Vascular Health and Risk Management (Oct 2019)
Adherence To Lipid-Lowering Therapy In Patients With Coronary Heart Disease From The State Of Saxony-Anhalt, Germany
Abstract
Stephan Waßmuth,1 Katharina Rohe,1 Frank Noack,2 Michel Noutsias,1 Hendrik Treede,3 Axel Schlitt4,5 1Department of Medicine III, University Clinic, Halle, Germany; 2Emergency Department and Department of Medicine II, University Clinic, Halle, Germany; 3Department of Cardiac Surgery, University Clinic, Halle, Germany; 4Paracelsus Harz-Clinic Bad Suderode, Quedlinburg, Germany; 5Medical Faculty, Martin Luther-University Halle-Wittenberg, Halle, GermanyCorrespondence: Stephan WaßmuthDepartment of Internal Medicine, St. Josefs Hospital Wiesbaden, Beethovenstraße 20, Wiesbaden 65189, GermanyTel +49 1726619946Fax +49 6452 5350Email [email protected]: Treatment with lipid-lowering therapy (LLT) such as statins, cholesterol absorption inhibitors, or PCSK9 inhibitors is of major importance for the survival of patients with atherosclerotic diseases, and adherence to LLT is essential for treatment success. The intention of this study was to investigate adherence to LLT in patients with coronary heart disease (CHD) in a 12-month follow-up period in Saxony-Anhalt, the state with the highest incidence and mortality for CHD in Germany.Patients and methods: Data were taken from 542 hospitalized patients with angiographically documented CHD who were prospectively included in this study conducted in the Department of Medicine III of the University Clinics (Halle). We collected data concerning medication at discharge and after 3 and 12 months.Results: A total of 542 patients were included in this study. Mean age was 69.2 ± 11.8 years. In all, 68.8% were males, 165 (30.4%) were smokers, 39.7% suffered from diabetes, and 86.9% had arterial hypertension. The follow-up time of this study was 12 months. At discharge, 463 patients (85.4%) were being treated with a statin. After 3 months 409 (75.5%) and after 12 months, 395 patients (72.9%) were still on statin therapy, respectively. In total treatment, adherence for the statin medication decreased by 15.7% in 12 months. Kaplan–Meier analyses showed that survival, taken as freedom of death from any cause, decreased significantly if statin treatment was stopped (p=0.001). This was confirmed by multivariate Cox regression (HR 1.78, p=0.012). Ezetemibe was prescribed for 56 patients at discharge (10.3%). After 3 months, 40 patients (7.4%) were still taking ezetemibe. After 12 months, adherence to ezetemibe treatment decreased to 4.1% (22 patients).Conclusion: During follow-up for 3 and 12 months, adherence for statin therapy decreased by 15.7% and for ezetemibe by 46.6%. Here, low adherence to statin therapy was associated with fatal outcome.Keywords: coronary heart disease, lipid-lowering drugs, adherence
