title: Cardiovascular events in statin recipients: impact of adherence to treatment in a 3-year record linkage study.
abstract: OBJECTIVE
  In the general population, lack of adherence to statin therapy remains a widespread phenomenon and an important matter of concern both in terms of cost-effectiveness and risk-benefit profile. This study aimed to evaluate the occurrence of cardiovascular events in Italian statin recipients, focussing on the relationship between degree of adherence to therapy and occurrence of events in a 3-year follow-up.
  
  
  METHODS
  Our cohort consisted of all patients from Emilia Romagna (4,027,275 inhabitants) who received statin prescriptions in January-February 2005 and who were followed for up to 36 months for cardiovascular hospital admission (i.e. coronary disease, cerebrovascular accidents, peripheral arthropathy), adherence to statin treatment (proportion of days covered: ≥ 80%) and use of other cardiovascular drugs. The relationship between adherence and cardiovascular events was analysed by multivariate logistic regression; age, sex, other cardiovascular drugs and previous events were covariates of the model.
  
  
  RESULTS
  Patients non-adherent to a statin regimen over the 3-year period (76% of the cohort) had higher odds of events, irrespective of risk factors, by more than 40% when compared with adherent patients. Odds of events were in particular: strongly non-adherent, adjOR=1.19 (CI95% 1.15-1.23), slightly non-adherent, adjOR =1.25 (1.21-1.30), highly variable in the amount of statins received, adjOR=1.69 (1.62-1.77).
  
  
  CONCLUSIONS
  This study shows the key role of adherence to statins in cardiovascular prevention at any level of risk. Appropriateness of statin use needs not only careful selection of patients to be treated, but also cooperation between patient and physician to ensure continued drug use whenever treatment is appropriate.
authors.affiliation: Department of Pharmacology, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Poluzzi
authors.affiliation: Department of Pharmacology, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Piccinni
authors.affiliation: Department of Pharmacology, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Carta
authors.affiliation: Drug Policy Service, Emilia-Romagna Regional Health Authority, Viale Aldo Moro 21, 40127, Bologna, Italy.
authors.forename: Aurora
authors.initials: A
authors.lastname: Puccini
authors.affiliation: Drug Policy Service, Emilia-Romagna Regional Health Authority, Viale Aldo Moro 21, 40127, Bologna, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Lanzoni
authors.affiliation: Department of Pharmacology, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Motola
authors.affiliation: Department of Pharmacology, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Vaccheri
authors.affiliation: Department of Pharmacology, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: De Ponti
authors.affiliation: Department of Pharmacology, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy. nicola.montanaro@unibo.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Montanaro
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000453:epidemiology*; D003625:Data Collection; D016208:Databases, Factual; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007558:Italy; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000453:epidemiology*; D018570:Risk Assessment; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology*; D016903:Drug Monitoring
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors