AHA: Non-adherence to statins after MI decreases ACS-free survival

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Post-acute MI (AMI), one out of four patients does not adhere to statin therapy, which decreased acute coronary syndrome (ACS)-free survival, and researchers say that more cost-effective strategies for statin therapy adherence are necessary, according to a poster presentation at this year’s American Heart Association (AHA) Scientific Sessions in Chicago.

To bolster existing data on the long-term risks of death or recurrent ACS, Anke Neumann, PhD, of the Hôpital Européen Georges Pompidou in Paris, and colleagues performed a 30-month observational follow-up of 10,501 patients admitted for AMI in France in 2006 to assess their adherence to statin therapy after discharge.

The researchers defined adherence as 80 percent or more days of follow-up covered by a filled statin prescription. During the study, ACS-free survival was compared between adherent and non-adherent patients and researchers adjusted for sociodemographic and medical factors by using a Cox multivariate analysis.

Of the patients, 24 percent were not adherent to statin therapy. The authors noted that all patients were covered by government health insurance.

The results showed that the crude risk of mortality or ACS was 17.7 percent for non-adherent patients versus 7.3 percent for adherent patients.

After the researchers adjusted for sociodemographic factors, the risk of mortality was 13.1 percent versus 8.1 percent, respectively. The adjusted hazard ratio for mortality of ACS in patients who were not adherent to statins was 1.58.

Cancer, diabetes, renal insufficiency, depression, a cardiovascular disease hospitalization in the six months preceding AMI, heart disease, stent implantation and CABG during index admission for AMI and prior statin use within the six months prior to AMI were “significantly associated” with a risk of mortality or ACS.

“After AMI, non-adherence to statins is observed in one out of four patients and is associated with a marked decrease in ACS-free survival,” the authors concluded. “Cost-effective strategies for adherence improvement should be developed.”