dr Lisandro D Colantonio, (University of Alabama, Birmingham).

Their cohort consisted of 57,898 Medicare beneficiaries hospitalized for MI (29,932 younger than 76 years and 27,956 aged 76 or older) between 2007 and 2011 and who filled their Medicare-covered prescriptions within a month.

A major conclusion from their work is that "we need to intervene," senior author Dr Robert S Rosenson (Icahn School of Medicine at Mount Sinai, New York, NY), told heartwire from Medscape.

"We need to educate and say that high-intensity statins are the norm, and the more cardiovascular risk factors you have, the more you need to follow the recommendations."

High-Intensity Statin Adherence at 6 and 24 Months for Medicare Beneficiaries Aged 66–75

Level of adherence 6 mo (%) 2 y (%)
High adherencea 58.9 41.6
Downtitration with high adherenceb 8.7 13.4
Low adherencec 17.3 19.1
Discontinuationd 12.4 18.8
a. High-intensity statin was used for at least 80% of days covered
b. Patients switched to a low-/moderate-intensity statin for at least 80% of days covered
c. Patients took any intensity of statin less than 80% of the days covered but didn't stop completely
d. No statin was available to take in the last 60 days of each follow-up period

The results were similar for patients who were aged up to 74 and those 75 and older.

As the group explains, high-intensity statins are those shown to reduce LDL- cholesterol levels by at least half, such as atorvastatin 40–80 mg and rosuvastatin 20–40 mg.

Generic and widely available statins are recommended at full dose by the American College of Cardiology and the American Heart Association for those 75 and younger. For patients older than 75 with coronary heart disease, the guideline recommends moderate-intensity statins, with high-intensity statins considered for some patients.

The researchers found patterns predicting adherence to a high-intensity statin. Those more likely to adhere included dual Medicare/Medicaid recipients and those with a greater number of cardiologist visits, undergoing cardiac rehabilitation, and those covered by Part D medication gap coverage after discharge.

"We know from other studies in the Medicare population that people who engage in cardiac rehabilitation have fewer recurring cardiovascular events and improved survival," Rosenson said. Taking advantage of those support systems will help in other areas such as adherence to high-intensity statins.

"I think we need to do a better job of that in terms of getting people at discharge or the first hospital visit into phase 2 cardiac rehabilitation programs."

Included among those less likely to continue high adherence were African Americans, Hispanics, and those new to taking the statin.

Primary-care physicians and specialists, Rosenson said, should have to justify why patients who fit the guideline population are not on a high-intensity statin. In addition, the study supports having healthcare team, pharmacists, and insurers work together to make sure people are filling their those prescriptions.

Moreover, high-intensity statins are recommended not only for their cholesterol-lowering effects "but their anti-inflammatory effects or plaque-stabilizing effects, which is what we need to strive for as our target," he said.

"Using lower-intensity statins, or discontinuing the statin because [patients are] feeling better, is placing them at greater risk for recurrent cardiovascular events and the need for another revascularization procedure."

The study was supported through a research grant from Amgen. Colantonio reports no relevant financial relationships. Rosenson receives research support from Amgen, AstraZeneca, Eli Lilly, Esperion, the Medicines Company, Regeneron, and Sanofi and serves on advisory noards for Akcea, Amgen, AstraZeneca, Eli Lilly, Regeneron, and Sanofi. Disclosures for the coauthors are listed in the paper.

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