Improving statin adherence key to preventing CVD
MedWire News: Results from a simulation show that increasing adherence to statins by 25% would prevent substantially more cardiovascular disease (CVD)-related events and deaths than lowering current treatment thresholds.
“In everyday practice, adherence to preventive medication for CVD is lower than in clinical trials and appears to decline to around 50% by about 5 years,” say authors Amir Shroufi (National Health Service Mid Essex, Chelmsford, UK) and John Powles (Institute of Public Health, Cambridge, UK).
The researchers carried out a simulation to compare the current scenario of around 50% adherence to statins and current treatment thresholds (20% or higher 10-year risk for CVD) with a scenario that increased adherence to statins from 50% to 75% at current treatment thresholds and a scenario that reduced treatment thresholds to allow more people to take statins at 50% adherence.
They used data from 38,264 CVD-free members of the Melbourne Collaborative Cohort Study to estimate risks for incident CVD and death from CVD associated with the two strategies.
Shroufi and Powles estimated that under the baseline scenario (current guidelines; 50% adherence) around 4563 (11.9%) of the study participants would be taking statins. Increasing adherence from 50% to 75% would increase this number to 6971 (18.2%) of the participants. In the lowered-threshold (15.5% or higher 10 year risk for CVD) scenario, treatment thresholds were reduced to allow a similar number (n=6991; 18.3%) of participants to take statins.
The team calculated that over 10 years the enhanced-adherence scenario would prevent 91 incident CVD events and 37 CVD deaths compared with 70 CVD events and 18 CVD deaths prevented by the lowered-threshold scenario.
“Improving adherence among the highest-risk subjects will avert substantially more CVD deaths than would equivalent increases in prescribing directed at those at lower risk,” conclude Shroufi and Powles in the Journal of Epidemiology and Community Health.
“Effective interventions to improve long-term adherence to medication are urgently needed,” they add.
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By Helen Albert