ArticleClinical research in cardiology : official journal of the German Cardiac Society2025
Adherence trajectories of oral lipid-lowering therapy in patients with myocardial infarction and its estimated impact on low-density lipoprotein levels.
Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLow adherence to lipid-lowering therapy (LLT) after myocardial infarction (MI) is associated with increased risk of recurrent cardiovascular events and death. However, little is known about long-term adherence patterns following treatment interruptions. The aim of this study was to describe adherence trajectories in MI patients following a LLT treatment gap, and model the impact of different adherence trajectories on estimated low-density lipoprotein cholesterol (LDL-C) levels.
methodsWe conducted a retrospective cohort study of 22,124 first-time MI patients in Sweden who dispensed statins and/or ezetimibe within 90 days of their MI. Patients with a treatment gap > 90 days within three years post-MI were identified, and adherence trajectories were evaluated over a five-year period following the treatment gap using group-based trajectory modelling. Associations between adherence trajectories and patient characteristics were analyzed, and the impact on estimated LDL-C levels was simulated based on trajectory-specific adherence.
resultsPatients were categorized in six different adherence trajectories - constant adherent (34%), constant non-adherent (26%), rapidly (7%) and slowly (6%) increasing and rapidly (9%) and slowly (19%) decreasing adherence. Patients with a constant adherent trajectory were more often managed in primary care (compared to hospital care). Lower age and male sex were also associated with a constant adherent trajectory. The average LDL-C level in patients with a constant adherence trajectory was estimated to be 1.0 mmol/L lower compared to patients with a constant non-adherence trajectory.
conclusionsSuboptimal adherence following a treatment gap is common and has a clinically significant impact on the degree of LDL-C lowering.
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